Neck Pain in Adults _________________________________________________________________________
Botulinum toxin A may also be effective in relieving primary headache disorders, trigeminal neuralgia, chronic neuropathic pain, and nociceptive and osteoarticular pain. The favorable side effect profile and long-lasting pain relief after a single injection, when effective, makes botulinum toxin A an attractive treatment option. As neck pain therapy, optimal dosing and patient selection need clarification [269]. Cervical Spine Surgery Cervical spine surgery is indicated when natural history and prognosis with surgical treatment is better than with non- operative treatment. Indications include progressive neurologic deficits, compression of the cervical nerve root and/or spinal cord, or intractable pain. Cervical spine surgical outcomes are most favorable for radicular pain, spinal instability, progressive myelopathy, or upper extremity weakness [51; 65; 103]. Detailed discussion of cervical spine surgeries is beyond the scope of this course. CHRONIC REFRACTORY NECK PAIN In patients with chronic neck pain refractory to standard therapies, established therapeutic options include stimulation of spinal dorsal horn columns to block spinal pain transmission, or intrathecal drug delivery systems to deliver opioids, with or without other medications, to maximize effectiveness and reduce systemic side effects [259]. CONCLUSION A significant proportion of acute neck pain resolves with conservative management. However, chronic neck pain is substantially more difficult to treat and can develop from an acute neck injury or insidiously over time. Long-term changes in the CNS maintain chronic pain. Anatomic, biochemical, and functional abnormalities develop in the brain and spinal cord that amplify pain perception and perpetuate pain. Pharmacologic and nonpharmacologic therapies have shown disappointing long-term outcomes in chronic pain. Pharmacotherapy focusing on tissue pathology has contributed to inadequate pain reduction. As such, pain mechanism identification and targeting is increasingly stressed, and combining pharmacotherapies that target different pain mechanisms is also emphasized. A substantial volume of new research is changing chronic pain assessment and treatment, and its uptake into clinical practice brings optimism for improving pain and functioning of patients with chronic neck pain in the near future.
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