Neck pain is a common problem, with two-thirds of the population having neck pain

Pain

Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 at some point in their lives.

Neck pain, although felt in the neck

Neck

The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...

, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae

Cervical vertebrae

In vertebrates, cervical vertebrae are those vertebrae immediately inferior to the skull.Thoracic vertebrae in all mammalian species are defined as those vertebrae that also carry a pair of ribs, and lie caudal to the cervical vertebrae. Further caudally follow the lumbar vertebrae, which also...

. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Neck pain may also arise from many other physical and emotional health problems.

Differential diagnosis

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body.

Major and severe causes of neck pain include:

• Carotid artery dissection
  Carotid artery dissection
  Carotid artery dissection is a separation of the layers of the artery wall supplying oxygen-bearing blood to the head and brain, and is the most common cause of stroke in young adults...
  
  
• Head and neck cancer
  Head and neck cancer
  Head and neck cancer refers to a group of biologically similar cancers that start in the upper aerodigestive tract, including the lip, oral cavity , nasal cavity , paranasal sinuses, pharynx, and larynx. 90% of head and neck cancers are squamous cell carcinomas , originating from the mucosal lining...
  
  
• Referred pain from acute coronary syndrome
  Acute coronary syndrome
  Acute coronary syndrome is usually one of three diseases involving the coronary arteries: ST elevation myocardial infarction , non ST elevation myocardial infarction , or unstable angina ....
  
  
• Infections: retropharyngeal abscess
  Retropharyngeal abscess
  Most commonly seen in infants and young children, retropharyngeal abscess is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall . Because RPA's typically occur in deep tissue, they are difficult to diagnose by physical examination alone...
  
  , epiglottitis
  Epiglottitis
  Epiglottitis is an inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea . Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency...
  
  , etc.
• Spondylosis
  Spondylosis
  Spondylosis is a term referring to degenerative osteoarthritis of the joints between the centra of the spinal vertebrae and/or neural foraminae. If this condition occurs in the zygapophysial joints, it can be considered facet syndrome...
  
   - degenerative arthritis and osteophytes
• Spinal stenosis
  Spinal stenosis
  Lumbar spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebra. This is usually due to the common occurrence of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc...
  
   – a narrowing of the spinal canal
• Spinal disc herniation
  Spinal disc herniation
  A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
  
   – protruding or bulging discs, or if severe prolapse.

The more common and lesser neck pain causes include:

• Stress
  Stress (medicine)
  Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
  
   – physical and emotional stresses
• Prolonged postures
  Human position
  Human positions refers to the different positions that the human body can take.There are several synonyms that refer to the human position, often used interchangeably, but having specific flavors....
  
   – many people fall asleep on sofas and chairs and wake with sore necks
• Minor injuries and falls – car accidents, sporting events and day to day minor injuries
• Referred pain
  Referred pain
  Referred pain is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction , where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury...
  
   – mostly from upper back problems
• Over-use – muscular strain is one of the most common causes
• Whiplash
  Whiplash (medicine)
  Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension. The term "whiplash" is a colloquialism...
  
  
• Herniated disc
• Pinched nerve

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis,
Carotidynia

Carotidynia

Carotidynia is a syndrome characterized by unilateral soreness of the carotid artery, near the bifurcation. It was first described in 1927 by Temple Fay. The most common cause of carotidynia is migraine, and then it is usually self-correcting. Common migraine treatments may help alleviate the...

, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis,
cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.

Treatment

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations which may help alleviate symptoms include applying heat or cold. Other common treatments could include medication, body mechanics training, ergonomic reform, or physical therapy.

Conservative treatment

Exercise plus joint mobilization

Joint mobilization

Joint mobilization is a type of passive movement of a skeletal joint. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect...

 and/or joint manipulation

Joint manipulation

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.- Biomechanics of joint manipulation :...

 (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders. Neither mobilization or manipulation without exercise however has been found to be helpful. Mobilization is equivalent to manipulation. Ultrasound

Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

 has been shown not to be efficacious.

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain.
Muscle relaxants such as cyclobenzaprine

Cyclobenzaprine

Cyclobenzaprine is a muscle relaxant medication used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions. It is the most well-studied drug for this application, and it also has been used off-label for fibromyalgia treatment.- Mechanism of action :The mechanism...

 have not been found to be useful and are therefore not recommended. Over the counter topical creams and patches containing counterirritant

Counterirritant

A counterirritant is a substance which creates inflammation in one location with the goal of lessening the inflammation in another location. They can be used as antipruritics. This strategy falls into the more general category of counterstimulation....

s have little evidence to support efficacy.

Surgery

Surgery is usually not indicated for most mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy

Physical therapy

Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...

.