What Is Neck Pain? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Neck pain is a common complaint that can be caused by a variety of different health conditions. It can range from mild to severe, with more severe cases possibly indicating a serious underlying problem.

Your neck and upper back (cervical spine) consist of seven vertebral bones that support your head. These bones are separated by vertebral discs, and are reinforced by a network of muscles and ligaments (connective tissue). A problem with any of these structures, or with nerves in or near your neck, can cause neck pain.

Mild to moderate neck pain can usually be treated at home and improves within a couple of weeks, but it’s important to seek immediate medical attention if you develop severe neck pain suddenly due to an injury, such as after a car accident or a fall. You should also consult a healthcare provider if, in addition to neck pain, you’re also experiencing numbness or loss of strength in your arms or hands, or a shooting pain down your arm.

Signs and Symptoms of Neck Pain

Neck pain may be characterized by the following symptoms:

• Persistent aching
• Stabbing pain
• Burning or tingling
• Tenderness or sensitivity to mild pressure
• Pain that gets worse when you hold your head in one place for a while
• Muscle tightness or spasms

Neck pain can be axial (limited mostly to the neck) or radicular (extending to areas such as the shoulders or arms). It may be accompanied by a headache, or by numbness or tingling in one or both arms.

Neck pain can also be acute, lasting days to weeks, or chronic, lasting longer than three months to several years.

Causes and Risk Factors of Neck Pain

Neck pain can be caused by various health conditions, including the following:

• Strained muscles
• Arthritis
• Herniated disc, disc degeneration
• Pinched nerves and bone spurs (nerve compression)
• Trauma or injury
• Growths, including tumors and cysts (in rare cases)

The following factors are known to increase the risk of developing neck pain:

• Older age
• Mental stress
• Strenuous physical activity
• Being overweight or obese
• Being a woman
• Driving or traveling long distances
• Working long hours at a computer
• Hunching your neck down often, such as to look at your phone
• Carrying heavy bags on shoulder straps
• Poor alignment while sleeping
• Smoking

How Is Neck Pain Diagnosed?

Your doctor will diagnose your condition on the basis of a personal medical history and a physical exam. During this exam, your doctor will check for tenderness, numbness, and weakness in your neck.

Your doctor will also ask about your regular activities, as well as any previous injuries that may have contributed to the problem, such as a herniated disc.

In some cases, you doctor may decide that imaging tests of your neck are needed, such as the following:

X-Ray This test can reveal degenerative changes that may be putting pressure on nerves.

Computed Tomography (CT) Scan This test combines X-ray images to create a detailed cross-section of structures in your neck.

Magnetic Resonance Imaging (MRI) Magnetic field and radio waves create detailed images of areas of your body.

Other tests that may help with diagnosis include:

Nerve Conduction Study This procedure measures nerve impulses when a small amount of electrical current is applied, in order to detect damaged nerves.

Electromyography (EMG) This test involves inserting a needle electrode into muscles to measure their electrical activity, to help detect damage to nerves leading to muscles.

Blood Tests Certain markers of inflammation or infection may help identify conditions that contribute to neck pain.

Prognosis of Neck Pain

How severe your neck pain is, how long it lasts, and how likely it is to resolve on its own will depend on the underlying condition causing your pain.

If your neck pain is due to a strained muscle, it will most likely respond to self-care and get better with time.

But more serious conditions may require sustained treatment, procedures, and possibly surgery to see significant improvement.

Duration of Neck Pain

Neck pain can be acute, lasting days to weeks, or chronic, lasting for 12 weeks or longer. How long your pain lasts will depend on the underlying cause and its severity.

If your neck pain lasts longer than a few days or gets worse, or if it interferes with your daily life, it’s a good idea to see your doctor.

Treatment and Medication Options for Neck Pain

Recommended treatments for neck pain vary with the cause of your pain. In general, the goals of treatment are to relieve pain and improve function.

