Neck pain medical therapy

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Editor-In-Chief: Robert G. Schwartz, M.D.[3],Piedmont Physical Medicine and Rehabilitation, P.A.

Medical Therapy

Most causes of neck pain and not life threatening and can resolve with conservative treatment. Medical therapy is the mainstay of treatment for chronic neck pain. Non-opioid analgesics like acetaminophen and NSAIDs are used as first line therapy for pain relief. NSAIDs are often used due to their analgesic and anti-inflammatory effects. Acetaminophen/paracetamol is also commonly prescribed. Muscle relaxants eg cyclobenzaprine, orphenadrine, metaxalone etc can also be effective due to their effect of relaxing the paraspinal muscles along cervical spine. Other therapies that may be tried in chronic neck pain include antidepressants like low dose tricyclic antidepressants and anticonvulsants. Depending on the origin of pain, injection therapies with local anesthetics and corticosteroids may be tried. Patients with radiculopathies may benefit from neural injections and those with localized cervical pain can benefit from soft tissue and joint injections. [1]

Neck pain is also treated by numerous other non pharmacologic therapies. They range in complexity depending on the severity and underlying causes of the pain. Treatment is administered by chiropractic, osteopathic and physical therapy. All of these specialties treat neck pain issues. The benefit of mobilisation and manipulation is not clear.[2][3] Neck pain can also be eased via many self help techniques such as stretching, strength building exercises. Non-traditional methods such as Acupressure, Reflexology and therapeutic massage are commonly used as well.

Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents (Prolotherapy) into affected soft tissues, joints, or nerve roots to more complex nerve blocks. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.


  1. Borenstein DG (2007). "Chronic neck pain: how to approach treatment". Curr Pain Headache Rep. 11 (6): 436–9. doi:10.1007/s11916-007-0230-4. PMID 18173978.
  2. Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane database of systematic reviews (Online) (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063.
  3. Hoving JL, Koes BW, de Vet HC; et al. (2002). "Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial". Ann. Intern. Med. 136 (10): 713–22. PMID 12020139.

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