Neck and shoulder pain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience pain in both areas.

There are many different causes of low back and neck pain. You may feel pain in your back that is caused by organs not even near the back. This type of pain is called referred pain. For example, kidney pain is often felt in the back and even some forms of vascular problems can cause back pain. When you have back pain that is not getting better, or the intensity is increasing, be sure to contact your doctor. The most common causes of back and neck pain are:

• sprain and strain of the back or neck.
• pain arising from the discs themselves called discogenic pain.
• pain from bulging discs compressing exiting nerve roots or radicular pain, which can lead to sciatica from the back or pain radiating down from the neck to one or both arms .
• pain from arthritis of the facet joints ¡ª the joints that hold the spine in alignment, also called facet joint syndrome.
• pain from bony compression of the nerves of the spine called spinal stenosis

What Causes Neck Pain?

Causes of neck pain include:

• Abnormalities in the bone or joints
• Trauma
• Poor posture
• Degenerative diseases
• Tumors
• Muscle strain

What Causes Shoulder Pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

• Strains from overexertion
• Tendonitis from overuse
• Shoulder joint instability
• Dislocation
• Collar or upper arm bone fractures
• Frozen shoulder
• Pinched nerves (also called radiculopathy)

How Are Neck and Shoulder Pain Diagnosed?

• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
• MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.
• Myelography/CT scanning: Sometimes used as an alternative to MRI
• Electrodiagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.

Continuum of care

A continuum of care is a course of treatment that begins with the simplest treatment options and then progresses to stronger more potent therapy if the condition, in this case pain, fails to respond.

For example, if you have a radiating back pain that did not begin with a traumatic injury such as an accident, here is what your continuum of care might look like:

• Typically the first treatments would be physical therapy, medications and stretching exercises. (See medications and physical therapy.)
• If the pain persists, a thorough diagnostic workup would be in order. This might include a history and physical examination, x-rays, assessment of medications and, possibly, flexion/extension studies, a computerized tomography (CT) scan of the affected and a magnetic resonance imaging (MRI) scan.
• If the pain persists, medications and physical therapy may continue and in the case of nerve-related pain, a series of three epidural steroid injections might be the next course of treatment. In the case of muscle pain, trigger point therapy using injections might be followed by icing and stretching exercises. In either case, the injections should be continued only if effective, and repeated steroid injections (more than three in a six-month series) should be avoided.
• At this point, you and your physician should evaluate whether you need to expand your therapy to include other options. A multi-disciplinary approach that coordinates different treatments, such as appropriate use of different types of medications, physical therapies and psychological therapies, helps improve your chances of recovery.
• If the comprehensive approach i not effective, further evaluation of the spine (anterior, vertebral body and disc, spinal cord structures with its nerves and posterior ¨C facets, ligaments, muscles) may be considered. Appropriate therapies at this stage may be spinal cord stimulation, spinal opiods, lysis (breaking up) of the adhesions (scar tissue, or a similar binding of tissues to nerves).

The continuum of care also must consider treatment of the emotional problems, such as depression and anxiety, that are often triggered by chronic pain. These problems worsen pain by interfering with your body's own pain control mechanisms. If not managed right away, anxiety and depression will interfere with the effects of treatment and your ability to recover from painful conditions. Your physician may treat these conditions with medications or refer you to an appropriate mental health professional for counseling and medication treatment. It is very important that you treat these problems right away, not delay treatment in the hope that these problems will just "go away". (See psychosocial section.)

How Are Neck and Shoulder Pain Treated?

The treatment of soft tissue neck and shoulder pain includes the use of anti-inflammatory medication (such as Aleve or Motrin) and/or acetaminophen (Tylenol). Pain also may be treated with a local application of moist heat or ice. Local corticosteroid injection is often helpful for arthritis of the shoulder. For both neck and shoulder pain movement exercises may help. For cases in which nerve roots or the spinal cord are involved, surgical procedures may be necessary.