Nerve and Neck Pain
Nerve and neck pain are closely associated, with the neck containing numerous nerve branches and acting as an important junction for nerves entering and leaving the spinal cord, and the brain.
Thoracic Outlet Syndrome
This condition involves the neurovascular structures of the neck and their compression causing circulatory problems and nerve signal transmission irregularities. Heavy backpack use can cause, in rare circumstances, a cervical rib fracture, which can then present as thoracic outlet syndrome, or simply as painless swelling (Kamath, 2010).
The brachial plexus, a complex nerve junction in the neck is heavily involved and may be put under pressure by a congenital abnormality such as a cervical rib, an inflicted trauma, or an inflammatory response. Circulation is affected due to compression of the subclavian artery or vein, resulting in ischaemia.
Multiple Causes of Nerve and Neck Pain
Rodine (2010) describes a case where a patient had three separate sources of neck pain, temporomandibular joint syndrome, trigeminal neuralgia, and mechanical/degenerative neck pain. This case highlights the need for a thorough diagnosis of the cause of neck and nerve pain, as there may be multiple causes.
Spinal Stenosis as a Cause of Nerve and Neck Pain
Spinal stenosis is a condition where the normal spaces in the spine through which nerves and blood vessels travel are reduced, whether through compression, disc bulging or herniation, or growth of osteophytes (bone spurs). This narrowing of the foramina can cause compression of blood vessels and nerves, leading to ischaemia and neuralgia.
When spinal stenosis occurs in the cervical spine, it can have consequences for neck pain, nerve pain, shoulder pain, and headaches, amongst other conditions. Numerous options exist for coping with spinal stenosis, including the use of anti-inflammatory medications, acupuncture, special neck pillows, and epidural steroid injections.
Nerve and Neck Pain which Leads to other Conditions
Glossopharyngeal neuralgia is a condition where nerve and neck pain are experienced, along with occasional jaw pain, and ear pain. Although generally considered a pain condition, there are reports of this leading to cardiac complications. A patient’s case as reported by Kim (2010), details how the original neuralgia in the throat and neck led to bradycardia, asystole and syncope; slowing of the heart, stopping of the heart, and loss of consciousness.
Acute and Repetitive Trauma
Those competing in contact sports often suffer repeated trauma, however minor, to their neck and shoulders. This can have serious consequences, along with the risk of acute trauma being inflicted on the area causing nerve and neck pain. Neurological testing and provocative exercises, in addition to nerve conduction study and electromyography can determine the extent and severity of nerve damage. Shoulder dislocation can lead to axillary nerve injury, and a blow to the neck can cause spinal accessory nerve injury and resulting trapezius paralysis.
Prevention of Nerve and Neck Injury
Taking care not to strain the neck, conducting daily strengthening exercises, and avoiding the risk of physical trauma can all help preserve neck and nerve health. This is particularly important for athletes involved in contact sports, where proper equipment, good technique, and conditioning are key. Using safety-approved car head-rests is also highly recommended to minimise whiplash injuries and neck pain.
Treatment of Nerve and Neck Pain
If the nerve and neck pain are a result of trauma then rest, anti-inflammatories (whether NSAIDs or nutritional/herbal), physical therapy, and sometimes splinting or cervical collars are the usual treatment options for neck pain. If a bone fracture or muscle tear has occurred then neck surgery may be indicated to repair the damage.
Another consideration when dealing with nerve and neck pain is that treatment for neck pain itself can then lead to further nerve pain and discomfort. So (2010) documents a case where cervical traction used to relieve the compression experienced by a patient with spinal stenosis may have actually caused facial nerve paralysis by impacting the nerve directly, or by blocking circulation to the nerve (ischaemia) and damaging it through lack of oxygen and nutrients. The condition was reversed after treatment ceased and prednisolone was administered.
Chemical sympathectomy is a procedure with little evidence to show its effectiveness, that is used to destroy nerve ganglia connected to the area of pain. It is based on the theory that the pain is conducted through a sympathetic chain and that disrupting this chain can alleviate or stop pain altogether (Straube, 2010). This should really be a last resort for any physician as it is a serious and irreversible procedure, although generally minimally invasive.
Surgical procedures to address spinal stenosis and nerve compression can successfully relieve the pressure on nerve roots that are responsible for nerve and neck pain. Kunert (2010) describes how posterior microlaminoforaminotomy can effectively address this condition with minimal invasion and quick post-surgical recovery time.
As there are many causes of nerve and neck pain, it is imperative to have a clear view of the cause, or indeed, causes of a particular patient’s symptoms prior to therapeutic intervention. This makes it easier to choose a treatment that is likely to give them maximum benefit and minimize afferent risks to their health for an individuals particular type of neck pain.