Neurology Case No 3.Neck Pain.

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Neurology Case No 3.Neck Pain.

What is neck pain (cervicalgia)?

Neck pain, sometimes called cervicalgia, is pain in or around your spine beneath your head. Your neck is also known as your Cervical Spine. Neck pain is a common symptom of many different injuries and medical conditions.

You might have axial neck pain (felt mostly in your neck) or radicular neck pain (pain that shoots into other areas, such as your shoulders or arms). It can be acute (lasting from days to six weeks) or chronic (lasting longer than three months).

Neck pain can interfere with your daily activities and reduce your quality of life if it’s not treated.

Fortunately, most causes of neck pain aren’t serious and improve with conservative treatments, like pain medicine, exercise and stress management.

What does neck pain feel like?

Some people describe the pain as:

A persistent ache.
A stabbing or burning pain.
A shooting pain that travels from their neck to their shoulders or arms.
Types of neck pain:-
Facet syndrome
Referred pain
Headache
Neuropathic Pain
Cervical Radiculopathy
Herniated disc
Muscle spasm
Muscle pain
Spinal stenosis
Whiplash
Axial neck pain
Spondylarthrosis
Muscle strain
Osteoarthritis
Radicular pain
Cervical spondylotic myelopathy
Myofascial pain syndrome
Torticollis

Other symptoms

Symptoms

Symptoms include:

Pain that’s often worsened by holding the head in one place for long periods, such as when driving or working at a computer
Muscle tightness and spasms
Decreased ability to move the head
Headache

Neck pain may involve other symptoms, including:

Headache.
Stiffness in your neck, shoulders and upper back.
Being unable to turn your neck or tilt your head.
Numbness or tingling (pins and needles) feeling in your shoulders or arms.

Possible Causes

Neck pain can result from physical changes related to strain, injury or aging, or it may be related to stress.

What are the possible causes of neck pain?

Neck pain has many potential causes, including:

Aging: As you age, natural wear and tear can cause parts of your cervical spine to deteriorate, or degenerate, causing pain. Degenerative conditions such as Osteoarthritis (the wearing down of joint cartilage) and Spinal stenosis (narrowing of the spaces in your spine) can lead to neck pain. Over time, stress and repeated movements can cause the disks in your spine to weaken, causing a Herniated Disk orPinched Nerve.
Physical strain: Overusing your Neck muscles during repetitive or strenuous activities can lead to stiffness and pain. Poor posture, weak abdominal muscles and heavier body weight can affect your spine’s alignment and contribute to neck pain. For example, straining your neck to view a computer screen for long periods is a common cause of neck pain.
Mental stress: Tightening your neck muscles because you’re stressed can lead to neck pain and stiffness. Many people who tighten these muscles when they’re stressed or agitated don’t realize they do it until their neck starts hurting.
Injury: Trauma and other injuries can damage muscles, Ligaments, disks, vertebral joints and nerve roots in your spinal cord and lead to neck pain. whiplash during automobile accidents is a common injury that causes neck pain.
Growths: Masses, including tumors, cysts and bone spures, can put pressure on the nerves in your neck, causing pain.
Other health conditions: Neck pain is a symptom of many health conditions, including Meningitis, Rheumatoid Arthiritis and Cancer.

Muscle strains. Overuse, such as too many hours hunched over a computer or a smartphone, often triggers muscle strains. Even minor things, such as reading in bed, can strain neck muscles.
Worn joints. As with other joints in the body, neck joints tend to wear with age. In response to this wear and tear, the body often forms bone spurs that can affect joint motion and cause pain.
Nerve compression. Herniated disks or bone spurs in the vertebrae of the neck can press on the nerves branching out from the spinal cord.
Injuries. Rear-end auto collisions often result in whiplash injury. This occurs when the head jerks backward and then forward, straining the soft tissues of the neck.
Diseases. Certain diseases, such as rheumatoid arthritis, meningitis or cancer, can cause neck pain.
worry or stress
sleeping awkwardly
an accident, which can cause whiplash
a sprain or a strain
a flare-up of cervical spondylosis; which can happen as the discs and joints in the spine age.

