颈项疼痛 Neck Pain

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(English version follows Chinese)

简介

颈部结构含有肌肉、神经、血管、骨骼（颈椎）、关节以及软组织。颈部支持头部，与活动头部。

颈项疼痛是时下常见的不舒服症状。它主要与姿势不良所致的肌肉牵拉有关。尤其是在3C时代【电脑、通讯（智能手机为主）、电子消费品】。其他常见因素也可导致颈项疼痛，例如：颈椎退化。通常，颈项较少涉及严重疾病，例如创伤。

一般上，颈项疼痛可通过家庭护理方式在数日内获得缓解，例如：调整姿势、涂敷外用消炎止痛药膏、休息、冰敷等等）。如有以下情况，则须寻求专业诊治：

• 打从开始即剧烈疼痛
• 较为长久的慢性疼痛（持续或间断发作），而且不能通过家庭式处理减轻症状
• 较久的颈项疼痛，而且消炎止痛西药无法缓解疼痛
• 当疼痛逐渐加重
• 颈项疼痛伴有放射性疼痛及，可能有一侧或双侧上肢手臂或手指麻木感，或者更大范围感觉麻木或疼痛的不适
• 一侧或双侧上肢手臂逐渐乏力
• 颈痛伴有一侧或双侧下肢麻木
• 涉及交通意外的颈部疼痛

常见症状与体征

• 不同程度的颈项疼痛
• 颈部或头部活动受到限制
• 固定头部在一个姿势较久时间可以诱发颈项疼痛，比如：查阅手机、使用电脑或笔电、驾驶
• 颈项周围和/或肩膀的肌肉绷紧，可能限制活动范围
• 一侧头痛，服用偏头痛药物不能缓解疼痛

颈项疼痛可根据病程分类：

• 急性：疼痛发作少于4周
• 亚急性：疼痛发作介于4周至12周之间
• 慢性：疼痛发作至少3个月或以上

现代医学（西医）治疗

• 非手术治疗：药物（消炎止痛药）、注射剂、物理治疗
• 手术治疗：当较为严重的症状通过非手术治疗方法无法缓解症状，可以考虑手术处理

中医药治疗方法

• 推拿按摩：最安全有效的其中有一个手法治疗
• 针刺：获广泛认可的有效止痛方法，适用于中等与较剧烈的疼痛
• 中药治疗：通过祛除风湿，达到遏止炎症、减轻疼痛的作用
• 拔罐：能减轻酸痛与肌肉绷紧

颈项疼痛的常见原因

• 肌肉牵拉
  较长时间的弯曲颈项，较常见于伏案工作、查阅手机、电脑工作；常坐姿睡觉较为少见。 
• 关节退化
  随着人体逐渐老化，颈椎关节无可避免也逐渐退化，称为骨关节炎（又称为退化性关节炎）。这过程使垫在椎关节之间的软组织也跟着退化，导致椎骨形成骨刺。当锥体活动，骨刺可诱发疼痛。
• 压迫神经根 在颈椎骨之间膨出的椎间盘挤压由脊髓分支出来的神经根，导致疼痛。
• 机械性损伤 交通意外当涉及从后撞击，突然加速-减速力度上的变化激发头颈迅速前倾后仰。这一刹那的机械性变化引起头部前后抖动，导致颈部软组织扭伤。
• 疾病的影响
  一些疾病，例如强直性脊柱炎、实体肿瘤、类风湿性关节炎、高血压控制不良等等，均可引起颈项疼痛。

预防

时下，大部分颈项疼痛跟退化和姿势不良有关。预防颈项疼痛的要领，是把头部跟脊柱呈一条直线。其他有帮助的办法如下：

• 保持良好姿势
  无论站立或坐着，肩膀都需要跟髋部呈直线
• 实践人体工程学
  把桌椅子、电脑的高度分别调整到适合个人身体与眼睛水平、椅子需要扶手。
• 休息
  旅途时间较长或使用电脑较久的话，需要多次休息。简易的颈项运动能减少酸痛来袭的机会。
• 避免负荷重物
  无论手拎或肩背负担一定重量，都会牵拉颈项
• 良好睡姿
  在颈项底下置放小枕头垫着颈部有所助益；头颈对准身体驱赶正中线；面朝上睡觉时，稍微垫高大腿有助于放松脊柱肌肉。
  

An Overview

The neck consists of muscles, nerves, blood vessels, bones(cervical spine), joints and soft tissues. It supports and move the head. Neck pain is one of the most common discomforts today. It can be a result from poor posture related muscle sprain., especially in the age of 3Cs [computer, communications (mostly smartphone), consumer-electronics] .
Other common conditions such as neck degenerative diseases contributes to neck pain as well. Neck pain is less commonly related to serious condition such as traumatic injuries.

