Myofascial Neck Pain Discussion and Treatment 2024
“That guy is a pain in the neck,” is a common phrase heard on the street. There is something about certain jobs, painting the ceiling, or looking up for a long time at a computer screen which is too high, which gives tight, bothersome pain in the back of the neck.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
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Chronic neck pain and headache can be caused by cervical myofascial pain. The pain is in the muscles of the neck and in trigger points noted on medical exam by palpation. The pain is improved temporarily by local pain killer anaesthetic injection into the trigger points or by trigger point massage.
This subject is controversial, and it has been difficult to demonstrate the “supposed trigger points” and response to treatment varies considerably. The term “myo” refers to muscle and “fascia” to the tissue surrounding around and through the muscle fibers.
Description of symptoms
Muscle pain that is deep and aching
Constant or worsening pain
Highly tender muscle knots or trigger points
Sleep disturbance due neck and headache pain and difficulty finding a comfortable position in bed
Common causation:
Repetitive muscle contraction from motions used in work or hobbies.
Stress related muscle tension. Persons with stress and anxiety more frequently have muscle trigger points. Persons like this clench their muscles frequently leading to repeated strain and increased susceptibility to trigger point development.
Traumatic neck injury such as whiplash with car crash
Poor posture
Temporal profile
Myofascial neck pain syndrome tends to be a chronic disorder, resulting in neck movement related neck pain, chronic neck stiffness, headache, and often thoracic and lumbar back pain.
The condition may exist for months to half a year, a year, or continuously.
Medical workup
Evaluation would be examination by an orthopedist or neurologist. For chronic cases rheumatology consultation may be helpful.
Testing includes cervical spine x-ray, or CT or MRI examination of the head and neck.
Differential Diagnosis
Differential diagnosis includes cervical muscle strain, spondylosis, cervical disk disease, radiculopathy, muscle spasm, and fibromyalgia.
Treatment options
Physical therapy with exercises centered around neck and shoulder movements.
Trigger point injections with local anaesthetics.
Pain medication such as NSAIDS (NonSteroidalAntiinflammatoryDrugs) such as naproxen, ibuprofen, or acetaminophen
Muscles relaxants such as Robaxin and Flexeril, and pain modulating tricyclic antidepressants such as amitriptyline or nortriptyline
Cervical and back of head Botox injections
Medical advice and help to stop smoking.
Advice to limit and deal with stress.
Medical advice to exercise aerobically lifelong.
Prognosis
Prognosis is better if treated early. Prognosis varies with myofascial cervical pain and headache. There may be effective treatment results with some patients while with others the symptoms recur either temporarily or chronically.
Complications
Acute or chronic insomnia due to pain worsened at night by neck position or movement, or trigger point aggravation.
Fibromyalgia is thought by some to develop with myofascial pain.
Etiology
Myofascial pain is not completely understood, yet situations of neck overuse or trauma to neck muscles may start it off.
Whiplash from motor vehicle accident, painting a ceiling, or improper positioning for computer visualization for persons who work at desks may start the pain process.
Epidemiology
Myofascial cervical pain and headache syndrome is a very common problem in the United States and worldwide. It is the cause of many visits to the doctor. Many persons have headaches and neck pain in their lives.
Twenty per cent of orthopedic clinic visitors have myofascial pain. More than eighty per cent of patients in pain management clinics have myofascial pain.
The neck region is a common place for myofascial pain. Both sexes have myofascial neck pain, but females have an increased incidence. Myofascial pain patients present in midlife and may improve with ageing.
Pathophysiology
Pathophysiology of the syndrome is not well understood. One theory is that acetylcholine increases and that this may lead to increased muscle tension and the formation of taut bands. These bands constrict blood vessels, leading to hypoxia, tissue distress, and nociceptor activation, resulting in autonomic modulation, more acetylcholine release and a cycle that repeats over and over.
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Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.
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All the best.
Britt Talley Daniel MD