Chronic Neck Pain: When to See a Neurologist

Cervical spine pain

Dear Doctor,
I have been experiencing pain in my cervical spine for over six months.
It hurts when I look down and also when I look up.
I had never had any symptoms before this.
The pain started about six months ago when I had to look down all day at work, but I only did that for a month before the pain became severe enough for me to quit.
I later went to a general orthopedic clinic for an X-ray, where they diagnosed me with cervical osteophytes and recommended physical therapy.
A friend suggested I get a second opinion at a larger hospital, so I went to the orthopedic department at National Taiwan University Hospital and had another X-ray.
The doctor said that having some osteophytes at my age is normal, but he indicated that my osteophyte condition should not cause such severe pain.
He then arranged for me to undergo electromyography (EMG) and nerve conduction studies, which all came back normal.

Later, the doctor referred me to the pain management department, where I had additional X-rays of my neck from the lateral and frontal views.
They did not mention any osteophytes and could not determine the cause of my pain.
After two or three follow-up visits, the doctor asked me some questions about my pain and then prescribed a three-month supply of medication.
After taking the medication for a month without any improvement, I stopped taking it.

I would like to know if I should see a neurologist for my cervical pain, as I am unsure which specialty to consult next.
Please guide me on what to do.

Mei, 40~49 year old female. Ask Date: 2017/05/16

Dr. Jiang Junyi reply Neurology

Hello, based on your description, the most common cause of neck pain is cervical myofascial pain.
Prolonged periods of looking down can lead to overuse of the trapezius muscle in the back of the neck, resulting in neck and shoulder discomfort.
Initially, resting may alleviate the pain, but eventually, it can worsen and affect daily activities.
Some patients experience severe neck pain upon waking, accompanied by stiffness, tightness, and intolerable pain levels.

I recommend the following strategies:
1.
Change positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Maintaining any posture (including a normal one) for an extended period can lead to tissue fatigue and inflammation, so moving around briefly can reduce the risk of muscle inflammation.
2.
Rest: Resting allows the muscles to utilize their self-repair capabilities; avoid vigorous exercise during this time.
3.
Neck heat therapy: Apply heat for 15 to 20 minutes, ensuring the temperature is safe to prevent burns.
4.
Non-steroidal anti-inflammatory drugs (NSAIDs): If you do not have a history of peptic ulcers, allergies to NSAIDs, or impaired kidney function, consider using NSAIDs as needed to reduce inflammation and alleviate pain.
5.
Neck muscle stretching exercises: After the acute pain phase, develop a habit of gently stretching the neck every 15 to 20 minutes at angles that do not cause discomfort, including movements up, down, left, and right.
I suggest consulting with a neurologist or a rehabilitation specialist for further evaluation and treatment.
Wishing you good health and peace.

Reply Date: 2017/05/16

More Info

Chronic neck pain can be a complex issue, especially when it persists for an extended period, as you have described. Given your symptoms and the diagnostic journey you've undertaken, it is indeed reasonable to consider a consultation with a neurologist.
From your account, it appears that your neck pain began after a period of prolonged neck flexion due to work demands. This type of repetitive strain can lead to various musculoskeletal issues, including cervical spondylosis, which is characterized by degenerative changes in the cervical spine, including the formation of bone spurs (osteophytes). While your orthopedic evaluations indicated that the bone spurs are not severe enough to cause your level of pain, it is essential to consider other potential causes.

The fact that you have undergone multiple imaging studies and nerve conduction tests, all of which returned normal results, suggests that there may not be a straightforward structural issue causing your pain. However, chronic pain can arise from a variety of factors, including muscle tension, nerve irritation, or even psychological components such as stress or anxiety, which can exacerbate physical symptoms.

A neurologist can provide a comprehensive evaluation of your symptoms, focusing on the nervous system's role in your pain. They can assess for conditions such as cervical radiculopathy, where nerve roots in the cervical spine become compressed or irritated, leading to pain that may radiate into the arms or shoulders. Additionally, they can evaluate for other neurological conditions that may manifest as neck pain or discomfort.

Moreover, if your pain is accompanied by symptoms such as numbness, tingling, or weakness in your arms or hands, these could be indicative of nerve involvement, which would warrant further investigation by a neurologist. They may recommend additional imaging studies, such as an MRI, to get a clearer picture of the soft tissues and nerve structures in your neck.

It is also worth considering the role of physical therapy in your treatment plan. Physical therapists can provide targeted exercises to strengthen the muscles supporting your neck, improve flexibility, and address any postural issues that may contribute to your pain. They can also teach you techniques for managing pain and preventing future episodes.

In summary, given the chronic nature of your neck pain and the lack of improvement with conservative treatments, seeing a neurologist is a prudent next step. They can help determine if there is an underlying neurological issue contributing to your symptoms and guide you toward appropriate treatment options. Additionally, exploring physical therapy and addressing any psychological factors may also be beneficial in managing your chronic neck pain effectively.

Similar Q&A

Understanding Chronic Neck Pain: When to See a Neurologist

Hello Doctor: I have been experiencing discomfort and pain in the back of my neck for about 6 to 7 years. I often feel dizzy and mentally fatigued, and the pain occurs at irregular intervals. Therefore, I am considering getting checked at the hospital, but I am not sure which dep...

Dr. Ye Boshou reply Neurology
Discomfort in the posterior neck is most likely due to tendonitis, commonly seen in individuals who maintain fixed positions, such as drivers and office workers. It can heal with continued movement. Other conditions like hypertension or cervical spondylosis may warrant referrals ...

Chronic Headaches: When to See a Neurologist for Relief

Hello, doctor. I would like to ask you some questions. I have been experiencing headaches for several years now. Each time, the pain starts from my neck and moves upward, and sometimes it only affects the left side of my head. I cannot feel better without taking painkillers. Occa...

Dr. Ye Boshou reply Neurology
Yes, if the neck pain persists, please visit a neurology clinic for a clinical examination, after which it can be determined whether further testing is necessary.

Understanding Neck Pain: When to See a Neurologist or Orthopedist

Hello Doctor, I have been experiencing a condition over the past few years where I occasionally feel soreness in the back of my neck. When I press on it, there is also a sensation of pain. This discomfort gradually spreads to the back of my head, where the soreness and sharp pain...

Dr. Wang Shouji reply Orthopedics
Ms. Tsai: Your symptoms are mostly not related to the vertebrae. They are likely caused by poor posture, muscle fatigue, and other factors. If you wish to go to the hospital for an examination, you can see either a neurologist, an orthopedic specialist, or a rehabilitation specia...

Neck Pain with Headaches: When to See a Neurologist?

My girlfriend initially experienced sudden pain in her upper body along with chest tightness. Later, she developed sharp pain in the back of her neck accompanied by headaches. Despite visiting the hospital outpatient department, no clear diagnosis was made, and pain relief medica...

Dr. Gao Chunde reply Neurology
If the rheumatology department confirms that there are no related issues, consideration should be given to neurological causes such as cervical spinal cord lesions, whether they are due to inflammation, hemorrhage, intervertebral disc problems, or other reasons. The on-site physi...