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Coping with that pain in the neck

Baltimore Sun
•
Thanks for joining us June 15 for a live chat on neck pain with Johns Hopkins pain specialist Dr. Paul Christo.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Read the transcript below.

Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Neck pain(06/15/2011) 
11:31
Baltimore Sun Health: 
Hi, Dr. Christo will be joining us in a half hour, but feel free to add your questions early in the queue and we'll get to them once the chat starts.
Wednesday June 15, 2011 11:31 Baltimore Sun Health
12:01
Baltimore Sun Health: 
Hi, welcome to our live chat on neck pain with Dr. Paul Christo of Johns Hopkins.
Wednesday June 15, 2011 12:01 Baltimore Sun Health
12:02
Baltimore Sun Health: 
We received a number of questions in advance and we'll get to as many as we can within the hour. If you're asking questions, I encourage you to be as specific as possible about yourself (age, where you're from, etc.) and your condition. It helps inform Dr. Christo as he considers an answer.
Wednesday June 15, 2011 12:02 Baltimore Sun Health
12:02
drchristo: 
Hello, happy to take your questions.
Wednesday June 15, 2011 12:02 drchristo
12:02
Baltimore Sun Health: 
OK, let's get started.
Wednesday June 15, 2011 12:02 Baltimore Sun Health
12:03
[Comment From JudyJudy: ] 
what do you do about knots in your neck and back? i have them all the time and sometime's they are so bad you can actually see them.
Wednesday June 15, 2011 12:03 Judy
12:05
Baltimore Sun Health: 
Just a reminder if you're new to our health chats, we do them every other Wednesday on a pain topic. If you want to read transcripts of previous ones (including shingles, lower back pain, nerve pain, etc.) go here: http://www.baltimoresun.com/health/bal-health-chats,0,3625121.storygallery
Wednesday June 15, 2011 12:05 Baltimore Sun Health
12:07
drchristo: 
Judy, musculoskeletal injury, stress,or strain can cause the muscles to tense and contract. This causes myofascial pain (muscular pain). Tense, taught bands are referred to as trigger points. We can insert a thin needle into the muscle and inject a small amount of local anesthetic to help reduce this pain. Sometimes, a short course of muscle relaxants can help is the muscles are in spasm.Heat is also beneficial.
Wednesday June 15, 2011 12:07 drchristo
12:08
[Comment From SaraSara: ] 
I had 3 auto accidents in 2004 within 6 months, none my fault. Since then, I have face numbness when I move my head, especially strong when I move my head looking down or up. It starts around my mouth and nose, my left eye, and my forehead. If I do not rest my head and neck quickly after it starts, then I get pain in my front forehead area. I have 2 herniated discs in my neck in the C5-C6 and C6-C7 areas with a reversal of the cervical spine and other bulges. I have tried physical therapy, various medications, but I still have this problem and it is getting worse. What should I do?
Wednesday June 15, 2011 12:08 Sara
12:11
Baltimore Sun Health: 
Some resources on neck pain: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm
Wednesday June 15, 2011 12:11 Baltimore Sun Health
12:11
Baltimore Sun Health: 
And
http://www.mayoclinic.com/health/neck-pain/DS00542
Wednesday June 15, 2011 12:11 Baltimore Sun Health
12:14
drchristo: 
HI Sara,
You should see your primary care doctor and have a full history and physical examination performed. Your doctor may want to get an x ray or MRI as well to determine if the spinal cord or nerves in the neck are affected. Rear-end motor vehicle accidents often cause whiplash injuries that can damage the ligaments, muscles, and joints of the neck area. Patients can experience headache, dizziness, and memory problems. Herniated discs can cause neck pain, but typically don't cause symptoms in the mouth, nose, eye, or forehead. A spine surgeon may also be helpful in assessing your symptoms and determining whether surgery may be needed to stabilize part of the neck. I think you need to a diagnosis before using other medications or treatments.
Wednesday June 15, 2011 12:14 drchristo
12:16
[Comment From KarenKaren: ] 
I was told that I have pinched nerves on both sides of the back of my neck. I went to Patient First about a week ago , and they gave me muscle relaxers, and Ibupro. and I am still in pain. I wear a neck collar to keep my neck in one position I was told by the doctor’s at Patient First. I go for an x-ray in about 3 weeks. I was also given a remedy to try C.L.A. in the natural health store. I also did warm compresses. I am in so much pain that I am almost willing to try anything but needles.
Wednesday June 15, 2011 12:16 Karen
12:21
drchristo: 
Hi Karen, pinched nerves can cause neck and especially shooting arm pain. Pinched nerves can result from disc herniation and other things like narrowing around the nerves by bony parts of the spine. Determining the source of your pain can help target particular injections, though it sounds like you want to avoid nerve blocks. A stronger drug called tramadol could be used given that your neck pain isn't getting better from ibuprofen and muscle relaxants. A short course of short acting opioids (e.g, oxycodone) may also be beneficial if the tramadol isn't effective.
Wednesday June 15, 2011 12:21 drchristo
12:22
[Comment From RebeccaRebecca: ] 
Boy do I have neck problems! I was in a car accident in 2006 and suffered whip lash. A few months later, I turned my head quickly and felt a "snap" and gradually my neck became immobile. With steroids, it eventually loosened over the course of a week, but has also gradually become more and more painful over the years. I am extremely active and this pain is killing me! I can't turn my head to the right without pain (the side I was hit on). I've gone to two specialist doctors, two chiropractors, an acupuncturist, a masseuse, two physical therapists, and a somatics instructor. I do fine when I am active, but I'm in pain the minute I have to sit. PLEASE HELP. I don't know where else to turn - literally! I'm afraid I will have to live with chronic pain.