Other causes

Other causes of neck pain include the following:

Rheumatoid Arthrities causes pain, swelling of the joints, and bone spurs. When these occur in the neck area, neck pain can result.
Osteoprosis weakens bones and can lead to small fractures. This condition often happens in hands or knees, but it can also occur in the neck.
Fibromyalgia is a condition that causes muscle pain throughout the body, especially in the neck and shoulder region.
As you age, the cervical discs can degenerate. This is known as Spondolysis, or osteoarthritis of the neck. This can narrow the space between the vertebrae. It also adds stress to your joints.
When a disc protrudes, as from a trauma or injury, it may add pressure on the spinal cord or nerve roots. This is called a Herniated cervical disc also known as a ruptured or slipped disc.
Spinal stenosis occurs when the spinal column narrows and causes pressure on the spinal cord or the nerve roots as it exits the vertebrae. This can be from long-term inflammation caused by arthritis or other conditions.

In rare instances, neck stiffness or pain occurs due to:

congenital abnormalities
infections
abscesses
tumors
cancer of the spine
Prevention:- Use good posture. When standing and sitting, be sure your shoulders are in a straight line over your hips and your ears are directly over your shoulders. When using cell phones, tablets and other small screens, keep your head up and hold the device straight out rather than bending your neck to look down at the device.
Take frequent breaks. If you travel long distances or work long hours at your computer, get up, move around, and stretch your neck and shoulders.
Adjust your desk, chair and computer so that the monitor is at eye level. Knees should be slightly lower than hips. Use your chair’s armrests.
If you smoke, quit. Smoking can increase the risk of developing neck pain.
Avoid carrying heavy bags with straps over your shoulder. The weight can strain your neck.
Sleep in a healthy position. Your head and neck should be aligned with your body. Use a small pillow under your neck. Try sleeping on your back with your thighs elevated on pillows, which will flatten your spinal muscles.
Stay active. If you don’t move much, increase your activity level.

Diagnosed:-Xray,Mri,Ct,CBC,etc.

Treatment Management:-

Physical treatments

Physiotherapists, Chiropractors and osteopaths are all trained to treat neck problems. Treatment carried out by one of these therapists, along with home exercises, are often all that’s needed. They can suggest general or specific stretching and strengthening exercises for the neck.

It’s important to make sure that any physical treatments are given by qualified practitioners who are registered with the relevant body.

Manipulation

Manipulation is a type of manual therapy used to adjust parts of your body to treat stiffness. It can be uncomfortable at the time, so it’s important to understand what’s involved. Make sure you discuss your condition with your therapist and explain what symptoms you have been experiencing. This will enable them to make a more informed decision on what types of treatments you are most likely to benefit from.

It’s also a good idea to seek advice from a healthcare professional before you try manipulation as, even though some people report to have benefitted from it, it’s not suitable for everybody. If you have a condition such as Osteoporosis, some therapies won’t be recommended.

The Alexander Technique

The Alexander Technique is a method of teaching bodily awareness and reducing unwanted muscle tension. A qualified teacher will advise you on your standing and sitting posture and your patterns of movement. Some Physiotherapist are trained in this technique, but it’s not always available on the NHS.

If you have spinal problems, such as a slipped disc, this technique might not be suitable for you.

TENS (transcutaneous electrical nerve stimulation)

A TENS machine is a small battery-driven machine which may help to reduce pain. Small pads are placed over the painful area and low-voltage electrical stimulation produces a pleasant tingling sensation. It’s suggested that this can interfere with pain signals from the nerves to the brain. You can buy TENS machines from pharmacies, but your Physiotherapist may be able to let you borrow one to try first.

Collars

Some people find a special collar helpful to support the neck in cases of more serious or complex health problems. They are not routinely required.

