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What Causes Moderate Neck Pain Despite Having Normal MRI And X-ray?
Question: I have had moderate neck pain for 3 years (3-4 on a scale of 1-10) which is severely affecting my ability to lift, read and travel. The pain is worst at the base of the skull near the occipitals. The pain is dull, aching, throbbing in nature and there is muscle spasm. There is some cracking / popping in my neck. MRI and X-rays are essentially normal, though flexion / extension xray shows 2-3 mm of motion in C3-4 and C4-5.
The first time I felt pain was when my neck cracked in summer of 2012, but the pain was very mild and only present once in awhile. I fell forward in the winter of 2012 (I did not hit my head or need to go to the emergency room for it) and that made the neck pain much worse. I did physical therapy and that made things better, but a friend hung on my neck and that brought on the pain again. I did physical therapy again, but the pain did not go away, though it got better. After that I have tried acupuncutre, massage, chiropractic care, CBP traction, osteopathic care, rapid release motion, laser and have recently started prolozone injections. Out of the treatments mentioned in the previous line, massage, acupuncture and traction helped, but again did not take the pain away. Please let me know what other possible treatment options are out there
The first time I felt pain was when my neck cracked in summer of 2012, but the pain was very mild and only present once in awhile. I fell forward in the winter of 2012 (I did not hit my head or need to go to the emergency room for it) and that made the neck pain much worse. I did physical therapy and that made things better, but a friend hung on my neck and that brought on the pain again. I did physical therapy again, but the pain did not go away, though it got better. After that I have tried acupuncutre, massage, chiropractic care, CBP traction, osteopathic care, rapid release motion, laser and have recently started prolozone injections. Out of the treatments mentioned in the previous line, massage, acupuncture and traction helped, but again did not take the pain away. Please let me know what other possible treatment options are out there
Brief Answer:
Periradicular injections could be tried.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
There's need for some clarifications first.
- MRI and dynamic x-rays you mentioned, are recent or more than 6 months old?
- did you tried drugs to ease the pain? (painkillers, NSAID drugs)
There is Spondylolysthesis at C3-C4 and C4-C5 levels that clinically affects the nerve roots that supply base of skull, so there is correlation of lesion with imaging findings in your case.
Most accepted treatment algorithm in such case is NSAID drugs and painkillers (opioids eg.), when free from pain, physical therapy with the aim of strengthening neck muscles and reducing joint loading, periradicular injections and in the end if all measures together with those prescribed by you, stabilization surgery.
In my opinion, you should discuss with your treating Doctor about having done periradicular injections of Marcain and Steroids at C3-C4 and C4-C5 nerve roots.
If MRI and x-rays too old ( 6 months eg.), since pain is still present, new ones should be done.
Hope this helps. I remain at your disposal for further questions and clarifications.
Take care.
Periradicular injections could be tried.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
There's need for some clarifications first.
- MRI and dynamic x-rays you mentioned, are recent or more than 6 months old?
- did you tried drugs to ease the pain? (painkillers, NSAID drugs)
There is Spondylolysthesis at C3-C4 and C4-C5 levels that clinically affects the nerve roots that supply base of skull, so there is correlation of lesion with imaging findings in your case.
Most accepted treatment algorithm in such case is NSAID drugs and painkillers (opioids eg.), when free from pain, physical therapy with the aim of strengthening neck muscles and reducing joint loading, periradicular injections and in the end if all measures together with those prescribed by you, stabilization surgery.
In my opinion, you should discuss with your treating Doctor about having done periradicular injections of Marcain and Steroids at C3-C4 and C4-C5 nerve roots.
If MRI and x-rays too old ( 6 months eg.), since pain is still present, new ones should be done.
Hope this helps. I remain at your disposal for further questions and clarifications.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
The x-ray is within 6 months
The MRI is a year and half old. I can get another MRI.
Follow up:
1) The exact flexion / extension x-ray language is "2 mm anterolisthesis of c3 on c4 seen on the flexion view, which reduces with extension. There is also minimal retrolisthesis of c4 on c5 on the extension view with 1 to 2mm anterolisthesis on flexion view. There is mild straightening of the cervical spine." Just to confirm - do you think this is causing base of the skull neck pain and which exact nerve is being impinged? Also, how could I test for that (EMG etc.)?
2) Wont the pain killers just temporarily ease the pain? Also, how long is the relief from the steroid injections and how often would I need to get them done to keep the pain away?
3) Prolozone is used for curing movement of vertabraes due to ligament laxity. Why would you say it did not work for me?
