Many patients with chronic pain feel that nothing works to reduce their pain and have lost hope. I have treated chronic pain patients who said they felt broken, depressed, and abandoned. I want my patients to feel heard and understood, and know they are not alone in their pain.
While neck pain for most people resolves itself within the first three months, there is still a sizeable minority of patients who continue with chronic neck pain for many more months or even years. My goal in this article is to give hope to those struggling with chronic pain after a motor-vehicle collision.
Cervical Whiplash Injury
Whiplash injuries to the neck commonly occur during motor-vehicle collisions. Whiplash is often mistakenly thought of by laypeople as nothing more than a soft-tissue muscular strain to the neck. While the neck muscles are involved, there is so much more going on underneath the surface.
Whiplash injury involves a sudden excessive acceleration and deceleration force on a part of the body and usually involves the neck. The sudden acceleration and deceleration forces that occur during such a collision not only apply abnormal stress to the ligaments and muscles along one’s neck, but also can involve:
- Intervertebral discs—the rings of cartilage that are located between each vertebral body of your spine
- Occipital nerves—nerves along the back of the head
- Zygapophyseal (a.k.a. facet) joints—small joints along the back of the neck underneath the muscles
Damaging the intervertebral discs can cause protrusions/herniations in the disc that can irritate the nearby nerve roots, which can cause radiating arm pain, numbness/tingling, or weakness. Damaging the occipital nerves can cause headaches starting along the back of the head and tending to radiate along the top of the head. Today, however, I am focusing more on when the facet joints are damaged.
Cervical Facet Syndrome
If someone is in a collision where their vehicle is hit in the rear, this causes their head to quickly extend backward. This motion abnormally compresses the facet joints, which damages them, and can even damage the nearby small nerves that act as pain receptors to those joints. This is called cervical facet joint syndrome, or cervical facet syndrome for short.
Treatment for this condition often starts with physical therapy and non-steroidal anti-inflammatory drugs (NSAIDS) to help reduce pain and inflammation. If the pain persists despite several weeks of treatment, it is often recommended to receive further treatment with a pain specialist or physiatrist (physical medicine and rehabilitation physician). This specialist can perform specific interventional pain management treatments, such as injections, to help diagnose and treat the condition.
A cervical medial branch block is a diagnostic injection used to determine if one’s neck pain and/or headache is originating from small nerves called medial branches. These nerves are located near the facet joints in the back of the neck and act as pain receptors to those joints. Since more than one of these nerves may be contributing to pain, usually multiple nerves are injected at one time, so it is less likely that the damaged pain-nerve levels are missed.
The injection is performed under X-ray guidance to confirm that the needle has reached the appropriate area in your neck. The injection contains an anesthetic, which temporarily numbs the small nerves along the facet joints. Contrast medication is often used during the X-ray to ensure the medication is reaching the appropriate spot.
If you experience significant temporary pain reduction with the injection, then sometimes a repeat injection is performed to ensure that the initial improvement was not a “false positive” response. If the second medial branch block again gives great temporary pain reduction, then the diagnosis of cervical facet syndrome is confirmed. The next step to treat the pain is with radiofrequency neurotomy (a.k.a. radiofrequency ablation) of those small nerves.
Success rates vary, but typically about 50% of patients undergoing the radiofrequency neurotomy/radiofrequency ablation procedure for neck pain will experience significant pain relief for 6 to 18 months. The pain relief usually isn’t permanent, because the nerve will regenerate over time. The good news, though, is that the procedure can be repeated, if needed, on those same nerves if at least 6 months have passed since they were last treated with radiofrequency neurotomy.
If you have been dealing with chronic neck pain, please contact our office so that we can help. You do not need to suffer with pain just because you have a chronic condition. We can help to improve your quality of life.