Acupuncture

During a session of Acupuncture, very fine needles are inserted, virtually painlessly, at a number of sites on the skin. These are not necessarily at the painful area. Acupuncture seems to relieve pain in the short term by interfering with the signals to your brain and by causing the release of natural painkillers, known as endorphins.

Injections

In a very small minority of cases, especially if you have continuing pain in the back of your head or arm, a long-acting local anaesthetic or a Steroid Injection may help. The injection is usually given into the small facet joints of your neck. These injections tend to be given in an x-ray department so that the specialist can position the needle precisely.

Surgery

Surgery is only rarely needed. It may be helpful if a nerve or the spinal cord is being squeezed and is causing weakness in the arm or severe pain that won’t go away. The surgeon will ask for a scan to look at the nerves and bones before discussing the pros and cons of surgery with you and whether to go ahead with an operation.

Drug treatments:-

Amitriptyline

If over-the-counter painkillers alone aren’t effective, you may be prescribed an additional medication called Amitriptyline. This is also prescribed as an anti-depressant drug, but in lower doses it can be used to relax muscles and improve sleep.

You shouldn’t take amitriptyline if you have glaucoma, prostate problems or urinary retention.

Tablet 1:- Amilin 25 mg (As a Amitriptyline Hydrochloride AS a Tricyclic Anti-depressant.)

Indications of Tablet .Amilin 25 mg (As a Amitriptyline Hydrochloride AS a Tricyclic Anti-depressant.):-

Amilin is indicated in-

Depressive Illness: particularly where sedation is required.
Nocturnal Enuresis in children.
Prophylaxis of Migraine.
Tension Headache.
Chronic Pain.

Pharmacology of Tablet .Amilin 25 mg (As a Amitriptyline Hydrochloride AS a Tricyclic Anti-depressant.):-

The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms.

Side Effects of Tablet .Amilin 25 mg (As a Amitriptyline Hydrochloride AS a Tricyclic Anti-depressant.):-

Anticholinergic: Excessive perspiration, dry mouth, blurred vision, hyperpyrexia, urinary retention and urinary tract dilatation.
Cardiovascular reactions: Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, etc.
CNS and Neuromuscular: Confusional states, disturbed concentration, disorientation, delusions, etc.
Allergic: Skin rash, urticaria, photosensitization, etc.
Haematological: Bone-marrow depression.
Gastrointestinal: Nausea, epigastric distress, vomiting, anorexia, stomatitis, unpleasant taste, weight loss, diarrhoea, constipation, etc.
Endocrine: Testicular swelling, gynaecomastia, breast enlargement, galactorrhoea, etc.

Gabapentin and pregabalin:-

Gabapentin and pregabalin aren’t usually given as an initial treatment for ‘ordinary’ neck pain. However, if a pinched nerve in your neck is causing discomfort in your arm or arms, then these drugs can help by reducing nerve irritation. Depending on what drug you’re taking, you may need to trial it for a period of three to eight weeks to begin with. As with all drugs there can be side-effects, so they won’t be suitable for everyone. You should discuss this with your doctor.

Capsule 2:-Pregaba 25 mg (AS A Pregabalin As a Adjunct anti-epileptic drugs, Primary anti-epileptic drugs.)

Indications Of Capsule :-Pregaba 25 mg (AS A Pregabalin As a Adjunct anti-epileptic drugs, Primary anti-epileptic drugs.)

Pregaba film-coated tablet is indicated for:

Neuropathic pain associated with diabetic peripheral neuropathy
Postherpetic neuralgia
Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older
Fibromyalgia
Neuropathic pain associated with spinal cord injury

Pregaba controlled release tablet is indicated for:

Neuropathic pain associated with diabetic peripheral neuropathy
Postherpetic neuralgia

Pharmacology Of Capsule :-Pregaba 25 mg (AS A Pregabalin As a Adjunct anti-epileptic drugs, Primary anti-epileptic drugs.)

