In a 2010 Global Burden of Diseases study, neck pain ranked 4th highest in terms of disability out of 291 conditions and as of 2020, almost 60% of the people around the globe suffer from neck or cervical pain. This is mainly attributed to improper seating postures, lack of exercise and extended work hours due to the increased work from home routines during the pandemic.
MedPiper Technologies and JournoMed in association with the Lysander Pain Care and Orthopedic Centre, Chennai, had conducted a webinar titled “Pain Management During COVID-19: Approach to Cervical Disc Problems” on 16th February, 2022. The speaker, Dr. Sheerin Sarah Lysander covered topics ranging from various reasons for cervical disc problems to how doctors can treat them. Dr. Sheerin Sarah Lysander is the Consultant Spine and Pain Physician at the Lysander Pain Care & Orthopedic Centre, Chennai and has a Fellowship in Interventional Pain Management.
The part of the spine that is found towards the neck and upper back region is called the cervical spine. The cervical spine has a natural lordotic curve (of around 20-40°) and is more mobile than the rest of the spine. There are 7 cervical vertebrae with a disc present between each of them from C3 to C7. The cervical disc is composed of an inner nucleus pulposus which acts as a cushion and shock absorbent and an outer annulus fibrosus which is made up of concentrically arranged fibrous tissue layers. Any morphological or biochemical alterations in this cervical disc can lead to pain in the upper body. This pain can be of two types:
- A dull, more centralised, aching pain in the neck, shoulder or upper back regions which may radiate to the arms and is caused by a herniated cervical disc.
- A sharper more localised pain that does not radiate to the arm and is caused by facet joint inflammation.
What causes cervical pain?
Improper posture and chronic pain conditions like spondylitis causes the cervical disc to jut out from the vertebral column. The height of this disc also reduces and compresses the associated spinal nerves causing neck pain that can radiate to the upper back and arms.
Facet joints are pairs of small joints in between the vertebrae towards the back of the spine. An inflammation in this joint presents as a sharp blunt pain with radiculopathy that can cause neck pain and cervicogenic headache which affects neck movement. Cervicogenic headaches present as a dull aching pain primarily in the occipital region and occur due to the compression of the 3rd occipital nerve. (Note: Cervicogenic headaches are different from migraines which is a more episodic, pulsating pain)
Cervical pain could also be due to muscle spasms. Muscle spasms are commonly seen in the rhomboid and trapezius muscles and the muscle feels like stone with specific trigger points. Tests like the spurling test and shoulder abduction test can help to determine this type of pain.
Investigating cervical pain
Before diagnosing cervical disc pain, the specialist must confirm patient history and consider their occupational patterns. They should formulate the treatments and rehabilitation strategies based on the patient’s lifestyle. While investigating cervical disc pain, the specialist has to rule out certain pre-existing and predisposing scenarios such as
- Neurological implications like cervical cord compression, demyelinating process, progressive neurological deficits
- Infections of the spine either as fever due to meningism, or the patient is under immunosuppression and IV drug use
- Fractures such as osteoporotic fracture and traumatic
- If the patient has a family history of cancer and the presence of tumours
- Inflammation due to rheumatoid arthritis or giant cell arteritis in which case the specialist should take the opinion of an rheumatologist.
The doctor can do bloodwork to check for vitamin D and vitamin B12 levels and other factors to prescribe the right kind of medication. An X-ray is done to rule out fractures or red flags and even to look for lordotic angles and disc height. An MRI however, is only done when the patient’s pain does not reduce with the initial medication. An MRI scan of the spine will show how much of the disc has herniated and help detect myelopathy. Nerve conduction study or electromyography is only performed when the pain is only radiating in the arm which could be due to peripheral nerve entrapment.
Pharmacotherapy helps to control acute pain. Common pain medications given for treating neck pain include paracetamols, opioids, NSAIDS, Cox-2 inhibitors, muscle relaxants and neuropathic pain medications. Along with pharmacotherapy, the specialists also suggest physiotherapy which includes cervical stretch and spine strengthening exercises. When pharmacotherapy and physiotherapy do not work, they opt for surgical cervical interventions like cervical epidural and cervical medial branch block.
The doctors need to reassure the patients to avoid panic and educate them about lifestyle modifications through diets and posture work. Dr. Lysander states that people should sit with their spine in a neutral position while working and driving and use ergonomically designed chairs to maintain the natural lordotic curve. Posture correction can also be done with a back brace and hard mattresses. Proper preventative measures and interventional strategies can help to relieve neck pain, improve quality of life and prevent the progression to chronic pain in these patients.