Neck pain and spine
Neck is the part of human spine which has to carry the weight of head. It is only spine there with muscles, ligaments and fascia to provide support. Neck pain is arbitrarily defined as pain in cervical spine and surrounding soft tissues. Neck also gives support to structures like larynx, thyroid gland. But their pains are not considered as neck pain. Neck has different names like CERVICALGIA, cervical spine pain, neck spine pain.
ICD-10-CM code of neck pain is M54.2 that can be used to specify a diagnosis. Its ICD9 code for neck pain is ICD-9-CM 723.1 and it is a billable medical code that can be used to specify a diagnosis on a reimbursement claim.
On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States and M54.2 and all other ICD-10-CM codes should only be used for training or planning purposes until then.
According to ICD9 neck pain is pain in neck.
According to ICD 10 neck pain is:
A disorder characterized by marked discomfort sensation in the neck area.
Discomfort or more intense forms of pain localized to the cervical region.
This term generally refers to pain in the posterior or lateral regions of the neck.
Experience of painful sensation around the neck area.
Neck pain causes
Most of the patients get neck pain from sleeping fault. If you use high up pillow or more than one pillow, sleep in bad posture, sleep after heavy drinking you will get neck pain. Neck pain and headache frequently associated with drinking and sleeping in bad posture. Neck pain from pillow or sleeping fault all are mechanical causes of neck pain. Neck pain is usually due to mechanical or degenerative problems. Serious spinal disease needs to be excluded. Neck pain in children should be taken with importance. Careful examination of neck for neck rigidity, BRUDZINSKI sign and other features of MENINGISM should be evaluated carefully. Most episodes of transient mechanical neck pain are not associated with demonstrable spinal pathology.
Juvenile idiopathic arthritis
Intra thecal tumors
- Referred pain
Cervical lymph nodes
Symptoms and Signs
Neck pain may be limited to the posterior region or, depending on the level of the symptomatic joint, may radiate segmentally to the occiput, anterior chest, shoulder girdle, arm, forearm, and hand. It may be intensified by active or passive neck motions. Mechanical neck pain is often acute in onset and associated with asymmetrical restriction of neck movements and a history of awkward posture or trauma. Radicular pain may arise from compression from osteophyte or disc prolapse. Most (70%) affect the C6 disc, compressing the C7 root, but 20% affect C5 and compress the C6 root. Massive cervical osteophytes or diffuse idiopathic skeletal Hyperostosis occasionally cause dysphasia due to esophageal indentation. The general distribution of pain and paresthesias corresponds roughly to the involved dermatome in the upper extremity. Radiating pain in the upper extremity is often intensified by hyperextension of the neck and deviation of the head to the involved side. Limitation of cervical movements is the most common objective finding. Neurologic signs depend on the extent of compression of nerve roots or the spinal cord. Compression of the spinal cord may cause paraparesis or paraplegia.
The radiographic findings depend on the cause of the pain; many plain radiographs are completely normal in patients who have suffered an acute cervical strain. Loss of cervical lordosis is often seen but is nonspecific. In osteoarthritis, comparative reduction in height of the involved disk space is a frequent finding. The most common late radiographic finding is osteophyte formation anteriorly, adjacent to the disk. Other chronic abnormalities occur around the apophysial joint clefts, chiefly in the lower cervical spine. Use of advanced imaging techniques is indicated in the patient who has severe pain of unknown cause that fails to respond to conservative therapy or in the patient who has evidence of myelopathy. MRI is more sensitive than CT in detecting disk disease, extradural compression, and intramedullary cord disease. CT is preferable for demonstration of fractures.
Neck pain treatment
Do not give neck pain treatment, give treatment of whole patient
Reassurance of patient is the first striking point in neck pain treatment. Then we have to find out the cause of neck pain and treat accordingly. Here are some neck pain treatment guidelines.
Education of patient
Patient education is paramount and should emphasize that pain does not imply harm to the underlying structures and that exercise is helpful rather than damaging. Return to work and normal activity should take place as soon as possible. Bed rest is not helpful and may increase the risk of chronic disability.
Rest is recommended for only short periods, typically 12 to 24 hours. After that you can go for active and passive exercises. Cervical collar or neck brace are helpful to provide rest to neck.
- Passive Manipulation and Mobilization
- Trigger Point Therapy
- Massage and Lymph Drainage
Neck pain exercises
Exercise techniques can be classified into nonresistive and resistive exercises. Nonresistive exercises include range-of-motion exercise and aerobic exercise. Resistive exercises are strengthening exercises that may be isotonic, isometric, or isokinetic.
With passive neck pain exercises, a therapist or assistive device moves the joint without any muscle contraction exerted by the patient. In active-assisted neck pain exercises, the patient exerts some muscle contraction while attempting joint movement, but is assisted in achieving the desired range. In active neck pain exercises, the individual exerts his or her own muscle activity to achieve the desired range of motion.