Pregabalin is a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It does not bind directly to GABA_A, GABA_B or benzodiazepine receptors. Pregabalin binds with high affinity to the alpha2-delta site (an auxiliary subunit of voltage-gated calcium channels) in central nervous system tissues. Although the mechanism of action of Pregabalin has not been fully elucidated, results in animal studies suggest that binding to the alpha2-delta subunit may be involved in Pregabalin’s anti-nociceptive and antiseizure effects.

Side Effects Of Capsule :-Pregaba 25 mg (AS A Pregabalin As a Adjunct anti-epileptic drugs, Primary anti-epileptic drugs.)

Most common side effects in adults are dizziness, somnolence, dry mouth, edema, blurred vision, weight gain and thinking abnormal (primarily difficulty with concentration/attention). Most common side effects in pediatric patients for the treatment of partial onset seizures are increased weight and increased appetite.

Tablet 3:-Gabastar 300mg (As a Gabapentin As a Adjunct anti-epileptic drugs).

Indications of Tablet :-Gabastar 300mg (As a Gabapentin As a Adjunct anti-epileptic drugs).

Gabastar is indicated for-

Neuropathic Pain.
Adjunctive therapy in partial seizure and secondary generalized seizure.

Pharmacology of Tablet :-Gabastar 300mg (As a Gabapentin As a Adjunct anti-epileptic drugs).

Gabapentin is an anti-convulsant. It is a structural analog of gamma-amino-butyric-acid (GABA). All pharmacological actions following administration of Gabapentin are due to the activity of parent compound. Gabapentin binds with the alpha-2-delta subunit of voltage gated L-type Calcium channel, and inhibits branched chain amino acid transferase & probably inhibits neurotransmitter release of excitatory amino acid.

Side Effects of Tablet :-Gabastar 300mg (As a Gabapentin As a Adjunct anti-epileptic drugs).

Fatigue, Dizziness, ataxia, weight gain, peripheral edema, dry mouth and somnolence may occur.

Pain Management:-

Tablet 1.Tory 60 mg 1+0+1 For 5 Days Am.(AS A Etoricoxib As a cyclooxygenase-2 (COX-2) specific inhibitor As a Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Indications Of Tablet Tory 60 mg .(AS A Etoricoxib As a cyclooxygenase-2 (COX-2) specific inhibitor As a Non-steroidal Anti-inflammatory Drugs (NSAIDs):-

Tory tablet is indicated for the symptomatic relief of-

Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Ankylosing spondylitis, and
The pain and signs of inflammation associated with acute gouty arthritis.
For the short-term treatment of moderate pain associated with dental surgery.

Pharmacology Of Tablet Tory 60 mg :-(AS A Etoricoxib As a cyclooxygenase-2 (COX-2) specific inhibitor As a Non-steroidal Anti-inflammatory Drugs (NSAIDs):-

Etoricoxib is a potent, orally active cyclooxygenase-2 (COX-2) specific inhibitor within, and significantly above, the clinical dose range. Two isoforms of cyclooxygenase have been identified: cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 is responsible for prostaglandin-mediated normal physiologic functions such as gastric cytoprotection and platelet aggregation. Inhibition of COX-1 by nonselective NSAIDs has been associated with gastric damage and inhibition of platelet aggregation. COX-2 has been shown to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever. Selective inhibition of COX-2 by etoricoxib (within the clinical dose range) decreases these clinical signs and symptoms with decreased potential for Gl toxicity and effects on platelet aggregation. Etoricoxib produced dose-dependent inhibition of COX-2 without inhibition of COX-1 at doses up to 150 mg daily. Etoricoxib did not inhibit gastric prostaglandin synthesis.

Side Effects Of Tablet Tory 60 mg :-(AS A Etoricoxib As a cyclooxygenase-2 (COX-2) specific inhibitor As a Non-steroidal Anti-inflammatory Drugs (NSAIDs):-

Side-effects may include palpitation, fatigue, influenza-like symptoms, ecchymosis; less commonly dry mouth, taste disturbance, mouth ulcer, appetite and weight change, atrial fibrillation, transient ischaemic attack, chest pain, flushing, cough, dyspnoea, epistaxis, anxiety, mental acuity impaired, paraesthesia, electrolyte disturbance, myalgia and arthralgia; very rarely confusion and hallucinations.

