Patient: Chronic pain and shoulder pain for 4 months, happens when I bend down my neck for more than 10 seconds and when I sit in a fixed position for more than 15 minutes
Symptoms: Dear Doctor,
I have a chronic pain in my neck for almost 4 months now, the pain usually start and increase in two situations, the first one when I bend down my neck for more than 10 seconds and the second one when I sit in a fixed position for more than 15 minutes while my neck carry my head.
Usually the pain starts in my neck, then increase to my shoulders and center back.
I have done an MRI (attached) and I have seen 4 different doctors till now (attached their prescriptions), unfortunately there no any significant improvement in my conditions but it stills the same as the first day.
I am a male with 32 years old and my profession is IT project manager.
Appreciate if you can provide a reason for my condition as it seems that i have been treated for the wrong reasons till now.
Doctor: Hello, and Welcome to ATD.You have not been prescribed wrong medication.You have cervical spine related pain due t o faulty posture or work related pain seen commonly in IT professional. You need to have lifestyle modification and add isometric cervical exercises to your routine part from medication mentioned by the doctors.Most improvement will be by the lifestyle changes and regular exercises.Pain improvement will take a few weeks from now.If there is anything else feel free to discuss.Regards
Comments / Follow Ups
Patient: Hi, Unforutantly your answer doesn’t add anything new to what I know or did in the last 4 months, i took all types of medications and there is no any significant improvement. And Cervical Isometric Exercises make my condition worse.
Please I need more detailed analysis of my condition and recommendations to improve, i have tried everything for 4 months so i need to hear something new that really help 🙁
I have seen all your prescriptions and MRI images attached with the query, you have the cervical disc prolapse at 3 levels. All of them are of mild grade, you don’t have any nerve compression or cord related changes as per your MRI and symptom profile, so operative intervention is ruled out; due to which almost similar treatment is prescribed by all the doctors.
I suppose you have undertaken physiotherapy in the form of short wave diathermy and intermittent cervical traction, if not these procedures can be of immense help. If you have already tried them then continuous traction is required in a hospital setting.
There are pain relief centres/ clinics usually managed by Anaesthetics where complimentary treatment modalities such as acupuncture, acupressure, nerve stimulators, radiofrequency ablation, epidural injections are used along with medication.
You need to modifications to your lifestyle, whatever treatment you choose to take. Here are the mechanics of neck musculature to help you understand role of posture-
The average weight of an adult head weighs between 8-12lb, so 12lbs of force need to be generated by the neck and shoulder muscles to hold your head up. If your head falls forward while working at computer or typing messages at the phone, the muscles now need to generate 36lbs of force to hold your head up. After a period of time, this amount of force generation will cause fatigue and pain.
The second factor is there is a common practise of popping or crackling joints of the neck just like knuckles which predisposes to early osteoarthritic changes in cervical vertebra and leads to chronic pain.
In your first post, you were concerned about wrong treatment received, so I answered accordingly. I there is anything you want to discuss or wish to know be free to ask.
There are surgical procedures where there is no relief with conservative treatment or relieve nerve/cord compression, but these are not indicated in your case.
Feel free to discuss, I’ll be happy to answer your questions.
Patient: Thanks for your detailed answer, my last two questions, if my condition was analyzed correctly by the 4 doctors, i have taken all required medication, have taken physiotherapy and i have changed my lifestyle:
1- Why I don’t feel any improvement after 4 months?
2- what is the new solution that will make me feel better and heal?
My problem now is my whole life is on-hold and i cant do or enjoy anything because of my neck
I have mentioned the usual treatment protocol which has been followed. Pain in cases of disc prolapse takes months to settle. People usually require multiple courses of traction, immobilization by soft collar or hard collar.
I have mentioned couple of alternative treatment methods, you can check their availability with your local doctor and try them.
Its better to go with multimodal treatment with chronic pain such as your to achieve better chances of pain relief.
Further discussion is invited.
Patient: Hi today my physiotherapy doctor asked me to visit nervous & brain specialist to advise if there is another cause for my case, do you think i should do? Is there a possibility that there is another cause for my case?
Doctor: Yes, there can be always be other causes especially when the disease with minimal findings on MRI is not resolving with correct treatment taken over 4 months.’since that is not my specialist its difficult to say what they’ll be looking for.
Issue is still open for discussion.