Most forms of mild to moderate neck pain respond well to self-care and conservative treatments, usually within two to three weeks. If your pain still isn’t resolved, your doctor may recommend other treatments.

Self-care options that may help resolve neck pain include:

• Taking over-the-counter (OTC) pain relievers
• Using heat or ice packs, or alternating between both
• Gentle stretches and neck exercises
• Rest

When to See a Doctor

You should call your doctor if you have persistent neck pain that interferes with your work or daily activities.

While neck pain usually isn’t a medical emergency, you should seek immediate medical attention if any of the following applies to your pain:

• It develops after an accident or trauma.
• It occurs with numbness or tingling in your arms, shoulders, or legs.
• It occurs with weakness in your arms or legs.
• You experience a headache, dizziness, nausea, or vomiting.
• You experience loss of bladder or bowel control.
• You have chills, fever, or unexplained weight loss.

Medication Options

Common OTC medications to help relieve neck pain include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen (Advil).

If OTC options aren’t strong enough for your pain, your doctor may consider prescribing or administering the following medications:

• Other NSAIDs
• Muscle relaxants
• Tricyclic antidepressants
• Steroid injections

Physical Therapy

Some conditions that cause neck pain, including strained muscles, may benefit from physical therapy.

A physical therapist can teach you exercises to help strengthen muscles in your neck, as well as help you correct your posture and alignment.

The following treatments may also be administered by a physical therapist or other therapist:

• Transcutaneous Electrical Nerve Stimulation (TENS) This therapy delivers electrical impulses through the skin to help relieve pain.
• Traction This therapy uses a specialized device to gently stretch your neck. It may help if nerve root irritation is the cause of your pain.

Surgery

Surgery is rarely needed for neck pain, but it may be recommended if you have nerve root or spinal cord compression. For these conditions, surgery involves removing tissue that is pressing against nerves.

Surgery may be performed to repair damaged or compressed discs in your spine, or to fuse vertebrae when repairing discs isn’t possible.

Alternative and Complementary Therapies

Alternative therapies that may help with neck pain include:

• Acupuncture
• Chiropractic care
• Massage
• Yoga, tai chi, and other fitness regimens

One study from 2015 of 517 patients found that those receiving two types of complementary therapies — acupuncture and the Alexander Technique — reported significantly less neck pain a year later compared to those using more standard approaches.

In general, though, there is not a lot of high-quality research on alternative therapies for neck pain, especially around Internet claims about the “wonders” of certain herbs and supplements. It’s best to discuss any potential alternative approaches to managing your neck pain with your doctor, reviewing the potential risks and benefits.

Prevention of Neck Pain

Not all neck pain can be prevented, but maintaining good posture — keeping your shoulders straight over your hips and your ears right above your shoulders — can help reduce your chances of developing neck pain.

Other simple modifications can also help:

• If you work at a desk, adjust your setup so your computer monitor is at eye level and your knees are slightly lower than your hips when you’re sitting.
• Avoid carrying heavy bags over your shoulder.
• Sleep with your head and neck in alignment with the rest of your body. The Mayo Clinic recommends you try to sleep on your back with your thighs elevated on pillows in order to flatten your spinal muscles.

Complications of Neck Pain

Neck pain can make it difficult to accomplish daily tasks, from driving a car to typing on a computer or doing kitchen tasks.

While it’s unlikely that most forms of neck pain will lead to long-term damage, it’s a good idea to see your doctor if you have pain that lasts longer than a few days or gets worse over time. Your doctor can make sure you don’t have a serious underlying condition that requires treatment.

Research and Statistics: How Many People Have Neck Pain?

Neck pain is a common issue, affecting 10 to 20 percent of adults, and the risk increases with age.

Other estimates, though, have found neck pain to be somewhat less common. A study from 2020 found that neck pain affected 3.6 percent of people around the world in 2017, a number that hadn’t changed significantly since 1990. Norway had the highest rate of neck pain in the world, with a prevalence of 6.2 percent.

