What are the treatment options for cervicalgia (neck pain)?

Treatment Options for Neck Pain

The most effective treatment approach for neck pain includes education, self-management strategies, exercise therapy, and appropriate pharmacotherapy, avoiding interventional procedures unless specifically indicated.1

First-Line Treatment Approaches

Non-Pharmacological Management

• Education and self-management strategies should be prioritized as first-line treatment1
• Exercise therapy is strongly recommended with evidence supporting:
  • Progressive resistance exercises for neck and shoulders
  • Postural correction exercises
  • Scapular strengthening1
• Manual therapy as an adjunct to exercise can be beneficial1, 2
  • Manipulation has shown significant short-term pain reduction (MD -22 on a 0-100 scale)2
  • Upper cervical translatoric mobilization can improve cervical rotation3
• Heat therapy may provide symptomatic relief1
• Cognitive-behavioral therapy (CBT) can effectively reduce both neck pain and anxiety symptoms1
• Relaxation techniques such as diaphragmatic breathing and progressive muscle relaxation can reduce muscle tension1

Pharmacological Management

• Acetaminophen: 650mg every 4-6 hours (maximum 4g/day) for acute pain relief
  • Use with caution due to potential liver toxicity1, 4
• NSAIDs (e.g., ibuprofen):
  • Effective for acute neck pain if no contraindications exist
  • Ibuprofen: 400mg every 4-6 hours as needed for pain5
  • Use lowest effective dose for shortest duration (maximum 3200mg/day)5
  • Monitor for gastrointestinal, renal, and cardiovascular side effects1
• Muscle relaxants may be considered for acute pain with muscle spasm
  • Be cautious regarding sedation and fall risk, especially in older adults1
  • Combination orphenadrine/paracetamol has shown significant short-term pain reduction2

Treatment Considerations for Specific Conditions

Chronic Neck Pain

• Most episodes of acute neck pain resolve spontaneously, but >1/3 of patients experience persistent or recurrent symptoms6
• Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive or predominantly neuropathic symptoms6
• Avoid opioids for chronic neck pain due to limited evidence for effectiveness and risk of dependence1
• Avoid interventional procedures including trigger point injections, joint radiofrequency ablation, epidural injections, and joint-targeted injections1

Cervical Radiculopathy

• Conservative management is first-line treatment1
• Consider MRI only after 6 weeks of failed conservative management1
• For persistent symptoms, weak evidence supports epidural steroid injections6
• Surgery appears more effective than non-surgical therapy in the short term but not long term6, 7

Red Flags Requiring Urgent Evaluation

Be vigilant for these warning signs that may indicate serious pathology:

• History of trauma to the neck
• History of cancer or suspected malignancy
• Spinal cord injury symptoms
• Progressive neurological deficits
• Suspected infection
• Intractable pain unresponsive to treatment1

Important Clinical Considerations

• Imaging is not necessary in the absence of red flags, as degenerative changes correlate poorly with symptoms1
• Exercise treatment shows the strongest evidence among complementary approaches6
• For older adults, exercise programs should be tailored to functional capacity with greater caution using NSAIDs1
• Most conservative interventions show only short-term effects; few demonstrate medium or long-term benefits beyond placebo2
• When referring for specialty consultation, consider physical therapy for structured rehabilitation programs including supervised progressive exercises1