What can you do about non-specific neck pain?

Photo of hands on a computer keyboard (PantherMedia / Sahaphon Phanpakdee)

If you have neck pain with no known cause, it's best to stay active and go about your everyday life as usual. You can do special exercises to strengthen the muscles in your neck. Most treatments for neck pain haven't been proven to work in good-quality scientific studies.

It's usually not possible to find a clear cause of neck pain. Neck pain with no known cause is called "non-specific" neck pain. It usually goes away on its own within a few days or weeks. But the pain lasts longer in some people, or it keeps on coming back. Neck pain is considered to be chronic if it lasts longer than three months.

In many cases, various factors contribute to the development of non-specific neck pain. These might include physical strain at work, such as working on something above you or sitting at a desk without moving enough. Emotional stress, like worries and anxiety about family or work, often plays an important role.

Non-specific neck pain can be very unpleasant, but it's not dangerous. There is no need to rest your neck. In fact, it's actually a good idea to stay active.

Although non-specific neck pain is very common, only a few good-quality studies have looked at the various treatment options. None of the treatment options have been clearly shown to provide long-term neck pain relief. But there are various simple things that you can try out for yourself.

What can I do about neck pain myself?

Many people use warm scarves, heating pads or heat packs to relieve tension and pain. If the neck pain is being caused by irritated nerves, ice packs can provide relief too. Make sure the pack you use isn't too hot or too cold. Wrapping a cloth or towel around the pack helps to protect your skin.

Stretching and strengthening exercises can be done to relax and strengthen the muscles with the aim of preventing neck problems. Once you have learned the exercises from a doctor or physiotherapist, you can do them at home too.

There are two main types of neck-strengthening exercises, known as isometric (static) and dynamic exercises. In isometric exercises, you tense your muscles without moving your body. For example, you might stand with your back to a wall and consciously push the back of your head against the wall (as firmly as you can without it being uncomfortable) for about 20 seconds. In dynamic exercises, you actively move your muscles – you can use your own body weight or objects like dumbbells and elastic exercise bands.

Studies have suggested that strengthening exercises for your neck, shoulders and shoulder blades can relieve chronic neck pain and improve the range of movement. The participants in these studies usually did the strengthening exercises two to five times a week, and sometimes combined them with stretching or endurance exercises. More good-quality studies are needed in order to be more sure about which neck exercises help and how often you should do them.

Are manual therapies or massages effective?

Manipulation and mobilization are manual therapy techniques. The aim of these approaches is to relieve pain and improve joint mobility using certain hand movements. Mobilization involves slowly moving the joint as much as possible. In manipulation, additional short, sharp movements are used to push the joint beyond its active range of movement. This is also known as chiropractic adjustment. For the treatment of neck pain, manipulation and mobilization techniques can be used on both the neck (cervical spine) and the upper back (thoracic spine). These treatments haven't been proven to be effective, though.

Manipulation of the spine can make the pain worse at first. It also sometimes causes temporary headaches or dizziness. There have been a few reports of blood vessel injuries and strokes following manipulation of the spine. But these serious complications are extremely rare. It is important to make sure that the physiotherapist or doctor providing the treatment has had special training in manual therapy.

The aim of therapeutic massage is to reduce muscular tension and relieve pain. It might temporarily relieve acute pain, but there are no good-quality studies about how effective it is in the treatment of neck pain. Because it involves applying pressure to the affected area, the massage can itself be painful.

Research summaries

Does physical therapy help?

Physical therapy is an umbrella term used to describe treatments that apply physical stimuli such as heat, cold, electricity and light. They are often carried out by physiotherapists.

Electrotherapy

Transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS) are types of electrotherapy. In these treatments, small electrical impulses are used to stop pain signals being sent to the brain and to stimulate the production of endorphins – the body's own pain-relieving hormones.

TENS involves placing electrodes on the skin to send electrical impulses across the skin (transcutaneously). In PENS, the electrical impulses are transmitted through acupuncture needles inserted into the skin (percutaneously). There are other types of electrotherapy too, such as interferential current therapy. The various types of electrotherapy differ in terms of things like the frequency of electricity used.

None of these approaches have been proven to relieve neck pain. In PENS, the small punctures in the skin may lead to minor bleeding or an infection. There were no reports of other side effects in the studies, but they can't be ruled out.