Another study, published in 2017, looked at a large sample of 600 adults age 20 and older from the general population. It found that 20.3 percent of participants reported neck pain, and that people who had lost a spouse or were separated were more than twice as likely to report neck pain. Other factors associated with an increased risk of neck pain included lower income and education level, sitting or leaning while working, or having two or more health conditions.

Related Conditions of Neck Pain

Neck pain is a common form of chronic pain. Other commonly reported forms of pain include:

• Back pain
• Arm pain
• Abdominal pain
• Leg pain

Resources We Love

American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM)

This medical association is dedicated to advancing treatment of neuromuscular and musculoskeletal conditions. Its website contains information on numerous disorders, including pinched nerves and neck pain in general.

American Academy of Orthopaedic Surgeons

This group, representing surgeons who specialize in the musculoskeletal system, provides information on specific disorders affecting the neck — including fractures, spinal cord compression, a herniated disc, and arthritis.

American Association of Neurological Surgeons

This organization of neurosurgeons provides an overview of common causes and treatments for neck pain, including when surgery may be warranted.

Arthritis Foundation

This leading arthritis research and advocacy organization provides information on joint conditions affecting the neck and spine, and also has detailed resources on managing pain.

Additional reporting by Quinn Phillips.

Editorial Sources and Fact-Checking

• Neck Pain: Symptoms and Causes. Mayo Clinic. August 25, 2022.
• Neck Pain: Diagnosis and Treatment. Mayo Clinic. August 25, 2022
• Anatomy of the Spine — Upper Back, Lower Back, and Neck. Arthritis Foundation.
• Neck Pain. Cleveland Clinic. December 9, 2022.
• Neck Pain and Problems. Johns Hopkins Medicine.
• Safiri S, Kolahi AA, Hoy D, et al. Global, Regional, and National Burden of Neck Pain in the General Population, 1990–2017: Systematic Analysis of the Global Burden of Disease Study 2017. BMJ. March 26, 2020.
• Genebra CVDS, Maciel NM, Bento TPF, et al. Prevalence and Factors Associated With Neck Pain: A Population-Based Study. Brazilian Journal of Physical Therapy. July–August 2017.
• Plastaras CT, Schran S, Kim N, et al. Complementary and Alternative Treatment for Neck Pain: Chiropractic, Acupuncture, TENS, Massage, Yoga, Tai Chi, and Feldenkrais. Physical Medicine and Rehabilitation Clinics of North America. August 2011.
• Complementary Therapies for Neck Pain. Harvard Health Publishing. November 3, 2015.

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Cervical Disc Disease Medications for Neck Pain

Written by Stephanie Watson

Neck pain is one of the main symptoms of cervical disc disease, in which discs between vertebrae become herniated or deteriorate, sometimes pinching nerves.

Several different drugs, from pain relievers to anti-inflammatory drugs such as steroids, can help ease your neck pain while you heal. Depending on the extent of your neck pain and the type of cervical disc disease, you can either take these medications alone or use them together with physical therapy or other treatments.

Drugs typically used to treat cervical disc disease include:

Acetaminophen (Tylenol). Acetaminophen is usually among first-line drug treatments for pain. It can help with neck pain, but don’t fall under the common misperception that acetaminophen is completely harmless just because it’s readily available over-the-counter. Research shows that regular acetaminophen use can damage the liver, even in people who take the drug at the recommended dose. To make sure you’re using acetaminophen as safely as possible, follow the directions carefully and don’t take any more than the label suggests and your doctor recommends.

Avoid using alcohol while taking acetaminophen to minimize the risks to your liver. Also, acetaminophen could be an ingredient in some other over-the-counter medications you may be taking. Look at all drug labels to be sure you’re not taking too much acetaminophen.