Tablet 2:-Sulidac 200 mg As a Sulindac As a Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Indications of Sulidac 200 mg As a Sulindac As a Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs):

Sulidac is indicated for the symptomatic treatment of-

Rheumatoid arthritis
Osteoarthritis
Ankylosing spondylitis
Periarticular inflammatory disorders
Acute painful shoulder
Acute gouty arthritis
Diabetic neuropathy
Diabetic retinopathy

Pharmacology of Sulidac 200 mg As a Sulindac As a Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs):-

Sulindac is a non-steroidal antirheumatic agent possessing anti-inflammatory, analgesic and anti-pyretic properties. Prostaglandin synthetase inhibition is probably the basis of the mechanism of action of non-steroidal anti-inflammatory agents. Following absorption, Sulindac undergoes two major transformations. It is oxidised to the sulphone and then reversibly reduced to the sulphide. The sulphide metabolite is the biologically active form which is an inhibitor of prostaglandin synthesis

Side Effects of Sulidac 200 mg As a Sulindac As a Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs):-

Gastrointestinal side effects are the most common and consist of abdominal pain, nausea and constipation. Gastrointestinal ulceration and bleeding may also occur. The most frequently reported central nervous system side effects are drowsiness, dizziness, headache and nervousness. Other adverse effects include depression, tinnitus, confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and mass gain, hypertension, hematuria, skin rashes, pruritus, urticaria, stomatitis, alopecia and hypersensitivity reactions. A hypersensitivity syndrome consisting of fever and chills, skin rashes or other cutaneous manifestations, hepatotoxicity, renal toxicity (including renal failure), leukopenia, thrombocytopenia, eosinophilia, inflammed glands or lymph nodes, and arthralgia have been reported. Leucopenia, purpura, thrombocytopenia, aplastic anaemia, haemolytic anaemia, agranulocytosis, epitaxis, hyperglycaemia, hyperkalaemia and vaginal bleeding have been reported. There have also been reports of hepatitis and jaundice or renal failure.

Tablet 3:-Myolax 100 mg AS A (Tolperisone Hydrochloride As a Central Depolarizing muscle relaxants, Centrally acting Skeletal Muscle Relaxants).

Indications of Tablet :-Myolax 100 mg AS A (Tolperisone Hydrochloride As a Central Depolarizing muscle relaxants, Centrally acting Skeletal Muscle Relaxants).

Myolax is indicated in-

Treatment of increased tone of skeletal muscles due to organic neurological disorders (injury of the pyramidal tract, multiple sclerosis, myelopathy, encephalomyelitis).
Treatment of muscular spasm, muscular contracture, rigidity, spinal automatism.
In the treatment of vascular diseases (Obliterative arteriosclerosis, diabetic angiopathy, obliterative thromboangitis, Raynaud’s disease, diffuse scleroderma).
In individual cases, post-thrombotic venous and lymphatic circulation disorders and crural ulcer.

Pharmacology of Tablet :-Myolax 100 mg AS A (Tolperisone Hydrochloride As a Central Depolarizing muscle relaxants, Centrally acting Skeletal Muscle Relaxants).

Tolperisone Hydrochloride is a centrally acting muscle relaxant, which acts on the central nervous system and used mainly for the treatment of elevated muscle tone and tension as well as for certain circulation problems in the extremities.

Side Effects of Tablet :-Myolax 100 mg AS A (Tolperisone Hydrochloride As a Central Depolarizing muscle relaxants, Centrally acting Skeletal Muscle Relaxants).

Possible side-effects include sometimes muscular weakness, headache, nausea, vomiting and rarely hypersensitivity reactions (itching, redness of the skin, skin rash) may occur.

