Neck stiffness/pain (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Neck stiffness/pain is a symptom. It can be caused by bad everyday habit and posture, and some diseases, including degenerative changes, infections of the spine, Infection of the spine, immune system diseases, neurological diseases and cancers. Patients with neck stiffness/pain may experience pain, muscle strain and tenderness, and neck stiffness in the mornings. Tests can indentify the cause of this symptom. Usual tests include x-ray, CT, MRI in neck and head, and whole bone scan. Treatment of stiffness depends on the underlying cause. For chronic neck stiffness/pain, pain reliever, heat treatment, massage, acupuncture or physical therapy may be reduce pain. Prognosis of neck stiffness/pain depends on the underlying cause.

What are the symptoms of Neck stiffness/pain?
Neck stiffness/pain itself is a symptom. It can appear in many diseases. The characteristics of neck stiffness/pain is the following;
 * Pain: Pain often occurs after activities such as in reading neapaper, watching TV, using computer.
 * Muscle strain and tenderness
 * Neck stiffness in the mornings

Who is at highest risk?

 * Bad everyday habits and postures: Chronic neck stiffness/pain is caused by everyday activities, including having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, bending over a desk for hours, or twisting and turning the neck in a jarring manner while exercising.
 * Trauma and injury
 * Degenerative changes in neck such as osteomyelitis, herniated disk
 * Fibromyalgia
 * Infection of the spine, such as abscess, meningitis
 * Immune system diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), polymyalgia rheumatica
 * Neurological diseases such as stroke, muscular dystrophy, multiple sclerosis
 * Cancer that involves the spine

When to seek urgent medical care?
Call your health care provider if symptoms of neck stiffness/pain develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible. It may suggest a serious problem.
 * Severe pain
 * Neck stiffness/pain after a severe trauma or injury, especially it gets worse
 * Neck stiffness/pain with fever, headache, confusion, seizures, double vision, numbness, paralysis or trouble speaking
 * Neck stiffness/pain with losing control over urine or stool
 * Neck stiffness/pain accomanying with difficulty swallowing or breathing

Diagnosis
The goal of tests is to identify the cause of your neck stiffness/pain and to treat certain disease.
 * Medical history and physical examination
 * Blood tests including CBC, rheumatoid factors, ESR, may supply clues for Immune system diseases such as rheumatoid arthritis and ankylosing spondylitis
 * Neck images such as x-ray, CT, MRI: These tests can show the structure of the cervical spine and muscle. They may help doctor diagnose fructure, tumor and other disorders.
 * Head images such as CT and MRI: When the doctor suspect that your neck stiffness/pain is one of the symptoms of brain disease such as stroke, head images may be ordered.
 * Whole bone scan: Bone scan is needed when the doctor suspect cancer spreads from other parts of the body to the neck bones. Abnormal concentrations in the cervical spine may be detected.
 * Lumbar puncture: When your pain is suspected meningitis, the doctor may order this test. During this procedure, the patient lies on the side, with knees pulled up toward the chest, and chin tucked downward. After injecting the anesthetic into the lower spine, the doctor insert a spinal needle into the lower back area to measure CSF pressure and collect a sample. The patient is often asked to lie down for a while after the process.

Treatment options
Treatment of stiffness depends on the underlying cause.
 * Treat underlying cause, such as antibiotics for bacterial meningitis, surgery for trauma or fracture, surgery or medications for stroke.
 * For chronic neck stiffness/pain, the following treatment may be helpful.
 * Medications
 * Non-Steroidal Anti-inflammatory Drugs (NSAIDS): NSAIDs relieve pain by reducing the inflammation that causes the pain. Usual drugs include aspirin, ibuprofen and naproxen.
 * Muscle relaxants: For severe muscular neck stiffness/pain, muscle relaxants such as baclofen or valium may be considered.
 * Corticosteroids: Corticosteroids such as depomedrol or prednisone can also beused to decrease inflammatory reaction.
 * Heat treatment: Light heat may relax your neck stiffness.
 * Massage
 * Acupuncture
 * Physical therapy

Where to find medical care for Neck stiffness/pain?
Directions to Hospitals Treating Neck stiffness/pain

Prevention of Neck stiffness/pain
For chronic neck stiffness/pain, the following measure may be helpful.
 * Do regular exercises, stretching for your neck and upper body. If you tend to get neck pain from exercise, apply ice to your neck after physical activity.
 * Use good posture when sitting and sleeping, adjust your computer monitor to eye level, avoid bending over a desk.
 * Use seat belts and bike helmets to prevent injuries.

What to expect (Outlook/Prognosis)?
Prognosis of neck stiffness/pain depends on the underlying cause. If it is caused by tumors, the outcomes are worse than other causes.