The neck supports the head and is flexible, but its position and structure make it prone to conditions causing pain and limited movement.
Neck pain is a common musculoskeletal issue. Most cases are mild and resolve on their own within a few days. However, if neck pain persists for over a week, medications or other treatments may be necessary.
This article discusses over-the-counter and prescription medications for neck pain, along with alternative treatments.
Table of Contents
OTC Medications for Neck Pain
You can use over-the-counter (OTC) medications like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) for neck pain.
Acetaminophen
Acetaminophen, also known as paracetamol or Tylenol, is a common pain reliever for neck pain. Doctors often give acetaminophen for mild to moderate neck pain. For more severe pain, they might combine it with a stronger pain reliever such as an opioid.
You must follow the doses your doctor prescribes for acetaminophen. Taking more than recommended or using it with alcohol can be harmful to your liver.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
When neck pain is caused by things like infection, injury, or other conditions that make the neck structures swell or become inflamed, doctors might suggest using NSAIDs to help with the pain and reduce inflammation.
NSAIDs work by blocking an enzyme called cyclooxygenase (COX). This enzyme is involved in the production of substances that contribute to inflammation. By inhibiting COX, NSAIDs help calm down the inflammatory response.
You can get NSAIDs in different forms: as pills you swallow or as creams, gels, and patches you apply directly to the skin.
Some examples of NSAIDs that doctors commonly recommend include:
- Ibuprofen (Advil)
- Naproxen (Aleve)
- Acetylsalicylic acid (Aspirin)
Prescription Medications for Neck Pain
Doctors may give you medications to help with neck pain. Some of these include:
Corticosteroids
Corticosteroids, also known as glucocorticoids, are powerful medications that help reduce inflammation and alleviate pain in the spinal nerves. This can be particularly beneficial for conditions like herniated discs or spinal arthritis.
There are different types of corticosteroids that can be injected, such as:
- Methylprednisolone
- Dexamethasone
- Triamcinolone
These injections usually provide relief from pain for a period ranging from 6 weeks to 6 months, but the duration can vary from person to person.
In certain situations, short-term use of oral corticosteroids like Prednisone, Methylprednisolone (Medrol Dosepak), or Dexamethasone might be recommended for issues like psoriatic arthritis or acute spinal cord injury.
However, using these medications for a long period might cause some side effects and complications.
For example, when using oral corticosteroids for back and neck pain, you might experience gastrointestinal upset, though you can reduce the risk of these side effects by taking the medicines with milk or food.
Prolonged use of corticosteroids, especially at high doses, can lead to increased blood sugar levels. People with diabetes should be cautious while taking these medications.
Opioids
Opioids are powerful pain-relieving drugs that work by blocking pain signals in the nervous system. While they are effective for managing pain, they come with side effects like sedation, cognitive impairment, and the risk of addiction. Because of these issues, doctors are cautious when prescribing opioids.
Studies show that opioids work best for moderate to severe non-neuropathic pain with low inflammation. The choice of opioid depends on the intensity of the pain.
There are two types of opioids:
- Weak opioids
- Potent opioids
Weak opioids (like codeine, hydrocodone, and tramadol) are suitable for moderate pain, while potent opioids (such as morphine, oxycodone, and hydromorphone) are used for severe and persistent pain.
There is a general agreement that all opioids, regardless of strength, should be used at the lowest effective dose and for the shortest duration possible.
Muscle Relaxants
If you have neck pain from tight muscles or damage to spinal cord nerves, your doctor might prescribe muscle relaxants along with pain medication.
Muscle relaxants work in different ways. They can target the brain, spinal cord, or the muscles directly to reduce stiffness, pain, and any discomfort that comes with it.
There are two types of muscle relaxants:
Antispastics: These work on the spinal cord or muscles and are helpful for treating spinal cord injuries and conditions causing spasms. Examples include baclofen (Lioresal), dantrolene (Dantrium), and tizanidine (Zanaflex).
Antispasmodics: These bind to receptors in the cell membrane of muscles and prevent sudden, involuntary contractions known as spasms. Common antispasmodic medications include diazepam (Valium), carisoprodol (Soma), cyclobenzaprine (Flexeril), and metaxalone (Skelaxin).