Nonsteroidal anti-inflammatory drugs (NSAIDs).Ibuprofen (Motrin, Advil) and naproxen (Aleve) are staples in the treatment of cervical disc disease because they reduce both pain and inflammation. Like acetaminophen, many NSAIDs are available over-the-counter, but they also need to be taken carefully. NSAIDs can have some serious side effects, such as gastrointestinal bleeding, ulcers, and kidney damage, especially when used for long periods of time. NSAIDs have also been linked to an increased risk of heart attack or stroke.

Select Cox-2 inhibitors are a newer generation of NSAIDs that are available by prescription and may have fewer digestive side effects, but can also increase risk for heart attack or stroke.

It’s important to read the labels carefully and never exceed the doctor’s recommended dose. You’ll also want to avoid taking NSAIDs together with certain other medications because of the possibility of drug interactions. Talk to your doctor about all the drugs you take. Be especially cautious about taking NSAIDS if you are over 65, and/or you have kidney problems.

Your doctor will make the decision as to whether to put you on an NSAID after weighing the benefits against the risks.

Narcotic painkillers. Because of their increased risks, opioids are not a first-line therapy for pain. Opioids such as codeine (contained in Tylenol with codeine), hydrocodone (contained in Vicodin and Lortab), and oxycodone (such as OxyContin, and contained in Percocet and Percodan) can provide significant relief when neck pain is particularly intense and other non-narcotic pain medications aren’t sufficient for pain relief. So can tramadol, a narcotic-like analgesic. Although opioids are effective for pain, they should be used with caution because they can lead to drowsiness, nausea, constipation, and depressed breathing. These prescription painkillers also have the potential for abuse and addiction. Narcotic painkillers are best used over the short term (one to two weeks) and under your doctor’s guidance.

Steroids. Steroids such as prednisone (Deltasone, Orasone, Sterapred) work by reducing inflammation. Although they can be taken orally, steroids given for neck pain are sometimes delivered directly to the spine via an injection to the area. Research shows that steroid injection does relieve neck pain over the short term, although its effectiveness for chronic pain is unclear.  The most common side effects of short-term oral steroids are an increase in blood sugars, water retention and stomach ulcers. For the epidural, the risks are infection, headache, and bleeding. Side effects of oral steroids, which are not generally used, include weight gain, and, less often, high blood pressure and osteoporosis.

Muscle Relaxants.Baclofen and other muscle relaxants calm muscle tightness, and some research suggests they can relieve neck pain within the first few days of an acute injury. When using these drugs, watch out for side effects such as drowsiness, dependence, and urinary retention. These drugs are best used short term under a doctor’s guidance.

Anticonvulsants. Although they are approved by the FDA to treat seizures, anticonvulsant drugs such as gabapentin (Neurontin), carbamazepine (Tegretol), and pregabalin (Lyrica) may help with nerve-related neck pain. How exactly anticonvulsants work on neck pain is unknown, but they are believed to affect the way the brain perceives pain. Side effects include dizziness, sleepiness, vision problems, and vomiting. Patients who take these drugs may be at a greater risk of having thoughts or actions of suicide. The risk may be greater in people who have had these thoughts or actions in the past. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur.

Tricyclic Antidepressants. TCA  are used off-label to treat chronic pain, especially nerve pain. Examples include amitriptyline and nortriptyline may help with chronic pain and with sleep. It may take several weeks to see an effect. Side effects include drowsiness, dry mouth, constipation, and urinary retention. 

Top Picks

Neck Pain, No Trauma

There are several possible causes of neck pain without injury.

• Sudden movement may cause minor sprains or muscle strains. The reason may also be sleeping in an uncomfortable position.

• Some people tense the muscles of the neck , shoulders and upper back when they are emotionally stressed . Chronic spasm of these muscles can cause neck pain and sometimes headaches.

• Gradual “wear and tear” of the spinal joints can lead to “degenerative arthritis”. This can cause neck pain, both chronic and occasional.

• Due to aging or as a result of repeated minor neck injuries, intervertebral discs (acting as shock absorber pads between the vertebrae) can bulge and put pressure on the spinal nerve. This causes a tingling sensation, pain, or numbness from the neck to the shoulder, arm, or hand.

