Treating a Stiff Neck: Understanding Cervical Injections

A stiff neck, also known as cervicalgia, is a common condition characterized by pain and decreased range of motion in the neck. It can make daily activities like driving, working at a computer, or looking over your shoulder quite difficult and uncomfortable. While mild cases often resolve with rest, gentle stretches, hot/cold therapy, and over-the-counter pain medication, more severe or persistent cases may require other treatments like cervical injections.

Cervical injections deliver medication directly into the cervical spine to help reduce inflammation, swelling, and pain associated with a stiff neck. They can provide targeted pain relief when other conservative treatments fail to fully address symptoms. If you’ve been dealing with stubborn neck pain, your doctor may recommend trying cervical epidural steroid injections or cervical facet injections. Understanding how these injections work and what to expect can help you decide if they are the right option for finding neck pain relief.

What Causes a Stiff Neck?

Before exploring cervical injections, it’s helpful to understand what’s causing a stiff neck in the first place. Common causes include:

  • Poor posture: Slouching at a desk or looking down at phones/devices strains the neck over time.
  • Sleeping positions: Sleeping in awkward positions can kink the neck muscles.
  • Injuries: Car accidents, sports injuries, or falls can sprain ligaments and tendons in the neck.
  • Arthritis: Degenerative cervical disc disease and arthritis in the facet joints can cause neck stiffness.
  • Stress: Chronic muscular tension leads to neck tightness and spasms.

In many cases, pain and inflammation result when delicate neck structures like intervertebral discs, facet joints, muscles, and nerves get compressed or irritated. Cervical injections work by delivering anti-inflammatory corticosteroids to the precise location that is generating the pain.

Understanding Cervical Epidural Steroid Injections

Cervical epidural steroid injections are one of the most common types of injections used to treat stiff necks. They involve injecting corticosteroid medication into the epidural space surrounding the spinal cord. This space contains the cervical nerve roots that transmit sensory information from the neck to the brain.

Injecting corticosteroid around inflamed nerves can reduce swelling and irritation, thereby alleviating radiating neck pain, arm pain or numbness caused by nerve compression. Steroids diminish inflammation by inhibiting the body’s immune response. The effects are temporary but can provide several months of pain relief while the body heals.

The procedure is performed under light sedation or local anesthetic. The patient lies face down while the doctor inserts a thin needle into the epidural space in the neck. Fluoroscopy (live x-ray) is used to precisely guide the needle to the target area. Once confirmed to be in the correct position, the steroid medication is injected.

Pain relief may not be immediate but over the next few weeks inflammation should subside. Most patients require at least three injections spaced out over several months for sustained improvement. Temporary side effects like headache or nausea are possible following the procedure. Rare but potential risks include infection, bleeding or nerve injury. Patients can usually return to normal activities within a few days.

What are Cervical Facet Joint Injections?

The small facet joints along the spine allow flexibility and stabilization in the neck. Like other joints, these facets can develop arthritis and become a significant source of neck pain. Cervical facet injections target these arthritic facet joints.

A facet joint injection procedure is very similar to an epidural injection. The patient is awake but sedated and the skin is numbed with local anesthetic. Under fluoroscopy guidance, the doctor inserts a thin needle directly into or just outside the facet capsule. After confirming proper needle position, a cocktail of numbing anesthetic (like lidocaine) and corticosteroid is slowly injected.

The fast-acting numbing medication blocks pain signals from the joint providing temporary but immediate pain relief. The time-released steroid starts working over the next few days to calm joint inflammation, which offers extended pain relief. Patients may get benefit for several months before needing repeat injections.

Potential side effects are minimal but can include bleeding, infection, nerve injury or temporary dizziness from the anesthetic. There is also a small risk of the needle fracturing a small bony fragment from the fragile facet joint.

Deciding if Cervical Injections are Appropriate

Cervical injections offer a minimally invasive way to directly treat the structures causing neck pain, but they aren’t right for everyone. Your doctor will determine if you are an appropriate candidate based on factors like:

  • Cause and severity of your neck pain
  • Extent of nerve involvement
  • Degree of degenerative changes shown on imaging like x-ray, MRI or CT scan
  • Duration of symptoms and failure to improve with more conservative treatments first
  • Lack of contradictions like bleeding disorders or infections

Potential benefits of trying cervical injections include:

  • Targeted delivery of medication right to the pain source
  • Both immediate and extended pain relief in one procedure
  • Avoiding prolonged use of oral NSAIDs and opioids
  • Avoiding neck surgery if injections successfully alleviate symptoms

Risks and downsides to weigh include:

  • Temporary pain or soreness after the injection
  • Potential side effects like headache or dizziness
  • Repeat injections required every few months to maintain improvement
  • Does not treat the underlying condition causing pain
  • Small risks from injection procedure itself

Talking through these pros and cons with your doctor can help determine if attempting cervical injections is your next best step for finding relief from a chronically stiff and painful neck. While not universally effective, they provide a relatively low-risk option that helps many people delay or avoid neck surgery. Understanding the basics of what’s involved and having realistic expectations makes these injections more likely to successfully reduce your neck pain.