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Medical Edge Newspaper Column from Mayo Clinic
OFTEN MISDIAGNOSED, NECK PAIN IS TREATABLE
DEAR MAYO CLINIC: I have had chronic neck pain for the past six years, and it is getting progressively worse. Last year, after I developed numbness in my right hand, I was given an MRI, which showed cervical stenosis caused by bulging disks and bony spurs. Also, an electromyogram showed that the numbness was caused by ulnar nerve entrapment. I was told that nothing could be done to fix the problem and was advised to reduce my physical activity, use a home traction unit and take painkillers. Please help me to improve the quality of my life. I am only 31, and I’ll try anything.
ANSWER: Your prospects might be a lot better than you think.
Bulging disks and bony spurs are much-maligned “usual suspects.” When detected in a magnetic resonance imaging (MRI) scan, the stenosis (narrowing) of the spinal canal that they cause — in the spine’s cervical, or neck, region — is frequently assumed to be the source of the patient’s pain. But they are not necessarily the culprits.
While MRI is a great technology that shows us what is going on beneath the skin, much of that information can be misleading. The fact is that we all — even people 31 years old and younger — have abnormalities such as bulging disks, and they can result in a little or a lot of stenosis. Short of a comprehensive neurological exam, however, there is no way to tell whether the stenosis is a big problem, a small problem, or, as with most of us, no problem at all (asymptomatic). A patient’s symptoms may actually derive from some other source altogether. For example, in your own case the electromyogram identified a compressed nerve in the arm — not a nerve in the neck — as the cause of your right-hand numbness.
Often, the true cause of neck pain remains unknown. Even so, we have options for minimizing the pain — sometimes, so that it ceases to be noticeable — and for maximizing function.
The first and most important option is to perform daily exercises, learned from a physical therapist, that are specific to neck-support muscles. You should also keep aerobically fit by walking, swimming or bicycling. Higher-impact exercises such as running can be added, if desired, once your pain has lessened.
At the same time we ask patients to begin rehabilitative exercises, however, we must also attempt to eliminate or sufficiently reduce their pain. Options include cervical traction — stretching — at first done by a physical therapist and later by the patient at home with the aid of purchased or rented devices. Traction on an intermittent basis can relax muscles, decrease disk pressure and relieve pressure on spinal joints.
Pain-relief medication is another option. Doctors usually recommend starting with the simplest and least expensive — acetaminophen (Tylenol) — and moving on, if necessary, to stronger agents. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil,), tramadol (Ultram), tricyclic antidepressants such as amitriptyline (Elavil), corticosteroid injections, and opioids such as hydrocodone with acetaminophen (Vicodin), which are effective but have habit forming potential.
Other pain-control options include occasional “spinal manipulations” (quick, short thrusts) performed by an osteopath or an appropriately trained chiropractor; physical-therapy modalities such as heat, ice, massage and electrical stimulation; acupuncture; intermittent bracing with either a hard or soft cervical collar; and over-the-counter anti-irritant creams.
Finding the right combination of treatments and exercises could mean you may not have to reduce physical activity after all, and you may actually be able to increase it.
— Randy A. Shelerud, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.
Additional Resources:
Physical Medicine and Rehabilitation
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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