Chronic Neck Pain: Causes, Treatments and When to Get Help

Chronic neck pain, also called cervicalgia, is typically defined as constant neck pain lasting more than three months. It usually stems from one of three causes: cervical disc issues, arthritis, or muscular inflammation.

While neck pain itself isn’t usually an emergency, it’s also not something you need to live with, says Sadiah Siddiqui, MD, an anesthesiologist at HSS with a subspecialty in pain management. “We have extensive ways to treat pain,” Dr. Siddiqui says. “We have so many advances in medicine, people should know that living in pain daily shouldn’t be the case.”

Often non-addictive pain medications are used to get chronic neck pain under control so patients can adopt lifestyle changes that will prevent the pain from happening again or being as severe.

Sometimes chronic neck pain can be a sign of a serious problem related to the spinal cord, Dr. Siddiqui says. Red flags include weakness in the arms, such as dropping objects; urinary or bowel incontinence; or difficulty walking. If you notice any of these symptoms, seek care immediately.

Causes of Neck Pain

Arthritis

Chronic neck pain caused by arthritis can affect people for months or even years before they seek treatment. It is most common in adults in their mid-40s or older.

This type of neck pain is often most noticeable with cervical extension, or when you turn your head from side to side—making daily activities like driving and cooking particularly challenging, Dr. Siddiqui says. It can sometimes be accompanied by recurrent cervicogenic headaches, which are headaches that begin in the neck.

“For people with arthritic pain, it’s usually years that they’ve had it before we see them in the office,” Dr. Siddiqui says. “It can be really debilitating, especially if they’re having those cervicogenic headaches alongside it.”

Herniated Disc

Sometimes a disc in the neck pushes down on a nerve, or herniates, causing neck pain that is accompanied by radiating pain down the arm, often below the elbow. Patients may also get numbness or tingling in the arm and hand. For some, this neck pain due to a disc herniation significantly affects their quality of life even if it has only lasted a few days, Dr. Siddiqui says.

Inflammation

Muscular neck pain can be acute (lasting just a few days) or chronic (lasting over three months). At times, this can also cause debilitating pain. Doctors have been seeing an uptick in muscular neck pain since the start of the COVID-19 pandemic as more people have been working from home without ergonomic support. This muscular neck pain can be caused by poor posture when working on a computer or favoring one side when holding a bag or pocketbook.

At-Home Treatments for Neck Pain

Common at-home remedies are over-the-counter anti-inflammatories, which Dr. Siddiqui recommends combining with physical therapy exercises to strengthen the neck.

Prescription medications can also be an option, she says. These include prescription-strength anti-inflammatories or muscle relaxants. Other options include certain antidepressants or epileptic drugs that can help calm down the nerve pain, though these take a few weeks to kick in.

It can also be helpful to take steps to improve your posture. It’s a good practice to take a break after about an hour of computer work to do some neck stretches. Other options include acupuncture and using heat on the muscle.

Injections and Other Treatments for Neck Pain

Nerve-Targeting Treatment

There is a medical procedure consisting of a three-step process to minimize the neck pain caused by arthritis by targeting a specific nerve that sends the pain signal from the arthritic joint to the brain.

First, the affected nerves are temporarily numbed with local anesthesia, which is done using fluoroscopy or live X-ray. If the patient experiences good pain relief for six to eight hours after the procedure, the next step is longer-term pain reduction. In this outpatient procedure, a doctor uses specialized needles with a heated tip to cut the nerve, removing the pain signal between the neck and the brain. The nerves ultimately do grow back, but this takes time to occur and varies from patient to patient. Typically patients can get eight to 12 months of pain relief.

“It’s such a big lifestyle change” for people who have been experiencing long-term pain, Dr. Siddiqui says.

Epidural Steroid Injection

For a herniated disc, doctors can use fluoroscopy or live X-ray to do an epidural steroid injection close to where the disc is pushing on the nerve and causing pain. This does not fix the herniated disc—it is purely for pain relief to help decrease the inflammation in the area, Dr. Siddiqui says. But for someone with debilitating pain, this can relieve the problem enough that they can do physical therapy and stretches that will provide more long-term relief.

“We’re trying to avoid doing surgery if we can,” Dr. Siddiqui says.

Trigger-Point Injections

If home remedies don’t help, doctors can relieve muscular neck pain with in-office trigger-point injections that use a small needle to go straight into the muscle and break up the knot, Dr. Siddiqui says. These injections are short-term solutions to control the pain and need to be followed up with lifestyle changes.

That’s when it’s important to consult with a physical therapist who can help target the underlying cause of the muscular neck pain. A PT can teach exercises and stretches that improve posture and strengthen the neck.