From the Guidelines
For cervical musculoskeletal pain, the most effective treatment approach is a combination of non-pharmacological and pharmacological interventions, prioritizing low-risk medications and therapies, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of cervical musculoskeletal pain should focus on reducing inflammation, relaxing tense muscles, and improving blood flow to the affected area.
- Start with non-pharmacological approaches such as physical therapy, heat/cold therapy, and orthotics, as suggested by 1.
- Gentle neck stretches, such as tilting the head side to side, forward and back, and rotating in circles, can help maintain flexibility and prevent further stiffness.
- Maintain good posture and ergonomics, especially if working at a desk, and take frequent breaks to move and stretch.
Pharmacological Interventions
- If non-pharmacological approaches are ineffective, consider pharmacological treatments, starting with the least risky medications, such as acetaminophen or ibuprofen, as recommended by 1.
- The CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, suggests that low-level laser therapy, massage, exercise, and acupuncture may be associated with improved short-term function and pain for chronic neck pain.
Alternative Therapies
- Cognitive behavioral therapy (CBT) and yoga may also be recommended for chronic pain management, as suggested by 1.
- Pilates has been associated with improved short-term function and pain, as reported by 1.
Consultation and Further Treatment
If pain persists beyond a week or is severe, consult a healthcare provider, who may recommend physical therapy, muscle relaxants, or stronger pain medications. These treatments work by reducing inflammation, relaxing tense muscles, and improving blood flow to the affected area, ultimately improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions The treatments for cervical (neck) musculoskeletal pain include:
- Rest
- Physical therapy
- Cyclobenzaprine hydrochloride tablets as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2
From the Research
Treatments for Cervical (Neck) Musculoskeletal Pain
The following treatments are used to manage cervical musculoskeletal pain:
- Manual therapy (MT) 3
- Exercise therapy (ET) 3
- Combined treatment consisting of MT and ET 3
- Muscle Energy Technique (MET) 4
- Multimodal care 5
- Manipulation or mobilization 5
- Range-of-motion home exercise 5
- Supervised graded strengthening exercise 5
- High-dose massage 5
- Supervised group exercise 5
- Supervised yoga 5
- Active neck muscle training 6
- Intensive isometric neck strength training 6
- Lighter endurance training of neck muscles 6
Effectiveness of Treatments
The effectiveness of these treatments varies:
- Combined treatment consisting of MT and ET does not seem to be more effective in reducing neck pain intensity at rest, neck disability, or improving quality of life in adult patients with grade I-II neck pain, than ET alone 3
- MET has a good clinical effect on reducing neck pain in patients with acute neck pain and improves cervical range of motion in patients with chronic neck pain 4
- A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain 5
- Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain 6
Treatment Recommendations
Treatment recommendations for cervical musculoskeletal pain include:
- For recent-onset (0-3 months) neck pain, offering multimodal care, manipulation or mobilization, range-of-motion home exercise, or multimodal manual therapy 5
- For persistent (>3 months) neck pain, offering multimodal care or stress self-management, manipulation with soft tissue therapy, high-dose massage, supervised group exercise, supervised yoga, supervised strengthening exercises or home exercises 5