What is the diagnosis and treatment plan for a patient with chronic cervical pain (neck pain) that has worsened since Sunday, with minimal improvement from Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and muscle relaxers, and is now considering alternative therapies such as massage and physical therapy, with an order for a radiograph (x-ray) of the neck to rule out underlying pathology?

From the Guidelines

For chronic neck pain worsening since Sunday but ongoing since 2022, the most effective treatment plan includes a combination of immediate interventions and longer-term management strategies, prioritizing non-pharmacologic treatments and considering the patient's refusal of physical therapy, as suggested by 1 and 1. Today, you'll receive a Toradol injection in the clinic for immediate pain relief, as part of a comprehensive approach to address both the immediate pain and inflammation. You should continue taking Tylenol 1000 mg every 8 hours as needed for pain. You're also being prescribed methocarbamol 750 mg twice daily for two weeks to help with muscle spasms, and a short 5-day course of prednisone to reduce inflammation, based on the guidelines for managing chronic pain, as outlined in 1. An X-ray has been ordered to rule out any underlying structural issues causing your pain, following the recommendations for initial imaging in chronic cervical or neck pain, as stated in 1. While you've declined physical therapy, you've agreed to try massage therapy, which is a recommended non-pharmacologic treatment for chronic low back pain, as suggested by 1, and you've been provided contact information to schedule these appointments. For home management, regular stretching, exercises, and alternating heat and cold packs are recommended, as part of a non-pharmacologic approach to managing chronic pain, as outlined in 1 and 1. A referral to orthopedics has been made to consider steroid injections if your pain persists, as a potential next step in managing chronic neck pain, as suggested by 1. A follow-up appointment is scheduled in one week to reassess your pain levels and treatment effectiveness, to ensure that the treatment plan is working and to make any necessary adjustments, based on the principles of managing chronic pain, as outlined in 1, 1, and 1. Some key points to consider in managing your chronic neck pain include:

• The importance of non-pharmacologic treatments, such as massage therapy, regular stretching, and exercises, as recommended by 1 and 1
• The potential benefits of steroid injections, as suggested by 1
• The need for regular follow-up appointments to reassess pain levels and treatment effectiveness, as part of a comprehensive approach to managing chronic pain, as outlined in 1, 1, and 1

From the Research

Treatment Options for Chronic Neck Pain

• The patient's condition is being managed with a combination of pharmacological and non-pharmacological interventions, including NSAIDs, muscle relaxers, and massage therapy 2, 3.
• The use of multimodal non-pharmacological interventions, such as exercise and manual therapy, has been shown to be effective in reducing pain and disability in patients with chronic neck pain 3.
• The patient has been prescribed a stronger muscle relaxer, methocarbamol, and a short course of prednisone to help manage their pain 2, 4.
• The patient has also been referred for an x-ray of the neck to rule out any unexpected pathology and has been given the option to try massage therapy 2, 5.

Rationale for Treatment Approach

• The treatment approach is based on the patient's history, physical examination, and the presence of reproducible pain with palpation 4, 6.
• The use of NSAIDs and muscle relaxers is supported by evidence from studies on the management of acute and chronic neck pain 2, 4.
• The referral for an x-ray and consideration of future steroid injections is based on the patient's disproportionate pain and emotional distress, as well as the need to rule out any underlying pathology 2, 4.

Non-Pharmacological Interventions

• The patient has been recommended to try regular stretches, exercises, heat/cold pack, and massage to improve discomfort 2, 5.
• The use of non-pharmacological interventions, such as exercise and manual therapy, has been shown to be effective in reducing pain and disability in patients with chronic neck pain 3, 5.
• The patient's refusal to complete physical therapy has been noted, and alternative options, such as massage therapy, are being explored 2, 5.