If your neck pain doesn’t improve with simple medications and other self-help measures there are a number of treatments and therapies that should help, and your doctor may be able to prescribe stronger painkillers if needed.
Physiotherapists, chiropractors and osteopaths are all trained to treat neck problems. Treatment carried out by one of these therapists, along with home exercises, are often all that’s needed. It’s important to make sure that any physical treatments are given by qualified practitioners.
These professionals can suggest general stretching and strengthening exercises for the neck or they may suggest specific ones.
Manipulation is a type of manual therapy used to adjust parts of your body to treat stiffness. It can sometimes be uncomfortable at the time, so it's important to understand what’s involved. Talk to your therapist about the treatments before they start. Your therapist should ask you about osteoporosis, as some treatments aren’t suitable for people with this condition. Recent research suggests that manipulation usually works best within the first three months of developing a neck problem.
The Alexander Technique
The Alexander Technique is a method of teaching bodily awareness and reducing unwanted muscle tension. A qualified teacher will advise you on your sitting and standing posture and your patterns of movement. Some physiotherapists are trained in this technique but it's not always available on the NHS.
TENS (transcutaneous electrical nerve stimulation)
A TENS machine is a small battery-driven machine which may help to reduce pain in the short term. Small pads are placed over the painful area and low-voltage electrical stimulation produces a pleasant tingling sensation. It's suggested that this can interfere with pain signals from the nerves to the brain. You can buy TENS machines from pharmacies, but your physiotherapist may be able to let you borrow one to try first.
Some people find a special collar helpful if a pinched nerve is causing pain that can be felt down the arm. However, there's little research evidence that they help with either short-term or long-term neck pain. The use of collars for neck problems varies across the UK – some healthcare professionals suggest they promote stiffness whereas others believe they can be helpful as long as they're fitted well and not used for long periods of time.
During a session of acupuncture, very fine needles are inserted, virtually painlessly, at a number of sites on the skin (meridians) but not necessarily at the painful area. It's suggested that acupuncture may reduce pain in the short term by interfering with pain signals to the brain and by causing natural painkillers (endorphins) to be released.
In a very small number of cases, especially if you have continuing pain in the back of your head or arm, a long-acting local anaesthetic and/or a steroid injection may help. The injection may be given into the small facet joints of your neck or sometimes into the narrow spaces where the nerves branch out from the spine.
These injections are usually given in an x-ray department so that the specialist can position the needle precisely.
Surgery is only rarely needed. It may be helpful if a nerve or your spinal cord is being squeezed and is causing weakness or severe pain that won't go away. The surgeon will take a scan of your nerves and bones before discussing the pros and cons of surgery with you. You can then decide whether to go ahead with the operation.
If over-the-counter painkillers alone aren't effective, you may be prescribed an additional medication called amitriptyline. This acts to relax muscles and improve sleep. You'll usually be prescribed the lowest possible dose to control your symptoms. If the medication isn't effective at first, your dose can be gradually increased. This approach helps to lower the risk of side-effects. Common side-effects include dry mouth, drowsiness and blurred vision.
Gabapentin and pregabalin
Gabapentin and pregabalin aren't usually given as an initial treatment for ordinary neck pain. However, if a pinched nerve in your neck is causing discomfort in your arm(s), then these drugs can help by reducing nerve irritation. They may need to be taken for six weeks to begin with, and sometimes longer. As with all drugs there can be side-effects, so they won't be suitable for everyone. You should discuss this with your doctor.