How A Pinched Nerve is Treated

How to Treat An Angry, Compressed Nerve in Your Neck

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Is Your Neck the Source of Your Headache?. laflor/Vetta/Getty Images

Did your doctor tell you that a pinched nerve in your neck is the source of your head and neck pain? The formal name for this condition is cervical radiculopathy. It can be a relief to finally have a diagnosis, but how do you treat it?

Going to the Doctor for a Pinched Nerve

When you go to the doctor with “radicular pain” in the neck, your doctor will first rule out any red flags like:

  • Difficulty walking or leg weakness
  • Bowel or bladder dysfunction
  • History of fever, weight loss, cancer, or a weakened immune system
  • Age younger then 20 or older than 50
  • Severe, sudden onset of pain (this could be indicative of cervical artery dissection)
  • Other neurological signs like difficulty speaking or swallowing (this could indicate a stroke)

If any danger signs are present, your doctor will order blood tests, imaging of the head and/or neck, refer you to a specialist, or possibly send you to the emergency room. It all depends on their suspicion and the condition's urgency.

If there are no red flags, and your doctor diagnoses a "pinched nerve" or cervical radiculopathy, he will likely recommend conservative management for approximately two to eight weeks.

What is Conservative Management for a Pinched Nerve?

Conservative management refers to non-invasive methods to help ease your discomfort until the nerve irritation and compression resolves -- usually it entails a combination of both medications and physical therapy.

Medications that may be prescribed for your pain include:

  • A nonsteroidal anti-inflammatory (NSAIDs) like ibuprofen or Aleve (naproxen)
  • An oral steroid like prednisone if pain is severe

In terms of exercise, it's best to not engage in physical activity that exacerbates the pain. That being said, laying in bed or long periods of inactivity can actually delay your recovery.

Your best bet is to continue your daily routine but limit activities that are uncomfortable.

Once the acute pain is improved with medication, your doctor will recommend physical therapy to help you retain neck range of motion and also strengthen your neck/back/shoulder muscles. Other therapies that your doctor may suggest for your pinched nerve include use of a cervical collar or pillow or cervical traction

What if My Pinched Nerve Symptoms Do Not Go Away?

If after six to twelve weeks, your symptoms persist, your doctor will likely re-evaluate the diagnosis and do imaging of the upper spine with an MRI or CT scan. He may also recommend a nerve conduction study (NCS) and electromyography (EMG) to further understand the source of your  pain. Sometimes, your diagnosis is more complex and requires the care of a spine specialist. 

With persistent cervical radiculopathy, despite adequate conservative therapies, treatment options include:

  • epidural nerve block -- a steroid is injected into a space near the spine and spreads out over the affected nerve root, calming it down
  • surgery

Clues that surgery is a reasonable approach would be if your cervical radiculopathy is not improving with conservative management and/or you are experiencing worsening weakness, like having increasing difficulty lifting your arm. Your doctor will also consult a surgeon if there is any involvement of the spinal cord (termed myelopathy) on neck imaging. Determining the need for surgery is something you need to discuss carefully with your doctor to ensure that the benefits outweigh any potential harms. 

The Bottom Line

The good news is that the majority of people recover favorably from a pinched nerve. That being said, some do have recurrences and have to repeat their prior regimen of medication and/or physical therapy. It's important to review your diagnosis and treatment plan with your doctor so as to maximize your healing and comfort.

Sources:

Carette, S., & Fehlings, M.G. (2005). Clinical practice. Cervical radiculopathy. New England Journal of Medicine, 353(4):392-9.

Eubanks, J.D. (2010). Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. American Family Physician, Jan;81(1)33-40.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.

Robinson, J., & Kothari, M.J. Treatment of cervical radiculopathy. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013. Accessed April 2016.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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