Neck pain is a common problem, affecting about two-thirds of all adults at some point in their lives. There are various treatments available; the most suitable treatment for you will depend on the cause of the pain and how severe it is. For most people, treatment involves a combination of medicines, exercises and relaxation therapies.
It’s important to note that there is limited scientific evidence proving the effectiveness of many of the therapies used to treat neck pain. Your doctor can advise you of the treatments that are most likely to be of benefit to you.
Severe neck pain that occurs after a neck injury can be a serious problem, and you should see your doctor immediately. Also, if you have problems with neck pain and experience symptoms such as shooting pains, numbness, tingling, or weakness in the arms or legs, especially if these symptoms come on suddenly or get worse quickly, you should see your doctor straight away.
These days, total or prolonged bed rest is generally not recommended for neck pain. In fact, most health professionals recommend that rest should be limited to a day or 2 after the onset of neck pain. The exceptions to this are if you have nerve root compression (pinched nerves), or an injury such as a ruptured disc or fracture.
There is no evidence that supportive neck collars relieve pain or improve function in people with neck pain.
By continuing to move your head and neck as usual, you can reduce pain and prevent further neck stiffness developing. However, you should still try to avoid quick movements, positions that hurt, and any activities you think may have caused the pain.
Short-term problems, such as neck pain resulting from a minor whiplash injury, may benefit from the application of a cold pack. Cold packs can help reduce inflammation and swelling after an injury and numb the pain. Heat helps relax stiff or tense muscles, but you should wait a day or 2 after an injury before using a heat pack (to make sure any swelling has gone down).
Remedial massage is offered by a number of healthcare providers, including physiotherapists, chiropractors and osteopaths. It involves your healthcare provider using their hands to apply pressure and movement to your skin, muscles and tendons. Massage can relieve muscle tension and spasm, help loosen stiff joints and promote relaxation.
Pain-relieving medicines are often needed to control pain and discomfort so that you can resume your usual activities. Over-the-counter medicines such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen, are often tried first. Paracetamol can also be used in combination with NSAIDs or stronger pain relievers (such as codeine) to treat more severe neck pain.
Muscle relaxants (including benzodiazepines) are sometimes used to relieve muscle spasms that can contribute to neck pain. These medicines are generally only prescribed for a short period of time because they are associated with significant side effects and can cause dependency. They are also usually used in combination with other treatments.
Physiotherapists can help treat your neck pain with a variety of treatments, including:
Specific neck exercises, as well as general physical activity, can help speed up the healing process following a neck injury and reduce the risk of developing chronic neck pain. People with neck pain that has lasted more than a few months can also benefit from exercise. A physiotherapist can tailor a programme of exercises to help you to increase muscle flexibility and strength, stretch your muscles and reduce spasm.
Spinal manipulation (usually performed by chiropractors and osteopaths) is another treatment option for certain neck conditions. The therapist uses their hands to adjust the joints in your neck with the aim of relieving pain and stiffness. Manipulation is not suitable for some people, and there is a small risk of serious side effects, including neck injuries and even stroke, so check with your doctor before receiving this treatment.
Certain antidepressants (the so-called tricyclic antidepressants) and anticonvulsant medicines (the same medicines that are used to control seizures in people with epilepsy) have been found to relieve certain types of pain, and can be prescribed to help control neck pain that is not responding to regular pain relievers. These medicines may also relieve pain that is worse at night, and pain that is caused by compression or damage to a nerve root in the neck.
Corticosteroids reduce inflammation and may be used to relieve neck pain in some cases. Corticosteroid medicines can be taken by mouth or injected into the joints and muscles in the neck, the epidural space (the space between the outer covering of the spinal cord and the vertebrae), or the space around nerve roots.
When given as an injection, corticosteroids are often mixed with a local anaesthetic, and can be used to treat neck pain resulting from:
Surgery is rarely needed for pain alone, and in most cases is usually performed only after non-surgical therapies have been tried. However, if you have spinal cord compression, surgery is generally required sooner rather than later. Spinal surgery is of benefit only for pain involving nerves — it does not help pain from spondylosis or soft tissue pain.
Another treatment that may provide relief from neck pain is acupuncture, which involves having small needles inserted into specific areas called acupuncture points just below the surface of the skin. While many people report that acupuncture improves their pain, there is currently no evidence from clinical trials to either prove or disprove its effectiveness as a treatment for neck pain.
Stress management and relaxation techniques are also useful, as they can help relieve chronic muscle tension that may be contributing to neck pain. Some doctors recommend psychological treatments such as cognitive behavioural therapy (CBT) for ongoing problems with neck pain. CBT can help you gain a sense of control over your pain and help you manage it more effectively.
If you’ve had trouble with neck pain in the past, there are ways of preventing further problems. One of the most important things you can do is to maintain good posture. Keeping your head centred over your spine helps reduce much of the strain on your neck muscles.
People who work long hours driving, sitting at a desk, or hunching over a workbench often suffer from neck pain due to their posture. Try the following:
Posture-correcting exercise processes that re-educate the body, such as the Alexander Technique and Pilates, can also help prevent neck pain, as can yoga and tai chi.
You can also help improve or prevent neck pain while you are sleeping by using a pillow that is the right height for you and supports the natural curve of your neck. There are pillows available that have a contoured surface that comes up to support the neck and recedes to leave more room in the head support zone. Also, use a firm mattress and try to avoid sleeping on your stomach (which can put strain on your neck).
Relaxation techniques and regular exercise are also important in preventing stress and tension in the neck muscles. Maintaining general fitness helps prevent further exacerbations of neck pain by improving muscle tone and posture.
Last Reviewed: 02 November 2009