Cervical pain (cervicalgia)

Cervicalgia is pain located in the region of the cervical spine at the back of the neck, sometimes radiating to the head, shoulder or dorsal spine.

The cervical spine region is formed by the cervical vertebrae and their joints, ligaments and muscles. In the central canal formed by the vertebrae is housed the spinal cord from where the nerve roots exit through the spine and surrounding tissues. The cervical spine has a great mobility and also holds the weight of the head so the muscles, tendons and joints of the cervical spine have a great job and any alteration at this level can cause pain.

What are the symptoms of cervical pain (cervicalgia)?

Pain in this location is very frequent. The pain may be located in the back of the neck, the nape of the neck or in the trapezius muscles. It is usually worse when maintaining certain head positions for long periods of time. It is frequent that it is accompanied by the contracture of the cervical musculature. It is painful to move the head and the pain is reproduced when palpating the cervical musculature. Headache and shoulder pain may also occur.

It is usually mild and is related to some posture during work or sleep or after exercise or sport. In these cases the pain is usually temporary.

Other times it is more intense and longer lasting and can sometimes be accompanied by arm pain or loss of strength, and tingling in the fingers. In this case it may be the symptom of something more important and requires a medical consultation.

What is the cause of cervical pain (cervicalgia)?

It depends on the level at which it occurs:

Muscular: In most cases it is due to poor posture or repeated efforts with the muscles that support the head. The persistent contraction of a muscle causes and translates into pain in the affected area. Sometimes these persist becoming myofascial trigger points that produce myofascial pain. This type of pain has a tendency to become chronic.

Articular: For example, due to osteoarthritis of the joints of the cervical vertebrae.

Nerve roots: Compression of the nerve roots that exit from the spinal cord through the intervertebral foramina causes neuropathic pain that usually radiates to the shoulder or down the arm. In this case the cause may be a herniated disc or other injury that compresses them.

Trauma such as cervical fractures, or whiplash syndrome. In the latter case, no signs of injury are seen in the examination or in the radiological tests and in most cases the patient recovers in two or three months.

Other diseases: Infections in the cervical area, tumors, or a spinal cord injury can also cause pain in the cervical area.

It should be kept in mind that cervical pain may be a reflection in this location of a problem elsewhere: shoulder injuries, rheumatoid arthritis and other rheumatic diseases, some esophageal diseases or cardiac vascular problems.

Diagnosis of cervical pain or cervicalgia

The history and physical examination are fundamental for diagnosis. The clinical history of pain includes onset, location, triggers, posture and type of work, history and others such as sleep disturbances. The physical examination of the muscles and cervical mobility and the neurological examination such as arm strength, reflexes, sensitivity, gait and balance indicate where the origin of the pain may be (muscle, joint, nervous system). With this information the physician decides which tests should be performed to confirm the diagnostic suspicion.

What are the tests for the diagnosis of neck pain?

MAGNETIC RESONANCE (MRI) provides images of both the vertebrae and intervertebral joints and soft tissues, including the discs between the vertebrae, the spinal cord and nerve roots.

ELECTROMYOGRAPHY This test evaluates the electrical activity of the nerve and confirms whether the pain is due to nerve compression and which nerves and muscles are functioning abnormally.

OTHER TESTS may also be useful, such as CT scan, simple X-ray and sometimes complementary analytical tests.

When should I consult for cervical pain (cervicalgia)?

In most cases cervical pain is not serious, although sometimes it is a sign of a more serious disease. A doctor should be consulted when:

• The pain does not improve in one or two weeks.
• The pain is intense
• Pain occurs after trauma
• Cervical pain is accompanied by arm pain or loss of strength in the arm or hand, or with tingling in the fingers.
• If you have trouble walking or keeping your balance.
• The pain appears when you lie down or wakes you up at night.
• Loss of sphincter control

What is the treatment of neck pain?

Treatment depends on the cause.

Pharmacological treatment of cervical pain or cervicalgia

It can be treated with analgesics and anti-inflammatory drugs or muscle relaxants. There are also other medications that decrease the nerve transmission of pain that may sometimes be indicated.

These drugs are used when the problem is of muscular origin or if the cause is an alteration of the vertebral joints (cervical osteoarthritis).

Physiotherapy for cervical pain or cervicalgia

Physical therapy is effective for muscle, joint and myofascial pain. Improving muscle tone and strength in the neck, neck and upper back muscles also helps prevent recurrent neck pain.

Surgical treatment for cervical pain or cervicalgia

The indication for surgical treatment is usually made when there is a spinal cord or radicular lesion or traumatic pathology. It may be considered in cases of disabling neck pain in which non-invasive treatment has failed and it is clearly defined that the cause of the pain can be corrected with surgical intervention.

Other treatments

Other times the pain is due to a disease such as arthritis, or an infection that requires specific treatment.

Self-care during neck pain

During the period of time that the pain lasts, it is recommended:

• Avoid gestures, postures and activities that increase neck pain.
• Avoid cervical extension postures (arching of the head backwards).
• Avoid movements to the side of the painful blockage if there is one.
• Resume exercise slowly. For this, it is advisable to consult a physiotherapist.

What can I do to prevent neck pain (cervicalgia)?

Since most of the time neck pain is caused by muscular problems and bad posture, it is recommended:

• Good posture. When sitting during work the chair should have an adjustable and swiveling backrest and seat.
• Good posture with cell phone use or using headphones.
• Rest periodically if the posture at work is not correct. Or if traveling. Walk, stretch your neck and shoulders.
• Avoid carrying heavy weights or bags over your shoulder.
• Sleep with a suitable mattress and pillow.