Wednesday June 15, 2011 12:22 Rebecca
12:28
drchristo: 
Rebecca, whiplash injury can cause damage to the facet joints of the neck. They allow for motion of the spine while limiting excessive motion. These joints have nerves that provide sensation to them, and pain specialists can perform diagnostic nerve blocks in the neck. Patients who report good relief can then have a radiofrequency ablation procedure performed that is more therapeutic and longer lasting. Consider seeing a pain specialist for diagnosis and treatment. Medicines like tramadol or even certain anti depressants can also help. A TENS unit can sometimes be helpful as well.
Wednesday June 15, 2011 12:28 drchristo
12:29
[Comment From SusanSusan: ] 
I have degenerative disc disease around C4-C5, C5-C6. My neck and my shoulder hurt if I overuse it. Also, I have the numbness feeling around my hand all the time. What do you recommend that I should do. I already took 20 days of anti-inflammation medication.
Wednesday June 15, 2011 12:29 Susan
12:33
drchristo: 
Susan, avoiding activities that cause the pain is important. Or, you may need to shorten the length of time you spend in certain activities. A course of physical therapy for your neck can help, acupuncture has been shown to be beneficial, and ice or moist heat can ease the pain. The numbness may be due to nerve irritation or compression. Medicines like neurontin, lyrica, or nortriptyline can be useful.
Wednesday June 15, 2011 12:33 drchristo
12:34
[Comment From SteveSteve: ] 
My wife Diane developed cervical dystonia seven years ago. She had been in a serious car accident ten years prior, had recovered from a minor stroke, and was taking Zokor to reduce cholesterol, which had peaked unexpectantly prior to her stroke because no one had checked here thyroid. All that being said, we are stuck with quarterly Botox injections and pain meds for Diane to cope. Are there exercises or special PT recommendations to improve her neck pain? Steve
Wednesday June 15, 2011 12:34 Steve
12:37
drchristo: 
Steve, correction of postural abnormalities and range of motion and strengthening exercises are important to ongoing care. For neck pain, physical therapists usually perform exercises that stress retraction of the neck and shoulders. Extension and rotation exercises may help, but need to be done gradually and carefully given your wife's condition.
Wednesday June 15, 2011 12:37 drchristo
12:38
[Comment From LorraineLorraine: ] 
Questions:1. Can neck pain cause lower back pain?2. What¿s the best way to sleep to prevent neck and shoulder pain? If I sleep on my side, what¿ the best type of mattress to have?
Wednesday June 15, 2011 12:38 Lorraine
12:43
drchristo: 
Lorraine,
If the spinal cord in the neck is compressed or damaged, symptoms can be felt in the legs and trunk. Certain signs are detected on physical exam X-ray or MRI tells us whether the spinal cord is compressed. Back pain usually doesn't result from problems in the neck in general. if your posture changes from neck pain, then other parts of the body may begin to feel painful. Firmer mattresses are more often recommended than softer ones.
Wednesday June 15, 2011 12:43 drchristo
12:44
[Comment From sugarbearsugarbear: ] 
Is there any hope for long-term relief for someone with issues (bone spurs, foramenal narrowing) at c4/5, 5/6? I have headaches and pain in my neck, shoulders, arms, hands.
Wednesday June 15, 2011 12:44 sugarbear
12:48
drchristo: 
Sugarbear,
Epidural steroid injections in the neck are commonly performed for shooting pain in the neck, shoulder, arm, hand. Evidence is strong for benefit in acute cases rather than in patients who've had the symptoms for awhile. Medicines like neurontin, lyrica, nortriptyline can also be quite helpful for your symptoms. If the narrowing becomes more severe, spine surgery may be needed to make room for the nerves and spinal cord.
Wednesday June 15, 2011 12:48 drchristo
12:48
[Comment From KimKim: ] 
Is there anything to do for arthritis in the neck and shoulder
Wednesday June 15, 2011 12:48 Kim
12:56
drchristo: 
Kim, arthritis in the neck can cause degeneration of the discs, joints, and vertebral bodies (cervical spondylosis). Facet joint blocks as mentioned earlier can help as a diagnostic measure followed by radiofrequency ablation for more sustained relief. The ablation uses heat to interrupt signals through the nerves. The nerves regenerate and pain can recur, but the procedure can be repeated. Anti-inflammatory medicines (motrin, aleve, celebrex) can be helpful by make sure you discuss with your doctor because they have side effects. Something called diclofenac gel (voltaren gel) may help with shoulder arthritis, but it's not specifically approved for shoulders. Physical therapy is beneficial as well. Read the response to Steve above about specific physical therapy recommendations.
Wednesday June 15, 2011 12:56 drchristo
12:57
[Comment From sugarbearsugarbear: ] 
Is there a difference between facet blocks and epidural steroid injections?
Wednesday June 15, 2011 12:57 sugarbear
1:00
drchristo: 
Sugarbear,
Facet blocks are nerve blocks with local anesthetic that target those nerves that provide sensory input to the facet joints. Epidural steroid injections involve the placement of a needle in a space surrounding the spinal cord (epidural space) and then injecting local anesthetic and steroid to reduce pain. Pain that is shooting or stabbing (neuropathic) typically responds better than other types of pain.
Wednesday June 15, 2011 1:00 drchristo
1:01
Baltimore Sun Health: 
That's all the time we have for today. Thanks for your great questions.
Wednesday June 15, 2011 1:01 Baltimore Sun Health
1:01
drchristo: 
Thank you for your questions.
Wednesday June 15, 2011 1:01 drchristo
1:01
 

 
 
 

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