What is the appropriate treatment for cervical neck pain at the base with radiation to the left (L) arm, including medication therapy (medication treatment) and physical therapy (PT)?

From the Guidelines

For cervical neck pain at the base with radiation to the left arm, I recommend a combination of medication and physical therapy, as most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1. This approach is supported by the fact that spondylotic changes are commonly identified on radiographs and MRI in patients over 30 years of age and correlate poorly with the presence of neck pain 1. The initial treatment should focus on relieving symptoms, maintaining or regaining functional capacity, reducing inflammation, and preventing structural musculoskeletal damage 1. Key aspects of the treatment plan include:

• Medication: Start with over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (500mg twice daily with food) for 1-2 weeks to reduce inflammation and pain.
• Physical therapy: Focus on gentle stretching, strengthening exercises, and proper posture training, typically 2-3 sessions weekly for 4-6 weeks.
• Additional measures: Apply ice for 15-20 minutes every 2-3 hours during acute pain, then transition to heat therapy after 48-72 hours. If symptoms worsen or don't improve within 2-3 weeks, further evaluation with imaging may be necessary to rule out disc herniation or spinal stenosis 1. It's also important to assess disease activity based on clinical symptoms and radiological measures, and to evaluate treatment response regularly 1. Overall, this combined approach prioritizes reducing morbidity, mortality, and improving quality of life by addressing the underlying causes of cervical neck pain and radiculopathy.

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 Cyclobenzaprine hydrochloride tablets should be used only for short periods (up to two or three weeks)

For cervical neck pain at the base with some radiation to the left arm, cyclobenzaprine may be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2.

• The medication should be used for short periods, up to two or three weeks.
• Ibuprofen may also be considered for mild to moderate pain, with a dose of 400 mg every 4 to 6 hours as necessary for relief of pain 3.

From the Research

Cervical Neck Pain Treatment

• Cervical radiculopathy, which describes pain in one or both of the upper extremities, often in the setting of neck pain, can be treated with nonoperative management, including physical therapy and medication 4.
• Nonoperative treatment for cervical radiculopathy includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage 4.
• Exercise treatment appears to be beneficial in patients with neck pain, and there is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm 5.

Medication Treatment

• Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm has been studied, and results show that all three treatment groups demonstrated significant improvements from baseline in patient global impression of change, spasm, pain, and medication helpfulness 6.
• Combination therapy with cyclobenzaprine 5 mg TID plus ibuprofen was not superior to cyclobenzaprine 5 mg TID alone in adult patients with acute neck and back pain with muscle spasm 6.

Physical Therapy and Interventional Treatment

• Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal or interlaminar approaches 7.
• A comparative-effectiveness study was performed in 169 patients with cervical radicular pain, and results show that combination therapy provided better improvement than stand-alone treatment on some measures, although no significant differences were found between treatments for the primary outcome measure 8.
• Patients with radiculopathy or myelopathy may benefit from surgery, which appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people 5.