From the Guidelines
Neck Muscle Pain
Neck muscle pain, also known as myalgia nuchae, refers to a condition characterized by pain and stiffness in the neck muscles, often accompanied by limited range of motion and tenderness to palpation 1, 2. This condition is a common presentation of mechanical pain associated with facet joints, intervertebral discs, muscles, or fascia, representing the majority of nontraumatic cervical or neck pain 2.
Causes and Symptoms
The causes of neck muscle pain can be diverse, including mechanical issues, trauma, or even systemic diseases such as ankylosing spondylitis or inflammatory arthritis 3. Symptoms may include pain in the neck, limited mobility, and tenderness to the touch. In some cases, patients may experience radicular symptoms if a nerve root is involved, such as pain radiating down the arm 1.
Treatment
Treatment for neck muscle pain typically involves over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg every 4-6 hours or acetaminophen 650-1000mg every 4-6 hours for a duration of 7-10 days 1. In cases where muscle spasm is a significant component, muscle relaxants like cyclobenzaprine 5-10mg every 4-6 hours for 3-5 days may be prescribed to alleviate muscle spasm and discomfort. It's essential to note that while these treatments can provide relief, identifying and addressing the underlying cause of the pain is crucial for effective management.
Diagnostic Approach
In the absence of red flag symptoms such as trauma, malignancy, or systemic diseases, imaging may not be required at the time of initial presentation 1, 3. The diagnostic accuracy of red flag symptoms, although not validated for the cervical spine, guides the clinician in deciding when to proceed with imaging or other diagnostic tests. MRI of the cervical spine is the most sensitive test for detecting soft tissue abnormalities associated with neck pain but is characterized by a high rate of abnormalities in asymptomatic individuals, making it not a first-line imaging modality in uncomplicated cases 4.
Management Considerations
Given the high prevalence of neck pain, with an annual prevalence ranging between 15% and 50% 2, and its significant impact on quality of life, a thorough clinical evaluation is essential. This includes a detailed history, physical examination, and consideration of red flags to guide the diagnostic and therapeutic approach. Most cases of acute cervical neck pain resolve spontaneously or with conservative treatment measures 1, emphasizing the importance of a conservative initial approach unless red flags or significant neurological deficits are present.
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 Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living The FDA drug label does not answer the question.
From the Research
Definition of Neck Muscle Pain
- Neck muscle pain is a common presentation in general practice, with muscle strain or osteoarthritis being the most common diagnoses 5
- It can result from musculoskeletal or neurological disease, or as a component of a wide variety of metabolic, infective, or malignant disorders 5
Characteristics of Neck Muscle Pain
- Stiffness of upper trapezius, levator scapulae, and sternocleidomastoid muscles in patients with neck pain were higher compared to asymptomatic participants 6
- Severity of pain and disability did not correlate to stiffness of these muscles in patients with chronic neck pain 6
- Myofascial release showed a significant difference in pain, rotation to the right, and lateral flexion to the right, compared to other treatment methods 7
Associated Factors
- Vitamin D deficiency and insufficiency can cause or worsen neck and back pain and muscle spasm 8
- Correction of vitamin D deficiency and insufficiency plays an important role in the treatment of chronic neck and back pain and muscle spasm among patients having concurrent vitamin D deficiency and insufficiency 8
- Deep tissue massage is effective on neck range of motion, pain, disability, and quality of life in patients with myofascial pain syndrome 9