Treatment of Chronic Neck Pain

by | Oct 22, 2018

What Causes Chronic Neck Pain?

A majority of chronic neck pain is due to injury to the cervical facets.  This condition is known as cervical facet arthropathy or cervical facet syndrome.

Diskogenic disease is another, albeit unlikely cause of localized neck pain.

What are the Cervical Facet Joints?

Facet joints are found on both sides of the spine.  Each is about the size of a thumbnail. Cervical facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right C6C7 facet joint for example, joins the 6th and 7th vertebrae on the right side.
Facet joints not only connect the vertebrae but they also guide the spine during movements.

What is Cervical Facet Joint Pain?

Cervical facet joint pain is a result of injury, either to the cartilage inside the joint or the connecting ligaments surrounding the joint.

Pain from an injured cervical facet joint may be aching and associated with muscle spasm, or may be acute producing a stabling or shooting pain. Depending on which facet joint is affected, the pain may produce associated headaches, or can produce referred pain to the shoulders. The diagram shows areas of pain usually associated with specific joints.

How is Cervical Facet Injury Diagnosed?

Specific signs and symptoms are associated with this condition. Patients will usually have upper or lower neck pain, which exacerbates with certain positions and activities. Although findings can vary, the classic signs are pain which worsens with extending the neck, tilting the neck to one side, and palpating the area where the pain originates in the neck. Common tests such as x-rays or MRI’s usually will not show abnormalities due to a symptomatic to facet joint.  Therefore the only way of truly diagnosing the condition is with a facet joint injection.

What is a Cervical Facet Injection?

There are several types of facet joint injections. The nerves to the joint can be blocked as a diagnostic test, the ligament structures overlying the joint can be injected to aid stability, and the joint itself can be injected with anti-inflammatory medication.

These injections are performed to both diagnose and treat the condition. If the nerve block brings temporary benefits, and improves the range of motion, this is a good suggestion that the condition exists.  A second procedure may be performed to both confirm the diagnosis and attempt to achieve long term benefit. The ligamentous structures may be injected during Prolotherapy or Platelet Plasma Injections to improve laxity and to regenerate tissue. More conventional treatment involves injecting the joint with corticosteroid to reduce inflammation.

How is the Injection Performed?

The injection is usually performed in an operating room setting. The patient is given an intravenous whereby sedation is administered. A local anesthetic is also used to help numb the skin and underlying muscles.

The injection is performed under fluoroscopy, a type of x-ray, to ensure the safe and proper positioning of the needles. Usually two or three joints are treated simultaneously. Once the needles are in proper position, approximately 1 ml of the anesthetic mixture is injected at each joint.

What Happens After an Injection?

After the procedure, the patient is brought to the recovery room and monitored for about 30 minutes before being discharged from the center, and will receive discharge instructions and a pain diary. The anesthetic will wear off throughout the day. Therefore keeping track of the pain score helps determine whether or not this is the condition which is causing the pain.

After the procedure, it is helpful to assess whether or not activities and positions which used to cause the pain, are now improved. If the patient can move his/her neck more fully and without pain in a manner which could not be done before, then this is a positive sign. Pain relief may be immediate or may take up to an hour to achieve maximum strength. The skin around the neck may be numb, and the muscles may be slightly week while the anesthetic is working. This will wear off in a few hours.

How Long will Pain Relief Last?

Pain relief from a single injection can be temporary or possibly permanent. There is no way of predicting this, as results may be due to the severity of the condition and the number of levels which need to be treated.  Some patients receive excellent long-term benefit from a single treatment but some patients do need a second treatment. If necessary, radiofrequency ablation, discussed in my next blog, is the most definitive and permanent treatment for this condition.  As is my philosophy, these and other minimally invasive modalities can achieve long-term pain relief without surgery.

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