What are the next steps for a 35-year-old male with new onset neck pain, particularly at the back of his neck, Degenerative Disc Disease (DDD) in C5-C6, and elevated C-Reactive Protein (CRP) of 57, who has tried Advil (ibuprofen) with minimal efficacy?

Management of Neck Pain with C5-C6 DDD and Elevated CRP

For a 35-year-old male with new onset neck pain, mild C5-C6 degenerative disc disease (DDD), and elevated CRP (57), an MRI of the cervical spine is the most appropriate next step due to the presence of red flag symptoms (elevated inflammatory markers) that warrant further investigation.

Assessment of Red Flags

• The elevated CRP of 57 represents a significant red flag that requires further investigation, as abnormal lab values (including elevated CRP) are considered red flags in cervical spine evaluation 1
• Recent history of swollen submandibular lymph nodes (one month ago) combined with pain on swallowing suggests a possible inflammatory or infectious process 1
• Minimal response to ibuprofen therapy indicates potential for a more serious underlying condition beyond simple mechanical neck pain 1

Imaging Recommendations

• MRI of the cervical spine without contrast is the recommended next imaging step due to:

  • Presence of red flag symptoms (elevated inflammatory markers)
  • Superior ability to evaluate soft tissue abnormalities that may be contributing to symptoms 1
  • Ability to detect potential inflammatory processes, infection, or other pathology not visible on X-ray 1

• The initial X-ray showing mild DDD at C5-C6 is insufficient for complete evaluation given the red flags present, as degenerative changes are common in asymptomatic individuals and correlate poorly with symptoms 1

Medical Management

• Continue appropriate dose of NSAIDs (ibuprofen) if not contraindicated:

  • 400-800 mg every 6-8 hours as needed for pain relief 2
  • Monitor for gastrointestinal side effects, especially with continued use 2

• Consider adding a muscle relaxant if pain has a significant muscular component 3, 4

• Physical therapy should be initiated after ruling out serious pathology:

  • Focus on cervical strengthening exercises and proper ergonomics 5, 4
  • Consider referral for manual therapy techniques if appropriate 3

Follow-up Plan

• If MRI reveals no serious pathology:

  • Continue conservative management with NSAIDs, physical therapy, and activity modification 1, 6
  • Consider repeat CRP testing in 2-4 weeks to monitor inflammatory response 1

• If MRI reveals significant pathology (infection, inflammatory condition, severe nerve compression):

  • Refer to appropriate specialist (neurosurgery, rheumatology, or infectious disease) based on findings 6
  • Consider additional diagnostic testing as indicated by MRI findings 1

Important Considerations

• Most cases of acute cervical neck pain resolve spontaneously or with conservative treatment, but the elevated CRP warrants further investigation before assuming a benign course 1

• Surgical intervention is rarely indicated for mechanical neck pain and should only be considered after failure of conservative management and clear identification of a surgically correctable lesion 7, 6

• The combination of DDD findings and elevated inflammatory markers requires careful evaluation to distinguish between mechanical pain and systemic inflammatory conditions that may be contributing to symptoms 1