In most cases, neck pain responds well to a patient’s attempts to treat it at home. Over-the-counter anti-inflammatory drugs such as aspirin, ibuprofen or naproxen can help relieve inflammation and pain. Analgesics such as acetaminophen relieve pain but do not reduce inflammation.

Ice (cryotherapy) can also help reduce inflammation. It should be applied for 15 to 20 minutes, with 40 minutes between applications. The ice should not be applied directly to the skin but should be covered with a towel, ice pack or other barrier. Heat and water treatments (thermotherapy and hydrotherapy) may also be used to relax sore muscles (e.g., hot compress, heating pad or hot shower). However, in some cases heat can aggravate inflammation, so it should be used with caution.

If self treatments do not begin to resolve neck pain within two weeks, prescription drugs or medical pain management interventions may be necessary. These may include:

• Physical therapy. Treatment in which a physical therapist will design and execute a stretching and muscle-strengthening exercise therapy program that enhances the support structures of the cervical spine. In many cases, such therapy is adequate by itself to relieve neck pain. The therapist may also use modalities such as hot packs, therapeutic ultrasound or electrical therapy to ease pain and maximize range of motion. Patients can be instructed to use transcutaneous electrical nerve stimulation (TENS) at home.
  
  
• Manipulation therapy. Professionals such as chiropractors, osteopaths or massage therapists may offer relief.
  
  
• Medications. Prescription pain medicines have many of the same anti-inflammatory and pain–relieving effects as over-the-counter drugs, but offer them in stronger doses. However, some are available only by prescription. Examples of these drugs include:
  
  
• Opioids. Prescribed to manage severe acute and chronic pain, these medications should be used only under close supervision of a physician, as they can have numerous side effects, including drowsiness, decreased reaction time, impaired judgment, depression and addiction.
  
  
• Antidepressants. Some antidepressants can relieve pain and assist with sleep.
  
  
• Injection therapy. A number of injections, which include epidurals, facet joint injections and nerve blocks, are available for patients not wanting surgery. These injections are usually performed by pain specialists trained in the neck area.
  
  
• Short-term immobilization. A soft cervical collar can be worn for a period of time. This supports the spine, reduces mobility and lessens pain and irritation while allowing the neck muscles to relax as they heal.
  
  
• Traction. A cervical traction device attaches to the head and uses weights and a pulley to pull up on the head. This is designed to “pull” the neck’s skeletal structure into better alignment. It is especially useful in treating nerve root irritation, and pain relief may last for hours or days. Traction may be used in cases of “unstable spine” or in vertebral fractures but is not commonly employed.

Other treatment methods that a physician may recommend include cognitive behavioral therapy for chronic neck pain or complementary and alternative treatments such as acupuncture, acupressure or biofeedback. If noninvasive methods fail, options may include:

• Cervical spine surgery. In rare cases, surgery may be necessary to treat neck pain. It is most often used to relieve compression of the nerve roots or spinal cord due to a herniated disc or bony narrowing of the spinal canal. Surgery also may be necessary to stabilize the neck and minimize the possibility of paralysis after an injury. Surgical options include:
  
  
• Anterior cervical discectomy. The most common surgical procedure used to relieve neck pain caused by pressure on one or more nerve roots or on the spinal cord. This procedure enlarges the nerve opening and removes troublesome spinal discs. Bone spurs compressing the spinal sac or nerve roots also are removed.
  
  
• Cervical corpectomy. A more extensive version of the anterior cervical discectomy, it involves removing vertebrae as well as discs. Risks are slightly higher with this procedure and include damage to nerve roots and the spinal cord, bleeding, infection, damage to the trachea or esophagus and paralysis.
  
  
• Posterior hemi-laminectomy. Operation performed through a vertical incision in the back of the neck in which bone around the spinal cord or nerve opening is removed. Attached ligaments exerting pressure on the spinal sac and nerve roots also are removed.
  
  
• Spinal fusion. This procedure will decrease the neck’s range of motion.
  
  
• Verebroplasty or kyphoplasty. These procedures may be used for compression fractures caused by osteoporosis.

Recent research suggests that injection of botulinum toxin type A, a popular method of fighting wrinkles, may ease chronic neck pain as well as other pain conditions ranging from migraines to tennis elbow to back pain.

Treatment by a physician or other healthcare professional is likely to proceed in three phases. Initially, treatment will focus on reducing pain and inflammation. The second phase concentrates on promoting increased strength and flexibility of the tissues. The final phase involves exercise and lifestyle techniques that will help the patient maintain this strength and flexibility to minimize the risk of future episodes of neck pain.