Sometimes, neck pain may be resolved after days or weeks with home treatment approach such as posture correction, topical analgesic cream, resting, ice pack etc.

Seek medical attention if :

• it started as severe pain
• there is prolonged chronic neck pain (may be intermittent or persisting) that unresolved by using home home treatment
• prolonged neck pain partially resolved by medication alone
• when pain is getting worse over time
• neck pain that accompanied by radiating pain and/or numbness of upper one limb/limbs and/or hand-finger or broader region (such as shoulder, upper back)
• there is decrease in muscle strength over the upper limb/limbs
• neck pain is accompanied by numbness and/or pain of lower limb/limbs
• neck pain involves motor vehicle accident

Common signs and Symptoms

• different intensity of pain over the nape of neck or sides of neck
• restricted movement over the neck and/or head
• pain that worsened by holding the head in one position for longer period of time, such as viewing smartphone, working on a computer/notebook, or driving
• muscle stiffness around the neck, sometimes shoulder region, may limit range of motion
• one sided headache that not gaining relieve after using migraine drug

Sometimes neck pain is classified based on duration:

• Acute. Pain that lasts less than 4 weeks.
• Subacute. Pain that lasts 4 to 12 weeks.
• Chronic. Pain that lasts 3 or more months.

Modern medical treatments:

• Non-surgical: medication(anti-inflammatory drugs), physical therapy, or injection therapy
• Surgical method will be considered if nonsurgical approaches are unable to alleviate symptoms, especially for severe cases

TCM approach:

• tuina massage
  one the of most effective and safe form of manual therapy
• acupuncture
  widely recognized as an effective pain control method, suitable for moderate to severe pain
• herbal therapy
  expels wind-damp in turn reduces inflammation within the affected area, and relieves discomforts
• cupping
  eases pain and stiffness

Common neck pain causes:

• Muscle strains prolonged hunching related to desk work, or over smartphone or computer is most common**. frequently sleep sitting up etc is less common.**
• Worn joints
  As human aging throughout the years, neck joints inevitably subject to wear and tear. This is called osteoarthritis. It causes the cushions (cartilage) between spine bones (vertebrae) to degenerate as well. The affected spine bones tend to form bone spurs that trigger pain during joint motion
• Nerve root compression
  Herniated disc (between spine bones) or bone spurs of spine bone of neck spine can physically press on the nerves that branching out from the spinal cord.
• Mechanical Injuries
  In whiplash injury involving rear-end motor vehicle collision, the sudden acceleration-deceleration force that causes unrestrained, rapid forward and backward movement of the head and neck. During this sudden mechanical impact, the head is jerked backward and then forward, resulting straining of the soft tissues of the neck.
• Diseases
  Some diseases such as Ankylosing Spondylitis, solid tumor, rheumatoid arthritis, uncontrolled hypertension etc may manifested as neck pain.

Prevention

Nowadays, most neck pain is associated with aging related degeneration and posture factor. To prevent neck pain, the head should be kept centered over the spine is the major principle. Other tips to follow:

• Adopt good posture
  Keep shoulders in straight line over the hips when standing and sitting
• Practice ergonomic
  Height of table, chair, and computer is adjusted according to fit individual`s body and eye level. Chairs should have armrests.
• Take breaks
  Take frequent breaks whenever working at computer or travelling for long hours. Short neck stretching session help to reduce neck pain tendency.
• Avoid carrying heavy objects
  Bearing some load of weight can strain the neck.
• Good sleeping position 
  Some support such as a small pillow under neck helps. Align head and neck with mid line of body. Elevate thighs when sleeping with face upward help relax spinal muscles.