Jodi pain tarpor o na kome then NSAIDs er sate nicher medicine ta suru korte hobe

Tablet 5.Relentus 2 mg (As a Tizanidine Hydrochloride As a Centrally acting Skeletal Muscle Relaxants).

Indications of Tablet .Relentus 2 mg (As a Tizanidine Hydrochloride As a Centrally acting Skeletal Muscle Relaxants):-

Treatment of painful muscle spasms:

Associated with static and functional disorders of the spine (cervical and lumbar syndromes).
Following surgery, e.g. for herniated intervertebral disc or osteoarthritis of the hip.

Treatment of spasticity due to neurological disorders:

Multiple sclerosis, chronic myelopathy, degenerative spinal cord diseases, cerebrovascular accidents, and cerebral palsy.

Pharmacology Indications of Tablet .Relentus 2 mg (As a Tizanidine Hydrochloride As a Centrally acting Skeletal Muscle Relaxants):-

Tizanidine is a centrally acting skeletal muscle relaxant. Its principal site of action is the spinal cord, where the evidence suggests that, by stimulating presynaptic alpha2 receptors, it inhibits the release of excitatory amino acids that stimulate N-methyl-D aspartate (NMDA) receptors.

Polysynaptic signal transmission at spinal interneuron level, which is responsible for excessive muscle tone, is thus inhibited and muscle tone reduced. In addition to its muscle-relaxant properties, tizanidine also exerts a moderate central analgesic effect.

Pharmacodynamic: Tizanidine is effective in both acute painful muscle spasms and chronic spasticity of spinal and cerebral origin. It reduces resistance to passive movements, alleviates spasms and clonus, and may improve voluntary strength. The antispastic activity (measured by the Ashworth score and pendulum test) and adverse effects (heart rate and blood pressure) of Tizanidine are related to plasma tizanidine concentrations.

Side Effects Indications of Tablet .Relentus 2 mg (As a Tizanidine Hydrochloride As a Centrally acting Skeletal Muscle Relaxants):-

With low doses, such as those recommended for the relief of painful muscle spasms, somnolence, fatigue, dizziness, dry mouth, blood pressure decrease, nausea, gastrointestinal disorder and transaminase increase have been reported, usually as mild and transient adverse reactions.

With the higher doses recommended for the treatment of spasticity, the adverse reactions reported with low doses are more frequent and more pronounced, but seldom severe enough to require discontinuation of treatment. In addition, the following adverse reactions may occur: hypotension, bradycardia, muscular weakness, insomnia, sleep disorder, hallucination & hepatitis.

Psychiatric disorders: Common- Insomnia, sleep disorder.
Nervous system disorders: Very common- Somnolence, dizziness
Cardiac disorders: Uncommon- Bradycardia
Vascular disorders: Common- Hypotension
Gastrointestinal disorders: Very common- Gastrointestinal disorder, dry mouth; Common- Nausea.
Musculoskeletal and connective tissue disorders: Very common- Muscular weakness
General disorders and administration site conditions: Very common- Fatigue
Investigations: Common- Blood pressure decreased, transaminases increased.

How to ease neck pain at home

If you have minor neck pain or stiffness, take these simple steps to relieve it:

Apply ice for the first few days. After that, apply heat with a Heating pad, hot compress, or by taking a hot shower.
Take OTC pain Relivers, such as ibuprofen or acetaminophen.
Take a few days off from sports, activities that aggravate your symptoms, and heavy lifting. When you resume normal activity, do so slowly as your symptoms ease.
Exercise your neck every day. Slowly stretch your head in side-to-side and up-and-down motions.
Practice good posture.
Avoid cradling the phone between your neck and shoulder.
Change your position often. Don’t stand or sit in one position for too long.
Get a gentle neck massage.
Use a special neck pillow for sleeping.
Don’t use a neck brace or collar without your doctor’s approval. If you don’t use them properly, they can make your symptoms worse.
Raiyyan Tahsan Date:-25-12-2024 Thursday Time:-8.24.45 PM.

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