Neck Pain

neck pain treatment in virginia



  • It is estimated that 20% of adults have neck pain some time in their lives.
  • Degenerative changes of the cervical spine (disc tear/bulge, arthritis of facet joints) represent the most common cause of acute and chronic neck pain in adults.
  • Other common causes include whiplash injury (acceleration/deceleration), neck sprain, poor posture with constant flexion position of head/neck, referred pain from shoulder, etc.
  • Most neck pain episodes are self-limited and improve with conservative measures. 
  • Conservative treatment includes combination of physical therapy, medications, trigger point injections, image guided spinal injections, and in some cases surgical interventions.
  • Risk factors associated with higher prevalence of neck pain include smoking, obesity, female gender, sedentary work, worker’s compensation insurance, job dissatisfaction, and psychological factors such as somatization disorder, anxiety, and depression. 

What Cause Neck Pain?

  • Nonspecific neck pain is generally attributed to cervical strain which is defined as pain or stiffness associated with neck movement. Strains to the muscles and ligaments by sleeping in improper position, poor posture like working on computers and smart devices, etc. Physical exam is generally notable for painful palpation of the neck and trapezius muscles. X rays are usually inconclusive. If symptoms lasts longer than 6 weeks, then advanced imaging is considered.
  • Cervical disc degenerative disease presents with pain and stiffness in the neck region which may or may not be associated with pain in upper extremities. Degenerative disc disease is a condition in which the shock-absorbing discs between your vertebrae slowly dry out, becoming thinner and more rigid. That might cause few if any symptoms at first but can lead to herniated discs and spinal stenosis (narrowing of the spinal column), which, in turn, causes painful radiculopathy (pinched nerves). Symptoms are exacerbated with provocative maneuvers which can include neck held in one position. Pain is considered largely mechanical due to inability of discs to effectively distribute pressure. If a disc bulge is associated with impingement of cervical nerve roots, symptoms often present with numbness/tingling/pain radiating up to the fingers. An MRI is generally very useful to delineate the level of the disc(s) affected but most commonly levels C4-C7 are more commonly affected. 
  • Cervical Spondylosis (osteoarthritis of facet joints) is commonly an age-related condition, developing after years of wear-and-tear on your spine, which causes the facet joints that link your vertebrae to lose their protective cartilage. As a result, the bones start rubbing together, causing chronic inflammation and pain. You might also develop bone spurs – little bony growths in your facet joints that your body produces to support arthritic vertebrae. Bone spurs are another common cause of pinched nerves. Degenerative changes can also cause conditions like spondylolisthesis, in which weakened ligaments in your spine allow the vertebrae to slide over each other.
  • Spinal stenosis (narrowing) due to degenerative arthritis (also knowns as spondylosis and spondylolisthesis) can put pressure on the spinal cord causing symptoms of neck pain associated with achy arms and legs with burning sensation. 
  • Whiplash Injury is defined as neck injury resulting from an acceleration-deceleration mechanism that causes sudden extension and flexion of the neck. It can cause injury to ligaments, muscles, and facet joints. The symptoms can include neck pain, headaches, dizziness, fatigue. It most commonly occurs due to rear-end motor vehicle collisions. Some patients can continue to experience symptoms up to 1 year from the original injury. 
  • Myofascial Pain Syndrome (MPS) is a regional pain disorder associated trigger points, taut bands, and pressure sensitivity. 
  • Other etiology includes diffuse skeletal hyperostosis, psychological stress (nonspecific pain throughout the body), fibromyalgia, etc.
  • Other medical non-spine related medical conditions such as heart attack, meningitis, malignancy, tension headache, referred shoulder pain, thoracic outlet syndrome, carotid artery dissection, vertebral artery dissection, esophageal obstruction, etc.

How is neck pain diagnosed?

  • The clinical evaluation of neck pain starts with history and physical to evaluate for signs and symptoms that indicated need for immediate imaging and further evaluation. 
  • A comprehensive history is important first step understanding the cause of neck pain. It is further complimented with a focused physical examination. 
  • Learning more about previous episodes of similar presentation of symptoms and administered treatment options is also very useful to initiate successful treatment. 
  • The need for advanced imaging and lab work is determined based on the initial evaluation and response to ongoing treatment.  
  • For symptoms that persist beyond 6 weeks and associated with some neurological signs and symptoms of nerve compression, an MRI scan is generally useful for further evaluation.  
  • Electrodiagnostic testing such as EMG/NCS are not necessary for routine evaluation of neck pain. These tests are used to distinguish cervical radicular pain from other causes of extremity dysesthesia such as peripheral nerve entrapment (carpal tunnel syndrome, cubital tunnel syndrome) and peripheral neuropathy (diabetes, vascular, rheumatologic) etc.  

Treatment Options

  • Treatment depends on the severity of your neck pain as well as the underlying cause. Most cases of neck pain usually respond to conservative measures such as rest, ice, over the counter anti-inflammatory medications (naproxen, ibuprofen, acetaminophen) and time. Sometimes muscle relaxants are also utilized for neck spasms or taut bands. 
  • Physical therapy plays an important role in neck pain relief and can help you improve your strength, posture, and flexibility to reduce risk of future flare ups. 
  • Nonsurgical treatment options are offered based on symptoms and underlying diagnosis. These include: 

Epidural Steroid (cortisone) injections

Trigger Point Injections

Medial Branch Nerve Blocks/Radiofrequency Ablations (RFA)

The team takes an integrative approach to patient care, so your doctor may combine several conservative treatments to relieve your back pain.

Will I need surgery for neck pain?

If no other treatments are working after at least six months, surgery may be necessary for your neck pain, providing the cause of the pain is identifiable.

Options include:

  • Spinal fusion
  • Disk replacement


Where suitable, your surgeon performs these procedures using minimally invasive techniques to reduce tissue damage and shorten recovery time.


While we ARE accepting NEW patients for Interventional Pain Treatment options, we are UNABLE to accept NEW patients for OPIOID medication management at this time.

We are always committed to providing the most honest compassionate care possible to all our patients