Acute neck pain usually improves in 1-2 weeks. Neck pain associated with disc disease, arthritis of the spinal joints, or spinal stenosis (narrowing of the spinal canal) can become chronic and last for months or years.

Unless the neck pain is due to some significant physical injury (such as a car accident or a fall), x-rays are usually not ordered at the initial examination. If the pain does not go away and is not treatable, then X-rays and other types of examinations may be prescribed in the future.

Home Care

1. Relax and relax your muscles. Use a comfortable pillow that supports your head and keeps your back in a neutral position. The head should not be tilted forward or backward. A rolled up towel can help you get into the most comfortable position.

2. Pain can be relieved by heat (hot shower, bath or heating pad) and massage or vice versa cold packs (a plastic bag wrapped in a towel with crushed ice or ice cubes). Try both methods and use the one that works best for you for 20 minutes several times a day.

3. You can take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) to relieve pain if no other drugs have been prescribed. [ NOTE . If you have chronic liver or kidney disease, or if you have had stomach ulcers or bleeding in the gastrointestinal tract, consult your doctor before taking these drugs.]

Follow up

with your doctor or at this medical facility if there is no improvement after a week. You may need physiotherapy or further testing.

[ NOTE . The results of an X-ray or CT scan will be checked by a radiologist. We will notify you if we discover new information that may affect treatment.]

Seek Medical Care Immediately

for any of the following:

• worsening pain or spreading to one or both arms;

• weakness or numbness in one or both arms;

• worsening headache;

• swelling of the neck, difficulty or pain in swallowing;

• At 100. 4ºF (38ºC) or higher, or as directed by a physician.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Paracetamol for back pain

Purpose of study

Find out how effective paracetamol is in the treatment of non-specific low back pain. Nonspecific low back pain or low back pain of unknown etiology is pain in the lower back for which there is no clear definition of the disease or condition.

Relevance

Paracetamol is one of the most commonly prescribed medicines for people with back pain. It is recommended by clinical guidelines for various diseases (diagnosis and treatment protocols), which are published to help the doctor. However, the results of recent studies have raised the question: how effective is paracetamol really?

Search date

Evidence is current to August 2015.

Study profile

We included three trials in this review with a total of 1825 patients, two of which included people with recent onset pain (acute type), and the third included participants with pain that lasted more than six weeks (chronic type) . The majority of people in this study (90%) were middle-aged and entered the study from a single trial that looked at acute back pain. All three trials compared the effect of paracetamol to a placebo (a dummy that contains nothing that could act as a drug). Patients were given a variety of treatments ranging from a single intravenous injection of one gram of paracetamol (1 g intravenously) to oral administration of four grams taken over a 24-hour period for up to four weeks. The follow-up period for participants ranged from one day to twelve weeks. The main outcomes we studied were: pain and disability; we also looked at quality of life, whether patients were able to carry out their daily activities without difficulty, whether there were any unpleasant or unwanted side effects, how participants themselves rated their improvement, sleep quality, whether medication was taken as prescribed, and whether there was a need in an emergency intake of another analgesic – a rescue drug – due to the fact that paracetamol did not work. We combined the results from two trials into one analysis (meta-analysis) comparing paracetamol with placebo; the third study did not report placebo results and therefore could not be included.

Main results and quality of evidence

We found high-quality evidence that paracetamol (4 g daily) is no better than placebo for acute low back pain in either the short or long term. In other aspects of the study (quality of life, quality of sleep), paracetamol also did not show better results than placebo. Approximately one in five patients reported side effects (although there were few serious cases). Thus, no difference with the control group was also found. Since most of the participants were middle-aged, it is not certain that the results would have been the same in other age groups.

In one of the very low quality studies that was retracted by the journal, paracetamol and placebo also did not differ in immediate relief of symptoms of chronic low back pain.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

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Translation notes:

Translation: Xenia Belyakova. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia – Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: cochrane.