Whiplash and neck pain chronic
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pain in the neck is a common reason for patients to seek medical attention.
A muscle spasm, brought on by poor posture, sleeping position or stress, is the most frequent causes of neck pain. But an aching neck can be due to other more serious problems. Disc degeneration, narrowing of the spinal canal, arthritis and even cancer can cause neck pain.
The neck is part of a long flexible column of bones, discs, ligaments, and muscles. The neck region of the spinal column is called the cervical spine, which consists of seven bones or vertebrae that are shaped like building blocks.
Intervertebral discs separate the vertebrae from one another. These discs allow the spine to move freely and act as shock absorbers when a person moves.
The posterior portion of each vertebra forms a tube-like canal of bone. This space is called the spinal canal, through which the spinal cord and nerves travel. The spinal cord is surrounded by cerebrospinal fluid and three protective membranes called the dura, the pia and the arachnoid.
A pair of spinal nerves exit each vertebra through small openings called foramina (one to the left and one to the right). These nerves connect to the muscles, skin and tissues of the body, providing sensation and movement to the rest of the body. The spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.
The discs in the neck degenerate during aging or can be damaged by sudden movement (whiplash) or diseases such as arthritis. Neck pain occurs when the herniated disc pinches the nerve or when arthritis progresses. Arthritis can lead to degeneration of the disc as well as abnormal bone growths (spurs) next to the joints. These spurs are the result of repetitive movement and can irritate the adjacent nerve and cause pain.
Cervical disc disorders are typically marked by intermittent neck pain, followed by severe neck and sometimes arm pain. Irritated nerves also can lead to numbness or weakness in the arm or forearm, tingling in the fingers and coordination problems. Severe nerve impairment or even paralysis can develop if the disorder is left untreated.
The joints in the neck deteriorate as people age, sometimes leading to osteoarthritis. The symptoms of osteoarthritis are pain radiating to the shoulder or between the shoulder blades and pain that is worse at the start of the day, improves during the day and gets worse again at the close of the day. This pain usually diminishes with rest. Patients with a previous history of a whiplash injury are six times more likely to develop this condition.
Whiplash is one of the most common injuries to the neck and commonly occurs after a rear-end automobile crash. What occurs at the time of whiplash is sudden acceleration where the head is whipped back then deceleration where the head is whipped forward. Severe damage to the soft tissue supporting structures is the result.
Whiplash symptoms include neck stiffness, shoulder or arm pain, headache, facial pain and vertigo. Pain from a whiplash injury can be caused by tears and bleeding in the muscles that support the neck, ligament rupture, or a disc tearing away from a vertebra.
After a careful history and physical examination, more diagnostic studies are needed.
A CT scan produces an image of the neck based on x-rays. The CT may be done in conjunction with a myelogram of the neck to provide additional information.
An MRI is probably the best test to see herniated discs since soft tissue injury is a common part of the whiplash syndrome.
Electromyography tests (EMG) studies are electrical tests designed to show the functioning of nerves and muscles.
Patients with neck pain are usually treated conservatively at first. Non-surgical treatments often can provide sufficient relief. Most cervical disc herniations, for example, heal with time and conservative treatment and do not require surgery.
Conservative treatment includes bed rest, reduction of physical activity, physical therapy and wearing a cervical collar, which provides support for the spine, reduces mobility and lessens pain and irritation. An injection of corticosteroids may be used to temporarily relieve pain. A cervical traction device may be used to further relieve the pressure on the nerves in the neck.
Treatment of whiplash injuries consists of analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants and aggressive physical therapy. Home cervical traction and manipulation are sometimes helpful. Approximately 65 percent of whiplash patients make a full recovery, 25 percent have minor residual symptoms and 5 to 10 percent develop chronic pain syndromes.
Conservative treatment options may continue for up to eight weeks. If there is severe muscle weakness or progressive symptoms, a more aggressive timetable may be warranted to avoid an irreversible wasting away of the muscles.
We have had some success using Botox for severe whiplash related pain. Another modality that is sometimes suggested is prolotherapy.
Surgery may be needed when conservative treatments for cervical disc problems do not provide relief.
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