Symptoms
One speaks of chronic neck pain if the complaints last longer than 3 months. Typical for chronic pain is a changing symptomatology, i.e. there is a permanent pain of varying intensity. Pain peaks are often in the morning after getting up and in the evening after the day’s workload has been completed, when the person concerned comes to rest.
The pain is often accompanied by additional permanent movement restrictions due to the fact that the neck is protected, so that the twisting, bending and stretching movements of the cervical spine are reduced. Chronic neck pain can be present as an isolated symptomatology, but it often occurs in combination with shoulder and arm pain, tension headaches or chronic back pain. Chronic and acute: sometimes both come together Acute neck pain can develop into chronic pain, but an acute problem of the cervical spine can also follow on from chronic pain.
Example: chronic neck and possibly headache is already present, the patient wakes up in the morning with an acute painful dysfunction and cannot turn his head to the side. Pain enhancer: Pain memory: The cause of the development and treatment of chronic pain has been intensively investigated for years in pain research, as chronic pain is an increasing problem for both the patient and the health care system.
- Overhead work/overhead sports (e.g. tennis or handball)
- Strenuous activities with the shoulder girdle
- Cold draught on the neck, humid cold weather
- Additionally acquired acute pain patterns due to blockages, accidents, etc.
- Increased “stress load” in everyday life and at work
Rest is recommended in case of acute pain (e.g.B.
in the case of a disc problem or a severe blockage caused by “moving the neck at night”) absolutely necessary and sensible to relieve irritated, severely painful tissue. The pain quality is described as sharp, stabbing, cutting or pointed. In this stage, depending on the cause, a medicinal (pain and inflammation inhibitors), manual therapy, physical measures such as heat, electrotherapy, tape and possibly careful active physiotherapeutic treatment for mobilization is indicated.
In addition, with an acute pain event of the neck the protection phase should be kept as short as possible in order to keep the risk of a chronification as small as possible. The prerequisite for this is a consistent and sufficient pain treatment in the acute pain phase. Otherwise, there is a risk that with continued rest and the fear of pain, a process of unfavorable posture and movement patterns in everyday life develops (e.g. the continuous crooked posture of the head), which the affected persons no longer perceive as changed behavior after some time and therefore cannot correct it.
The consequence of the pain-related relief is an increasing decrease in the stress limit and decreasing resilience in everyday life and at work. However, there are also affected persons who do not take the path of protection, but have rather developed perseverance strategies (“the happy bite through bites”) for their everyday life. Since you do not take any consideration for their complaints, they constantly go beyond their stress limit.
This group appears outwardly cheerful and light-hearted, so that the therapists, relatives and friends get the impression that the affected persons are free of complaints and well resilient. This behavior also acts as a so-called “pain trigger”. The mechanisms of pain chronification are based on the ability of nerve cells to adapt to different stimuli.
There is no precisely defined period of time between acute damage and the point in time when chronification occurs. Multiple tissue damage and inflammation lead to an increased excitability of pain-conducting nerve cells in the brain if these injuries (medical trauma) have not been treated consistently and sufficiently with pain medicine. In addition, there are psychosocial aspects that significantly influence the individual perception of pain.
The consequence of the increased excitability of nerve cells (the pain is “quasi stored in the cells” = pain memory) is the excessive perception of pain stimuli, or pain sensation in the case of stimuli that do not actually trigger pain. The pain quality is described as dull, drilling, pulling, burning or tearing. An independent clinical picture has developed.
The affected persons do not react appropriately to cold stimuli, low physical strain or stress (triggers), but also cannot be influenced deliberately with an increase in pain of the known neck and/or headaches. This “hypersensitivity” is difficult to understand for the patients themselves, but also for employers and close persons. The lack of understanding and acceptance of the environment increases the emotional and psychological stress and thus in turn increases pain sensitivity.
A comprehensive treatment concept should be the consequence of the knowledge about the manifold mechanisms of the development of chronic neck pain. Multimodal pain therapy (therapy that includes different treatment approaches) can only be realized in an interdisciplinary way in a team of physicians, psycho- and physiotherapists and has already proven its worth in the treatment of chronic back pain. It has been proven that these multimodal treatment concepts achieve the best results. Unfortunately, however, in reality they are often not consistently or only partially feasible due to cost or time constraints.
