Question :

Possible cervical degenerative bone changes causing severe pain

Dear Ask The Doctor:
I am a 47 year old female; I have been having severe neck pain for several months. The pain is in the top center of my neck, down both sides of my neck and into both shoulders. I have seen my physician who is a MD (internal medicine); which ordered an MRI on the spine. His opinion after reading the results of the MRI was a pinched nerve or nerves; and wanted me to see a specialist. This doctor was also aware that I had been seeing a chiropractor, and said I could continue seeing him. The chiropractor tried massage therapy along with "trying" to adjust my neck; which did not work, it only made the pain worse. When he saw that I was in so much pain he suggested that I "lay off" the visits until a specialist had seen me. I continued with my doctor's advice and the advice from the Chiropractor and scheduled an appointment with a Neurosurgeon. When I saw this "specialist", I was told that he specializes in "spine surgery"; and I did not need surgery. He ask me to move my head downward; then backward; (which I did until there was pain) then he ask me to move side to side which I told him I could not do without pain. Not once did he put his hands on my neck, back, or spine. He had only read the MRI results; looked at the images, and checked my reflexes and watched me walk. His diagnosis was arthritis. I tried to explain to him that my pain level was an 11 based upon the 1 to 10 scale. He suggested Pain Management and sent me on my way. Next, I continued my search for pain relief and went to Acupuncture clinic; which I feel was a waste of time and money. I have tried moist heat, ice, massage, soft neck brace, and narcotics. The only way I feel any relief is if I take something that makes me go to sleep; then I feel no pain; which can't be good. I have included the results of the MRI that I think would be most helpful in trying to determine a suggestion for a possible diagnosis. I am currently seeking a second opinion, but for now I am really scared. The pain won't go away, I haven't been able to work for almost 3 months now, and I just want to cry all the time because the pain is so intense. My question is: What do you think it could be and where should I turn to for more help? I am very limited for specialist visits with my insurance (5 per year); and I've used 1 already with No satisfying results. Unfortunately, if I do go to a Pain Management that is considered a specialist visit, so I am trying to avoid that. Thank you!


Answer :

Dear Patient: 
The severe neck pain radiated to your shoulders as you described might be due to a cervical nerve compression, In the younger patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone spur(osteophyte) formation, decreased disc height and degenerative changes due to aging process, all these should be showing in the MRI. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory medication NSAIDs (“motrin”, “Aleve”), also a re-education of your habits and posture to improve quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If after try all these, your condition fail to improve even with a comprehensive rehabilitation program and selective injections you should be presented with a surgical evaluation. I strongly recommend you to go to a orthopedic surgeon specialized in spine problems and get your second opinion.


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