Neck Pain Treatment

Neck pain is a common condition that affects a significant number of people. It can arise from various sources, including discogenic, facetogenic, radicular, and traumatic/whiplash-related pain.

Interventional pain procedures may be a valuable option for individuals experiencing neck pain when other treatments have failed to provide adequate relief.

Below are some of the most common interventional pain procedures for neck pain and how they can be used to treat different types of neck pain:

• Facet joint injection: Facet joint injection is a minimally invasive procedure involving the injection of a steroid medication and a local anesthetic into the neck’s facet joints. This procedure is used to treat facetogenic pain arising from the facet joints of the spine. Facet joints are the small joints between each vertebra in the spine that help with movement and stability. Facet joint injection can relieve pain for up to several months, and the pain may not return at all in some cases. This procedure is usually repeated several times, depending on the severity of the condition.
• Medial branch block: A medial branch block involves the injection of a local anesthetic into the medial branches of the nerves that supply the facet joints. This procedure is used to diagnose facetogenic pain and to provide temporary pain relief. Suppose the patient experiences significant pain relief after the injection. In that case, it indicates that the facet joint is the source of pain, and a facet joint injection may be recommended. The duration of pain relief may vary, but it can last up to several weeks.
• Epidural steroid injection: An epidural steroid injection involves the injection of a steroid medication and a local anesthetic into the spine’s epidural space. This procedure is used to treat radicular neck pain caused by the compression or irritation of a nerve root in the neck. The medication reduces inflammation and can relieve pain for several months, allowing the body to heal the underlying condition. This procedure may need to be repeated several times to achieve optimal results.
• Radiofrequency ablation: Radiofrequency ablation is a minimally invasive procedure that uses heat to destroy the nerves that transmit pain signals from the facet joints or other structures in the neck. This procedure can provide long-term pain relief for individuals with chronic neck pain. Radiofrequency ablation can be used to treat facetogenic pain, whiplash-related pain, and other types of neck pain.
• Trigger point injection: Trigger point injection involves the injection of a local anesthetic and a steroid medication into trigger points in the neck. Trigger points are small areas of tight muscle fibers that can cause pain and discomfort. This procedure is used to relieve pain and improve range of motion. It may be recommended for individuals with traumatic neck pain or myofascial pain syndrome.

Interventional pain procedures for neck pain can be grouped based on complexity, with some techniques being less invasive than others.

Here are the procedures listed in order from least invasive to most invasive:

• Trigger point injection: Trigger point injection is the least invasive procedure for neck pain. It involves the injection of a local anesthetic and a steroid medication into trigger points in the neck. The procedure can be performed in the physician’s office, and patients can typically return to normal activities immediately after the injection.
• Facet joint injection: Facet joint injection is a minimally invasive procedure involving injecting a steroid medication and a local anesthetic into the neck’s facet joints. The procedure can be performed outpatient and typically takes less than 30 minutes to complete.
• Medial branch block: Medial branch block involves the injection of a local anesthetic into the medial branches of the nerves that supply the facet joints. The procedure is typically performed on an outpatient basis or in the physician’s office and takes about 20-30 minutes to complete.
• Epidural steroid injection: Epidural steroid injection involves the injection of steroid medication and a local anesthetic into the spine’s epidural space. The procedure is more invasive than the previous three and is typically performed in an outpatient setting. Patients may need to rest for a short period after the injection.
• Radiofrequency ablation: Radiofrequency ablation is a more invasive procedure involving heat to destroy the nerves that transmit pain signals from the facet joints or other structures in the neck. The procedure is typically performed in an outpatient setting and may require sedation.
• Intradiscal Procedures: Intradiscal procedures are invasive procedures used to treat discogenic neck pain caused by damage to the spinal discs. These procedures involve injecting medication into the affected disc to relieve pain and improve function. There are several types of intradiscal procedures, including:
  • Intradiscal Electrothermal Therapy (IDET): This procedure involves the insertion of a catheter into the affected disc and the application of heat to the disc to destroy nerve fibers transmitting pain signals. The procedure takes about an hour to complete and can be outpatient.
  • Discography: Discography involves the injection of a contrast dye into the affected disc to help identify the source of pain. This procedure is usually performed before other intradiscal procedures to ensure the correct disc is treated.
  • Nucleoplasty: Nucleoplasty involves using radiofrequency energy to shrink and remove disc material that is compressing a nerve root. This procedure can be performed on an outpatient basis and typically takes less than an hour to complete.
  • Spinal Cord Stimulation (SCS): Spinal cord stimulation is a more invasive procedure used to treat chronic neck pain that has not responded to other treatments. The procedure involves the insertion of electrodes into the spinal canal to stimulate the nerves responsible for transmitting pain signals. The patient is provided with a remote control that allows them to adjust the stimulation level to provide maximum pain relief. The procedure is typically performed under sedation in a hospital or outpatient surgery center.

It is important to note that the complexity of a procedure does not necessarily correlate with its effectiveness. The choice of procedure will depend on the patient’s needs and the underlying cause of their neck pain.

These procedures are typically reserved for patients who have yet to respond to other forms of treatment, such as physical therapy, medications, and lifestyle modifications.

The expected outcome and success rates for these interventional pain procedures can vary based on the patient’s condition, the type of procedure performed, and the severity of the neck pain. However, many patients experience significant pain relief and improvement in function after undergoing these procedures.

For example, facet joint injections have been shown to provide relief for up to several months in some patients, while epidural steroid injections can provide relief for several weeks to several months. Radiofrequency ablation can provide long-term pain relief for patients with chronic neck pain, and spinal cord stimulation has been shown to provide significant relief for patients with severe and chronic neck pain.

Some potential risks of these procedures include infection, bleeding, and nerve damage but they are relatively rare, and most patients tolerate the courses well.

In conclusion, interventional pain procedures can be valuable for individuals experiencing neck pain when other treatments have failed to provide adequate relief. The procedure selection depends on the type of neck pain and the underlying cause.

Patients are encouraged to consult with their physician to determine the best course of treatment as part of a comprehensive therapeutic plan. It is essential to understand that while interventional pain procedures can be effective, they should not be relied on as the only form of treatment, and they should be used in conjunction with other forms of therapy, such as physical therapy, medications, and lifestyle modifications.