From the Guidelines
Cervical pain can be effectively managed through a combination of approaches, including over-the-counter pain medications, ice and heat therapy, gentle stretching exercises, and physical therapy, as recommended by the American College of Radiology in 2019 1. For immediate relief, over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) can reduce inflammation and pain. Apply ice for the first 48-72 hours (20 minutes on, 20 minutes off), then switch to heat therapy using a heating pad or warm shower for 15-20 minutes several times daily. Gentle stretching exercises focusing on neck rotation, side bending, and chin tucks can improve mobility; perform these 2-3 times daily, holding each stretch for 30 seconds. Maintain proper posture, especially when using electronic devices, by keeping screens at eye level and taking frequent breaks. Physical therapy may be beneficial for persistent pain, typically involving 6-12 sessions over several weeks. For sleep, use a supportive pillow that maintains proper neck alignment. If pain is severe, persists beyond 2-3 weeks, is accompanied by arm numbness/weakness, or follows trauma, consult a healthcare provider promptly as prescription muscle relaxants like cyclobenzaprine (5-10mg) or specialized treatment may be necessary. These approaches work by reducing inflammation, relaxing tense muscles, improving circulation, and maintaining proper spinal alignment. Additionally, cognitive behavioral therapy (CBT) and yoga may be recommended for chronic pain management, as suggested by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1. It is essential to note that the presence of "red flags" such as trauma, malignancy, or neurological deficits may require immediate medical attention and a different treatment approach, as outlined in the ACR Appropriateness Criteria for cervical neck pain or cervical radiculopathy 1.
From the Research
Treatment Options for Cervical (Neck) Pain
- Conservative care is the initial approach for managing cervical discogenic pain, including rest, physiotherapy, and oral medications 2
- Percutaneous minimally invasive radiological procedures, such as periradicular steroid injection and percutaneous disc decompression techniques, can be considered when conservative treatment fails 2
- Medications like ibuprofen and cyclobenzaprine can be used to manage acute cervical strain, but there is little benefit to routinely using or adding cyclobenzaprine to NSAIDs 3
- For cervical facet-related pain, first-line therapy includes focused exercise, graded activity, and range-of-motion training, while pharmacological treatment may be considered for acute pain 4
- Radiofrequency treatment of the medial branches can provide long-term analgesia for cervical facet pain 4
- Conservative treatments like physiotherapy, collar, and traction can be effective for patients with cervical radiculopathy, but no single intervention seems to be superior or consistently more effective than others 5
- Individualized physical therapy interventions based on a clinical decision-making algorithm can be effective in improving impairment, physical performance, and disability in patients with neck pain 6
Interventional Procedures
- Periradicular steroid injection under image guidance can reduce periradicular inflammation and relieve radicular pain 2
- Percutaneous radiofrequency nucleoplasty is a minimally invasive technique that can be used to treat cervical pain of discal origin 2
- Radiofrequency treatment of the medial branches can provide long-term analgesia for cervical facet pain 4
Pharmacological Treatment
- NSAIDs like ibuprofen can be used to manage acute cervical strain 3
- Cyclobenzaprine can be used to manage acute cervical strain, but its addition to NSAIDs may not provide significant benefits 3
- Pharmacological treatment may be considered for acute facet joint pain, but evidence for chronic facet joint pain is lacking 4