What is the treatment for cervicalgia?

From the Guidelines

Treatment for cervicalgia should prioritize a multi-faceted approach, including pain management, physical therapy, and lifestyle modifications, with a focus on NSAIDs, muscle relaxants, gentle neck stretches, heat therapy, and lifestyle adjustments to improve posture and reduce neck strain. When considering the management of cervicalgia, it's essential to address the underlying causes of pain and inflammation.

• Pain management:
  • Over-the-counter pain relievers: Start with NSAIDs like ibuprofen (400-600 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours) for 1-2 weeks, as recommended by general medical guidelines 1.
  • Muscle relaxants: Cyclobenzaprine (5-10 mg three times daily) for 7-10 days can help reduce muscle tension.
• Physical therapy:
  • Gentle neck stretches and exercises: Perform 2-3 times daily for 10-15 minutes each session.
  • Heat therapy: Apply a heating pad for 15-20 minutes, 3-4 times daily, which is conditionally recommended based on very low certainty evidence indicating improvement in pain and physical function 1.
  • Cold therapy: Use ice packs for 10-15 minutes every 2-3 hours, especially in the first 48-72 hours after pain onset.
• Lifestyle modifications:
  • Improve posture: Maintain proper alignment while sitting and standing.
  • Ergonomic adjustments: Ensure proper desk and computer setup to reduce neck strain.
  • Sleep position: Use a supportive pillow that maintains proper neck alignment.
• Additional treatments:
  • Massage therapy: 1-2 sessions per week for 4-6 weeks, which is conditionally recommended based on very low certainty evidence indicating improvement in pain 1.
  • Acupuncture: 1-2 sessions per week for 6-8 weeks, which is conditionally recommended based on low certainty evidence indicating inconsistent improvements in pain and function 1. It's crucial to note that if symptoms persist or worsen after 4-6 weeks of conservative treatment, consultation with a healthcare provider is necessary for further evaluation and potential additional interventions.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. There is no direct information about the treatment of cervicalgia. However, for mild to moderate pain, the dose of ibuprofen is 400 mg every 4 to 6 hours as necessary for relief of pain 2.

• Key points:
  • The dose may need to be adjusted based on individual patient response.
  • The lowest effective dose should be used for the shortest duration consistent with individual patient treatment goals.

From the Research

Treatment Options for Cervicalgia

The treatment for cervicalgia can vary depending on the underlying cause and severity of the condition. Some of the treatment options include:

• Nonsteroid anti-inflammatory drugs (NSAIDs) such as tenoxicam, which has been shown to have a rapid analgesic effect in patients with acute cervical pain 3
• Physical therapy, which can include posture training, dynamic shoulder/scapular strengthening, cervical stabilization, stretching, ultrasound, interferential current, and a progressive home exercise program 4
• Biological treatments such as periradicular injections of autologous conditioned serum (ACS) or platelet-rich plasma (PRP), which have been shown to be effective in reducing pain and improving disability index and proprioception of the hand 5
• Mechanical treatments such as manual therapy or traction therapy, which can provide improvement in pain and disability, but may not have a regenerative effect 5
• Physical treatments such as laser therapy or collagen magnetophoresis, which can provide mild improvement in pain and disability, but may not have a regenerative effect 5
• Exercise, which has been shown to be effective in reducing neck pain and improving function 6
• Muscle relaxants and non-steroidal anti-inflammatory drugs, which are effective for acute neck pain 6
• Complementary and alternative treatments such as massage, acupuncture, yoga, and spinal manipulation, which have weaker evidence supporting their use 6
• Epidural steroid injections, which have been shown to be effective in reducing arm pain and neck pain in patients with cervical radicular pain 7
• Combination treatment, which includes a combination of conservative treatment, epidural steroid injections, and physical therapies, and has been shown to be effective in improving outcomes in patients with cervical radicular pain 7

Specific Treatment Approaches

Some specific treatment approaches for cervicalgia include:

• Conservative treatment, which can include physical therapies, medication, and lifestyle modifications 7
• Interdisciplinary approach, which includes a combination of conservative treatment, epidural steroid injections, and physical therapies, and has been shown to be effective in improving outcomes in patients with cervical radicular pain 7
• Regenerative treatments, which aim to promote healing and regeneration of damaged tissues, and have been shown to be effective in reducing pain and improving disability index and proprioception of the hand 5