Raj N. Sureja, MD
When a patient with chronic neck pain gets referred to me, an Interventional Pain Management Specialist, I am often considered a last resort for treatment. Typically, the patient has tried every treatment that their PCP has to offer, been to a Chiropractor, Physical Therapist, massage therapist, to an Orthopaedist, and may or may not have had surgery. I pride myself at being an excellent diagnostician, and I see so many mis- or under diagnosed problems where the patient’s original diagnosis was simply incorrect, surgery was ordered too quickly or was never ordered when needed. Unfortunately, my patients have had to suffer the consequences of those decisions. In this article, I am going to discuss chronic neck pain, how I treat it and help my patients find a better quality of life, even with their neck pain.
The causes of chronic neck pain can be many and varied. One of the most common is osteoarthritis, which is simply the aging, wear-and-tear arthritis that almost everyone gets if they live long enough. Bone spurs can develop in the spine, which can irritate nerves or the spinal cord. Spinal stenosis or a narrowing of the spinal canal can develop in the neck. The discs between the neck vertebrae can degenerate, lose water, and stiffen or they can bulge or herniate their contents to press on a nerve. Oftentimes, stress and overuse of muscle and tendons can cause micro-tears to develop in the tissues of the neck, which causes trigger points and chronic soreness to develop. Fibromyalgia is known for causing chronic neck pain. Occasionally, we can’t find a reason for chronic neck pain, but it exists. This is called idiopathic pain.
When I see a patient initially, the first order of business is to do a thorough review of their medical history before they walk in the door to my practice. I want to know which physicians they have seen for their neck pain, what medications they have tried and for how long, was Physical Therapy or exercise therapy ever used, what procedures or surgeries they might have had, has the patient ever had Behavioral Counseling or emotional support of any kind, the list goes on and on. That way, I am better prepared for the visit, the patient doesn’t have to spend and hour or two bringing me up to speed and we can focus on what’s happening in the here and how. I do a complete physical exam with the patient, ask tons of questions about their neck pain, check to see if we have a current MRI and x-rays and if not, order those. We review medications being taken, if any. Then, the patient and I will develop a treatment plan for their chronic neck pain based on their diagnosis, failed/successful therapies tried, specific lifestyle, activity level, pain intensity, and goals for treatment.
Some patients I find, upon consultation, to have been misdiagnosed or under diagnosed. If that is the case, and treatment options remain available to us, I will recommend the least invasive procedures that I feel will get to the root of the chronic neck pain issue to fix it without surgery. Perhaps that will be a non-narcotic medication or combination of medications that has not be tried before. Often steroid injections can be very effective for treating disc-related or facet joint related chronic neck pain. I also can use Radio Frequency Ablation which is a treatment that temporarily burns the myelin sheath off the affected nerve to block pain signals to the brain. The sheath eventually grows back, but often the pain will be reduced or gone altogether. If the pain does return, the procedure can be repeated.
If surgery is the only treatment option that will fix the painful root cause of the symptoms, then I will recommend surgery be performed by a highly skilled spine surgeon who has performed many cervical spine procedures successfully.
I may also recommend that the patient see our Clinical Psychologist, Dr. Andrew Martin, for emotional support and to learn coping skills to use while dealing with their chronic neck pain. Dr. Martin provides another important component in our comprehensive approach to treating pain and the whole patient. Research shows that patients who receive mental health support while undergoing treatment for chronic pain often have better outcomes.
I also may recommend the trial of a Spinal Cord Stimulator, aka Neurostimulation, to ascertain whether it provides significant pain relief. Neurostimulation seeks to disrupt painful signals that are sent to the brain, by instead sending other mild electrical signals, like high frequencies, tapping, buzzing, etc. to the brain. To understand how this works, think about hitting your funny bone. What is the first thing that you do? You rub it, because rubbing it overwhelms the weird, painful sensation of hitting it against something, and sends different signals to the brain. In a nutshell, that is what Neurostimulation does with pain signals. The great thing about Neurostimulation is that you can try it for a week and see if it works to relieve your pain. It can be adjusted up or down, turned on or off, different signals can be tried alone or in combination. If it provides significant relief, it can be permanent implanted. If not, the patient hasn’t gone through a major surgery to no effect.
Chronic neck pain can be extremely difficult to deal with in everyday life; however, I have many tools in my doctor’s bag that I can use to reduce patient’s pain to more livable, manageable levels and provide a better quality of life for them.
Make an appointment with Dr. Sureja or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.