Treatment Overview

Treatment for neck pain consists of reducing the pain with ice and medicine, improving neck movement and flexibility with exercises or physical therapy, and avoiding further neck injury by changing activities and body mechanics, such as how you sit or sleep. The specific treatment may depend on whether your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain.

Because most neck pain is caused by repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain caused by activities resolve within 4 to 6 weeks.¹

Acute neck pain

For sudden (acute) neck pain:

• Place an ice pack or cold pack over painful muscles for 48 to 72 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 7 to 10 minutes, long enough to numb the pain. Ice frozen in a paper cup works well. Be sure not to damage your skin (frostbite).
• Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
• Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after a neck-strain injury helps resolve some symptoms faster than taking time off from work and using neck immobilization.²
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
• Take pain relievers. Acetaminophen (such as Tylenol) can help relieve pain. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.

For severe pain or muscle spasm, your doctor also may prescribe:

• Muscle relaxants, which treat severe pain spasms when neck pain begins. They include diazepam (such as Valium), cyclobenzaprine (such as Flexeril), and carisoprodol (such as Soma).
• Narcotic pain relievers, which are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (such as Vicodin, Lortab), aspirin and oxycodone (such as Percodan), and acetaminophen and oxycodone (such as Percocet).

The treatment that is right for you may be different from the treatment for someone else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven't been very well researched, even if they are used a lot. A review of studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain.²

Your doctor may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. See a picture of a cervical collar.

Chronic neck pain

For long-lasting (chronic) neck pain, you can use the same treatment used for acute pain, although you do not have to worry about swelling. Your doctor may prescribe other medicines, such as antidepressants. These include doxepin (such as Sinequan) and amitriptyline.

You can aid healing and prevent further injury by:

• Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness.
• Changing or avoiding any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
• Maintaining good health habits. If possible, reduce stress and tension at work and home. Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Smoking, and Fitness.
• Trying manual therapy. A trained practitioner may use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as "mobilization." Avoid rapid, forceful movements, which are known as "manipulation." Talk to your doctor before trying manual therapy.

Surgery

Surgery is rarely required for neck pain. It may be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include:

• Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
• Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
• Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

What To Think About

A review of studies reports that:²

• Exercise reduced pain better than medicine for muscle pain or spasm, stress management, or no exercise.
• There is not enough evidence to determine whether medicines, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain.

In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for 1 year. Compared with people who had chronic neck pain and were not using the exercises, the exercise group had less pain and disability.³

Keeping your neck moving improves its function and helps it heal. In general, cervical collars are only used after a surgery or for a day or two after a neck sprain.

People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling in addition to medical treatment may help in recovery.