Laser therapy

Sometimes a treatment approach known as low-level laser therapy is used to relieve neck pain. This involves exposing the affected area of skin to light rays of a specific wavelength. Low-level laser therapy is sometimes also called cold laser therapy because – unlike with other types of laser therapy – the tissue doesn't become warm. Advocates of this treatment believe that the laser beams reduce inflammation, increase blood flow or stimulate the nerves. But no evidence has been found to support these theories.

There are no good-quality studies on the effectiveness of low-level laser therapy in the treatment of neck pain. So it's not possible to say whether this treatment can noticeably improve neck pain.

How effective is acupuncture?

Acupuncture is a traditional Chinese medical practice. No good-quality studies have shown that acupuncture can relieve neck pain. The risk of side effects is low. Inserting the acupuncture needles sometimes causes minor bleeding or bruising. To avoid infection, it's important to use sterile disposable needles.

Research summaries

Can painkillers help?

Different kinds of medication can be used to treat neck pain. Many people try to relieve acute pain with over-the-counter or prescription painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen or diclofenac. Some also use acetaminophen (paracetamol). But there are hardly any good-quality studies on the effect of these medications in the treatment of neck pain. So it's difficult to say for sure whether they work and how effective they are. NSAIDs may have various side effects, and aren't appropriate for people who have kidney failure. Although acetaminophen (paracetamol) is well tolerated, it isn't suitable for people with impaired liver function because it is broken down in the liver.

Diclofenac and ibuprofen are often used as topical painkillers in the form of gels applied to the skin. There is a lack of good-quality research in this area too. One advantage of applying painkillers in this way is that gels have fewer side effects than tablets. They sometimes irritate the skin, causing side effects such as redness, dryness or itching.

Prescription medications

If the pain is very severe, your doctor might prescribe an opioid painkiller. These drugs are used in the treatment of conditions like cancer, severe nerve pain (for instance, in people with shingles) and a slipped disk. They are only used to treat neck pain if the pain is acute and very severe. Typical side effects include constipation and feeling nauseous, drowsy, dizzy and sleepy.

Medications that relax the muscles (muscle relaxants) are sometimes used too. These drugs are usually sedatives that influence the brain. They have to be prescribed by a doctor and can have various side effects, such as drowsiness.

Painkillers and muscle relaxants should generally not be taken over long periods of time, but rather be used for short-term treatment. To avoid accidents, people who take opioids or sedatives may have to refrain from driving and operating machinery. These medications also increase the risk of falls in older people.

The German College of General Practitioners and Family Physicians (DEGAM) advises people not to take painkillers or muscle relaxants to treat non-specific neck pain.

Injections

Medications such as NSAIDs, steroids and the local anesthetic lidocaine can be injected directly into a muscle or the joints between the vertebrae (bones of the spine). Sometimes the nerve poison botulinum toxin ("Botox") is injected, too. The effects of local injections are not well studied, though.

The German College of General Practitioners and Family Physicians also advises against the use of injections to treat non-specific neck pain because of the possible risks. These risks include skin injuries, allergic reactions and seizures. Also, injections are always associated with a low risk of germs entering the body and causing an infection.

Lidocaine injections can have several side effects such as a temporary increase in the pain, abnormal sensations like tingling, numbness, or a burning sensation at the site of injection. NSAID injections probably aren't any more effective than NSAID tablets are.

When is it a good idea to use a neck brace?

Neck braces were commonly used for whiplash in the past. This is hardly ever recommended nowadays, though, because wearing a neck brace weakens the muscles in the neck, which can make the problems even worse. If the pain is very severe, neck braces are still sometimes used for a short while to take some pressure off your neck or help you sleep better. To stop the muscles from becoming weaker, neck braces should only be worn a few hours a day, and not for longer than one to two weeks.

Can making changes at your workplace help?

Ergonomic adjustments may include things like correcting the height of your office chair, the position of the back of the chair, the distance between the chair and the keyboard, and the height of your computer monitor. There are also ergonomic tools such as special keyboards, mouse devices or mouse pads. These are meant to help avoid awkward postures at the workplace. But it's not clear how effective these measures and tools are because there are no good-quality studies on ergonomic adjustments in the workplace.

In the past, there were fairly rigid guidelines concerning the "correct" seating position at the workplace. Nowadays, occupational health specialists believe that incorporating regular movement is more important. This includes things like changing your seating position as often as possible throughout the day, and making sure you regularly get up and move around. Movement increases the blood flow to your muscles, spinal disks and other tissues in your body. It is also thought to prevent problems caused by your muscles getting tired when you stay in the same position for too long.

Labels: M50, M53, M54.1, Muscles, bones and joints, Neck pain