Thanks, XXXXXXX
The MRI is a year and half old. I can get another MRI.
Follow up:
1) The exact flexion / extension x-ray language is "2 mm anterolisthesis of c3 on c4 seen on the flexion view, which reduces with extension. There is also minimal retrolisthesis of c4 on c5 on the extension view with 1 to 2mm anterolisthesis on flexion view. There is mild straightening of the cervical spine." Just to confirm - do you think this is causing base of the skull neck pain and which exact nerve is being impinged? Also, how could I test for that (EMG etc.)?
2) Wont the pain killers just temporarily ease the pain? Also, how long is the relief from the steroid injections and how often would I need to get them done to keep the pain away?
3) Prolozone is used for curing movement of vertabraes due to ligament laxity. Why would you say it did not work for me?
Thanks, XXXXXXX
Brief Answer:
C3nerves are causing your pain.
Detailed Answer:
Welcome back XXXXXXX
Base of skull is supplied by C3 nerves, so most likely this is causing your pain.
Best evaluation tool in this case is clinical assessment by a Neurologist, EMG with concentric needles should help to confirm diagnosis.
NSAID drugs ease the pain and reduce the swelling of the nerves and tissue around the nerves, reducing this way compression.
About half of patients that undergo periradicular injections of steroids remain free of pain for long periods of time (years).
If first injection is not successful, two other injections with a distance of 20 days between each, could be tried.
I didn't say Prolozone didn't work for you, if you still having pain is probably not working.
If Prolozone is used to improve instability, new assessment with x-rays and MRI needed.
In my opinion, the appropriate treatment of your condition is physical therapy with the aim of strengthening cervical musculature.
Hope this helps. Best regards.
C3nerves are causing your pain.
Detailed Answer:
Welcome back XXXXXXX
Base of skull is supplied by C3 nerves, so most likely this is causing your pain.
Best evaluation tool in this case is clinical assessment by a Neurologist, EMG with concentric needles should help to confirm diagnosis.
NSAID drugs ease the pain and reduce the swelling of the nerves and tissue around the nerves, reducing this way compression.
About half of patients that undergo periradicular injections of steroids remain free of pain for long periods of time (years).
If first injection is not successful, two other injections with a distance of 20 days between each, could be tried.
I didn't say Prolozone didn't work for you, if you still having pain is probably not working.
If Prolozone is used to improve instability, new assessment with x-rays and MRI needed.
In my opinion, the appropriate treatment of your condition is physical therapy with the aim of strengthening cervical musculature.
Hope this helps. Best regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Okay, thank you. I have tried physical therapy for a total of 6 months and it has not work. It is very difficult for me to lift anything at all and so weights in physical therapy are not even possible.
Couple of follow ups:
1) I was wondering why you think prolozone did not work for me? Also, what do you mean by "If Prolozone is used to improve instability, new assessment with x-rays and MRI needed"
2) Apart from consulting a neurologist and doing an EMG, what other tools can help diagnose the pain?
Thanks!
XXXXXXX
Couple of follow ups:
1) I was wondering why you think prolozone did not work for me? Also, what do you mean by "If Prolozone is used to improve instability, new assessment with x-rays and MRI needed"
2) Apart from consulting a neurologist and doing an EMG, what other tools can help diagnose the pain?
Thanks!
XXXXXXX
Brief Answer:
Pain cannot be diagnosed, can only be measured.
Detailed Answer:
Welcome back XXXXXXX
Prolozone injections are used to improve pain ( in your case neck pain) and to reconstruct the connective tissue of joints.
If you continue to have pain and there is still instability, there is nerve damage too by compression and Prolozone doesn't work on nerves.
Pain cannot be diagnosed, it is your experience, only causes of pain could be assessed by clinical examination and different tests.
In your case, appropriate tests are EMG, MRI and dynamic x-rays to assess possible nerve compression.
Hope this helps. Best regards.
Pain cannot be diagnosed, can only be measured.
Detailed Answer:
Welcome back XXXXXXX
Prolozone injections are used to improve pain ( in your case neck pain) and to reconstruct the connective tissue of joints.
If you continue to have pain and there is still instability, there is nerve damage too by compression and Prolozone doesn't work on nerves.
Pain cannot be diagnosed, it is your experience, only causes of pain could be assessed by clinical examination and different tests.
In your case, appropriate tests are EMG, MRI and dynamic x-rays to assess possible nerve compression.
Hope this helps. Best regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
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