Anticonvulsants
Doctors often suggest anticonvulsants for those with epilepsy, but they can also help ease the burning sensation from nerve damage causing neck pain.
Examples of these medicines are:
- Divalproex sodium (Depakote)
- Lamotrigine (Lamictal)
- Valproic acid (Depakene)
- Carbamazepine (Equetro)
- Topiramate (Topamax)
Antidepressants
Sometimes, doctors prescribe antidepressants to help with long-lasting pain, even if someone isn’t dealing with depression. These medications work on pain by increasing certain chemicals in the spinal cord.
These chemicals, called neurotransmitters, can lower the transmission of pain signals to the brain and spinal cord.
Here are some types of antidepressants that doctors might prescribe to treat pain:
Selective Serotonin Reuptake Inhibitors (SSRIs)
These medicines help boost serotonin levels in the brain, which can improve mood. SSRIs usually have fewer side effects compared to other types of antidepressants.
Some examples of SSRIs are:
- citalopram (Celexa)
- fluvoxamine (Luvox)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs can help people with chronic neck pain and depression by raising the levels of serotonin and norepinephrine in the brain.
Some examples of SNRIs are:
- levomilnacipran (Fetzima)
- duloxetine (Cymbalta, Yentreve)
- venlafaxine (Effexor)
Tricyclic Antidepressants (TCAs)
TCAs can help with neuropathic pain by blocking the reabsorption of certain brain chemicals called serotonin and noradrenaline.
Some examples of TCAs are:
- clomipramine (Anafranil)
- amitriptyline (Elavil)
- desipramine (Norpramin)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
Other Treatments
Neck pain can be treated through various non-medication methods, including physical therapy, acupuncture, massage therapy, and specific exercises. Each of these treatments addresses different aspects of neck pain and may be used alone or in combination depending on the your specific condition and preferences.
- Physical Therapy: Physical therapy is a common treatment for chronic neck pain. It involves targeted exercises, stretches, and manual techniques to reduce pain, improve mobility, and strengthen the muscles around the neck. Physical therapists may use both passive treatments (such as massage, heat therapy, and electrical stimulation) and active treatments (like exercise and stretching) to aid recovery.
- Acupuncture: Acupuncture, rooted in Traditional Chinese Medicine, involves inserting thin needles into specific points on the body to alleviate pain and improve bodily functions. It has been shown to be effective in reducing neck pain for some people. The treatment may also include other techniques such as cupping or dry needling.
- Massage Therapy: Massage therapy helps relieve neck pain by improving blood flow, reducing muscle tension, and promoting relaxation. Techniques like Swedish massage and deep tissue massage are commonly used. Massage therapy is often recommended for managing chronic conditions or recovering from stress-related tension.
- Lifestyle Adjustments: Making lifestyle changes such as improving posture, setting up an ergonomic workplace, taking breaks from electronic devices, staying well-hydrated and incorporating regular low-impact aerobic exercises can help manage and prevent neck pain.
- Exercises: Specific exercises can also be very effective in managing neck pain. These might include stretching and strengthening exercises designed to improve posture and enhance muscle function. Exercises such as chin tucks, neck stretches, and shoulder blade squeezes are often part of a daily routine prescribed by physical therapists to maintain neck health and prevent pain.
When to See a Doctor
If your neck pain doesn’t get better after a few days, it’s a good idea to talk to a doctor.
Here are some signs mentioned by the American Academy of Orthopaedic Surgeons that mean you should definitely see a doctor if you have neck pain:
- Fever
- Nausea
- Vomiting
- Tingling in your neck
- Stiffness in your neck
- Pain that spreads to other parts of your body
- A lump on your neck
- Severe headache
- Really bad or getting worse pain
A doctor can figure out if there’s an underlying problem and suggest the right treatment for you.
Sophia Anderson, PT, DPT is a physical therapist who offers online pain management consultations. She helps people with various types of pain, especially neck, back, and knee pain.
She graduated from the University of St. Augustine with a Doctor of Physical Therapy (DPT) degree. She has experience in orthopedic physical therapy, sports medicine, neurological rehabilitation, advanced assessment and treatment of running injuries, and advanced treatment of the pelvic complex, spine, and extremities.
If you’re experiencing any pain, let Sophia Anderson, PT, DPT help you out.