From the Guidelines
For chronic cervical strain lasting 5 years, a multimodal approach is recommended, prioritizing physical therapy, pain management, and lifestyle modifications to improve morbidity, mortality, and quality of life.
Key Components of Management
- Physical therapy focusing on neck strengthening exercises, postural correction, and gentle stretching 2-3 times weekly for at least 8-12 weeks, as supported by the American College of Radiology's guidelines for cervical neck pain or cervical radiculopathy 1.
- Complementing physical therapy with daily home exercises to enhance flexibility and strength.
- Pain management using NSAIDs like naproxen (500mg twice daily) or ibuprofen (400-600mg three times daily) for short periods during flare-ups, not exceeding 2 weeks continuously, to minimize the risk of adverse effects while managing pain effectively.
- Utilizing muscle relaxants such as cyclobenzaprine (5-10mg) at bedtime for severe spasms, under the guidance of a healthcare provider.
- Considering trigger point injections with lidocaine if specific painful areas are identified, as part of a comprehensive pain management strategy.
- Applying heat therapy for 15-20 minutes several times daily to reduce muscle tension.
- Implementing ergonomic modifications at work and home to prevent further strain and promote healing.
- Incorporating stress management techniques like meditation or yoga to address psychological factors that may contribute to chronic pain, acknowledging the significant psychological and socioeconomic impact of cervical or neck pain as highlighted in the Global Burden of Disease 2010 Study 1.
Referral and Further Intervention
If these conservative measures fail, referral to a pain specialist for consideration of interventions like radiofrequency ablation might be appropriate, taking into account the patient's overall health status, the presence of any "red flags," and the potential benefits and risks of such interventions, as discussed in the context of chronic cervical or neck pain management 1.
Outcome Prioritization
The management strategy should always prioritize reducing morbidity, mortality, and improving quality of life, considering the long-term implications of chronic cervical strain on the patient's well-being and functional capacity, as emphasized by the importance of addressing both the physical dysfunction and the pain cycle in chronic cervical strain management.
From the Research
Management of Cervical Strain
- Cervical strain that has been ongoing for 5 years may be managed through various interventions, including conservative management and interventional pain management techniques 2, 3, 4, 5, 6.
- Conservative management may include pharmaceutical medications, physical therapy, acupuncture, prednisolone, cervical manipulation, and low-level laser therapy, although the evidence for these interventions is limited and inconclusive 3, 5.
- Interventional pain management techniques, such as radiofrequency ablation (RFA) and epidural steroid injection (ESI), may be effective in managing cervicogenic headaches and neck pain, with RFA demonstrating a low complication rate and potential for long-term pain relief 2, 4.
- The selection of patients for these procedures should be based on clinical presentation and imaging, and conservative treatment should be used before injections whenever possible 4.
- Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections 4.
Treatment Options
- Pharmaceutical medications, such as NSAIDs, muscle relaxants, and pure analgesics, may be used to manage chronic neck pain, although their efficacy is largely based on clinical experience rather than evidence-based studies 5.
- Local injections of anesthetics with or without soluble corticosteroid preparations may offer additional pain relief, with the purpose of diminishing pain to facilitate normal neck movement 5.
- Surgical therapy with cervical spine fusion may be indicated for rare patients with intractable neck pain resistant to all nonsurgical therapies 5.
Diagnosis and Treatment
- Evidence-based diagnosis and treatment of cervical spine disorders is essential for effective management of neck pain, which can exist alone or with the presence of upper extremity symptoms 6.
- A comprehensive approach to diagnosis and treatment should include a thorough clinical evaluation, imaging studies, and a range of treatment options, from conservative management to interventional pain management techniques 2, 3, 4, 5, 6.