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Pain Management

Neck Pain and Facets



Hi I`m looking for an answer that so far no doctors have been able to help me with. Since May 2006 I have a neck pain that prevents me from turning my head right, left forward without pain. They have done x-rays, bone scans they have come out normal. They have given me 2 different muscle relaxers and it hasn't done anything. Maybe you can guide me in a right/different direction. This really painful, its gotten to a point were I move my hole body to look to the side. Thank you in advance.


The most likely cause is a facet problem. Facets are small joints on the back of the spine that help us turn our necks and they can be involved in arthritis and cause pain. Whiplash injury as in a car accident can also cause facet pain in the absence of arthritis. Typically with facet mediated pain, physical exam and radiologic findings are of no use in making the diagnosis. The only method proven to diagnose facet mediated pain is through precision guided injections of small amounts of numbing medications (without steroids or cortisone) close to the nerves that supply the facet joints. If you get 80-100% pain relief after two diagnostic blocks then radiofrequency ablation can be carried out and coupled with physical therapy for prolonged relief.

Another potential cause of the pain is muscle spasm in a condition known as cervical dystonia. Botox injections in the muscles can then relieve the spasms.

A pain medicine specialist consultation may be helpful.

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Response by:

Salim M Hayek, MD, PhD Salim M Hayek, MD, PhD
Associate Professor of Anesthesiology & Perioperative Medicine
School of Medicine
Case Western Reserve University