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SUNDAY JANUARY 18, 2015

Not again, my neck hurts

T

HE Cervical Facet Pain

Syndrome is perhaps
one of the most frequent conditions diagnosed among patients
with neck pain. We used to think
that neck pain only occur among
elderly as it is part of ageing
manifestation. However, this is no
longer true as cervical facet pain
syndrome is also experienced by
younger population. According to
Dr. Chen Chee Kean, a consultant
anaesthesiologist who manages
chronic pain in Kuching Specialist
Hospital, patients with cervical
facet pain syndrome commonly
present with neck, shoulder and
shoulder blade pain.
Facet joint is the pair of joints
between two vertebrae (spine
bone). The facet joints in neck
(cervical) area allow various
movements of the head and neck,
like nodding, extending the neck
and also turning the head to the
left and right. Cervical facet joint
pain caused by arthritis (joint
inflammation), in which movement of the joint (neck) will
cause pain. Neck (cervical) and
low back (lumbar) are two areas
where facet joint pain commonly
occurs secondary to wear and tear
as movement frequently happen
around these areas.
When cervical facet pain is not
well addressed or treated, surrounding muscle will tense up,
harden and stiffen. These muscles
(trapezius, sternocleidomastoid,
scalene) work hard to reduce the
burden of the inflamed facet joint.
When this condition is being prolonged, trigger point will develop
around the involved muscle, and
this muscle will become very
sensitive and painful when being
pitched. The muscle pain is often
described as dull and pulling pain.
Together with muscle pain, the
pain experienced by patient is not
only limited and confined to the
neck region, but also extends sideway towards shoulder and forearm, upwards towards the face,
forehead and occipital area. The
affected areas will depend on the
level of facet joint involvement.
Cervical facet syndrome is a
painful condition where both
facet joint and surrounding muscle pain are the sources of pain.
Facet joint pain can be more
severe than muscle pain at times
and vice versa. The number of
patients suffering from this problem has increased tremendously,
owing to changes in lifestyles and
living conditions. According to
Dr. Chen, more than 50 percent
of patient with neck pain who
visited his clinic are having this
condition. Previously, this condition occurs commonly among
manual workers and the elderly,
but the trend for this condition
has changed, where young white
collar workers also suffer from this
condition.
As current working environ-

DR CHEN CHEE
KEAN doing a
cervical facet joint
injection under xray guidance.

COMMON pain distribution in cervical facet pain.

ment heavily depends on technology, prolonged maintaining ones
head and neck position in front
of a desktop computer monitor is
inevitable for many individuals.
Other related occupations, such as
tailor and electronic factory operator which require constant neck
straining during their work also
will eventually develop neck pain
secondary to cervical facet pain
syndrome. Long hour of mobile
phone usage with the head and
neck constantly bending forward
and downward also contributes
to the development of this condition among youngsters. Poor body
posture and position will further
speed up the wear and tear process of the neck. Thus, condition
which commonly occurs among
elderly due to ageing process will
happen among youngsters, especially after they started working. A
part from constant poor posture,
or better known as micro-trauma,
history of direct trauma to the
neck, such as whiplash injury during motor vehicle accident can
cause cervical facet syndrome
much later, even when whiplash
injury has recovered.
Cervical facet pain syndrome
mimics other conditions
Besides neck and shoulder
pain, patients with cervical facet
pain syndrome can also present
with other symptoms, which
include dizziness, blurred vision
and tinnitus. Prior to getting
proper diagnosis and treatment,
many patients with this condition ended up undergoing some
other unnecessary procedures
and treatments. Some had their
spectacles changed, some had
a scan on brain and others had
tried on various medications, but

all futile. These symptoms can be

so misleading that even invasive
procedures, such as angiogram
and gastric scope have been performed to exclude serious medical
condition, such as heart attack or
gastric ulcer. On the other hand,
patients with neck pain and stiffness should have a relevant systemic clinical examination done,
in order not to miss any serious
conditions, such as uncontrolled
hypertension which will cause
more complications if missed and
left untreated.
Cervical facet syndrome is
common among general population, but is often missed as not
many doctors are able to identify
it. At times, imaging investigations which include neck X-ray
and magnetic resonance imaging
(MRI) are needed to exclude red
flags, such as infection, fracture
or malignancy. Once cervical
facet pain syndrome is diagnosed, the treatment will depend
on the severity and duration of
pain. The treatment can be as
simple as muscle stretching,
exercise, massage followed by
taking short-term oral pain medications. When all these measures
fail to provide satisfactory longterm pain relief, or when patients
suffer from side-effect of pain
medications, non-invasive pain
intervention procedures, such
as muscle or facet joint injection
or radio-frequency treatment
can be offered when indicated.
Patients understanding on this
condition is crucial, as lifestyle
modifications including stress
management and improvement
in posture will prevent recurrence of this condition after treatment.

CMYK

CMYK

CMYK

Dr. Chen Chee Kean is a consultant

anesthesiologist and interventional pain physician in Kuching
Specialist Hospital, Malaysia. He
obtained his MD from University
Malaysia Sarawak in 2002 and
completed Master in Medicine
(Anaesthesiology) from University
Science Malaysia in 2010. Dr.
Chen further persuaded his training in pain management in India
in 2011 and passed Fellowship of
Interventional Pain Practice from
World Institute of Pain, USA in
2012. Dr. Chen became a member
of Academy of Medicine Malaysia
in 2013.
Reference:
1. Evidence-based interventional pain medicine according to
clinical diagnsoses of cervical
facet pain. Pain Practice 2010;
10: 113-123.
2. Myofascial pain syndrome in
chronic back pain patients.
Korean Journal of Pain 2011;

FRONT and side views of neck spine bone (cervical vertebrae) with red circles
showing cervical facet joints.

NECK muscle stretching exercise: With the head facing downward and one hand holding on opposite of the head, pull the head site way until tension is felt around the neck muscle and hold for 10 seconds, then relax the neck. Repeat similar
action with the head facing upward.

CMYK