In strengthening neck pain exercises, a force from a therapist, free weights, or a machine applies resistance in opposition to the attempted movement of a specific muscle group by the subject. Resistance can be increased in strengthening exercises over time as muscle strength improves. The types of strengthening exercises are isometric or dynamic isotonic and isokinetic.
Bathing in water (balneotherapy or spa therapy) has a long-standing practice in neck pain relief. Its effect is attributed to the physical properties of water resulting in biomechanical changes, such as joint unloading and relaxation. Further expected effects are physiologic changes, such as increased diuresis and hemodilution. Aquatic therapy is a subgroup of balneotherapy and consists of exercises in a hot water pool. The recommended water temperature is 33°C to 34°C (92°F to 94°F).
Heat and Cold
Heat and cold modalities have been used for many years in the treatment of neck pain. Heat can be applied by radiation (infrared light), conduction (hot packs, paraffin, or water) or conversion of another form of energy to heat (diathermy or ultrasound). Radiation and conduction are forms of superficial heat, whereas deep heating is achieved by conversion. These techniques must be used with caution to avoid burns. Hot water bottles should be filled with warm, but not boiling, water. Timers should be used with heating pads; application of the heating pad should not exceed 20 minutes. A suggested approach is to alternate between 20 minutes using heating pads and 20 minutes without a heating pad. Superficial heat can increase the threshold for pain, produce analgesia by acting on free nerve endings, and decrease muscle spasm. A more recent review of the effects of superficial heat is short-term reduction in pain and disability.
Ice is useful to control pain and swelling because it induces a vasoconstriction of superficial and intra-articular tissues, reduces local metabolism and slows nerve conduction. It may be applied using cold packs, ice massages or ice baths and vapocoolant sprays. In knee osteoarthritis, administration of ice massages had significant effects on range of motion and the function and strength of the quadriceps muscle. Cold packs decreased knee edema
Electrotherapy is the use of electricity as a therapeutic agent to stimulate nerves and muscles and to alleviate pain. Electricity is mostly applied by surface electrodes. Only electroacupuncture and dorsal horn stimulation use needle electrodes percutaneously. The types of currents used for electrotherapy include direct continuous galvanic currents and modulated direct currents.
The gate control principle works with all classic forms of electrotherapy and with transcutaneous electrical nerve stimulation (TENS). The advantage of TENS devices is their small size because they can be worn by the patient and used when and where desired.
Ultrasound is a special form of heating. It interacts with skin, fat, muscles, and bones during treatment. Heating occurs mostly at tissue interfaces. The most important interfaces where heating occurs are the bone soft tissue interfaces that are well reached with ultrasound. Ultrasound may penetrate 7 to 8 cm of fat, but less than 1 mm of bone, depending on what energy level and which frequency is chosen. In practice, ultrasound with frequencies of 0.1 to 1 MHz can produce an increase of temperature of 4°C to 5°C at depths of 7 to 8 cm. Ultrasound is used for patients with localized musculoskeletal pain secondary to tendinitis or osteoarthritis of various joints. Ultrasound may be used in rheumatoid arthritis. A review found evidence that continuous ultrasound increases grip strength, decreases morning stiffness, and reduces the number of swollen and tender joints. Contraindications for a treatment with ultrasound are the same as for heat therapy. Ultrasound should not be applied over fluid-filled cavities, such as eyes and gravid uterus.
An orthosis may restore lost function or may help to maintain optimal function by altering biomechanics and reducing pain. Orthotic devices such as cervical collar decrease forces passing through painful neck, stabilize subluxating joints, improve motion patterns, and maximize functional positioning
Subluxation of the atlantodental joint can occur in rheumatoid arthritis. If surgery is not applicable, cervical collars may be prescribed. Cervical collars include soft collars, the Philadelphia collar, and the sterno-occipitomandibular plaster immobilization. None of these cervical orthoses provides a high level of mechanical restriction of motion, and all are ineffective in preventing pathologic displacements. Patients with night pain resulting from a cervical disk syndrome may profit from wearing a soft collar during night.
A vast variety of assistive devices serve to reduce disability. If necessary, an experienced occupational therapist can assess which devices are appropriate for a patientVarious kitchen aids may simplify kitchen work and eating (e.g., big handles on knives, forks, and spoons; knives with vertical grip for cutting bread or meat; electric opener for bottles).
Vocational rehabilitation contains an interdisciplinary approach aimed at the maintenance of gainful employment.
Cognitive Behavioral Treatment
It also acknowledges that pain and its resulting disability are not only influenced by somatic pathology, but also by psychological and social factors. In general, three behavioral treatment approaches are distinguished: operant, cognitive, and respondent. They are helpful to reduce disability.
Neck pain relief
All the above mentioned methods reduce neck pain. Besides adequate analgesia by PARACETAMOL, NSAIDs, muscle relaxant, corticosteroids or OPIOIDs must be provided for relief of pain. Oral or intravenous or intramuscular medications used on the basis of patient’s condition.
Pain from neoplasia or referred causes of neck pain should be treated according to diagnosis and neck will be if their treatment given.