PONOS · Persistent neck pain
Neck pain that does not go away
When persistent neck pain requires specialist assessment and a more targeted approach.
Understanding whether pain arises from the facet joints, nerve roots or other structures is the first step towards effective treatment.
Persistent neck pain
When neck pain does not go away
Not all neck pain is the same. In many patients, it persists for months, worsens over time or returns despite previous treatment, medication, physiotherapy or injections.
When neck pain becomes chronic, its duration is only part of the problem. It is often still treated in a general way, without accurately identifying the structure responsible.
In these cases, the first step is to understand where the pain comes from before adding another treatment.
- neck pain lasting months or years
- only temporary relief from medication or physiotherapy
- pain that flares up easily
- restricted neck movement
- pain radiating towards the head, shoulder or arm
A common pitfall
Why treatment often fails
In chronic neck pain, many treatments fail because they are applied without a clearly defined target, rather than because the treatments themselves are inappropriate.
The term “cervicalgia” is often used as though it were a diagnosis, but it only describes the location of pain. It does not establish whether the problem arises from the facet joints, nerve roots, discs or other structures in the cervical spine.
When the responsible structure is not identified, treatment remains non-specific and pain may continue.
An overly broad diagnosis
Simply saying “neck pain” is not enough. Effective treatment requires an understanding of the structure responsible.
Symptom relief
Medication, rest or physiotherapy may help, but do not always change the mechanism maintaining pain over time.
No clearly defined target
Without a precise clinical target, even appropriate treatments may fail to provide lasting benefit.
Structures involved
Where neck pain may originate
Persistent neck pain does not have a single source. Different structures may contribute, each with specific clinical features and implications for treatment. Pain may persist despite several treatments if the responsible structure has not been clearly identified. A similar pattern may occur with treatment-resistant headache (in Italian), where pain continues despite multiple therapies.
Cervical facet joints
The joints at the back of the cervical spine can be a frequent source of chronic pain, particularly in patients with stiffness, pain on movement and symptoms aggravated by neck extension and rotation.
Cervical nerve roots
When pain radiates towards the shoulder, arm or hand, or is accompanied by tingling and altered sensation, possible nerve root involvement should be assessed.
Intervertebral discs and deeper structures
In some cases, pain may arise from disc structures or deeper, more complex mechanisms. These require careful clinical assessment, rather than interpretation of imaging alone.
Referred pain or a mixed presentation
Not all pain felt in the neck originates there. Some patients have a mixed presentation involving muscles, joints, neuropathic pain or pain referred from other structures.
Clinical assessment
When specialist assessment is needed
Not all chronic neck pain requires an interventional approach.
However, when pain persists, returns despite treatment or significantly limits daily life, specialist assessment is needed to distinguish the symptom from the structure involved and establish whether a treatment is indicated.
- neck pain lasting months or years without sustained relief
- frequent relapses after medication, physiotherapy or non-specific treatment
- pain affecting work, sleep or neck movement
- pain radiating towards the shoulder, shoulder blade or arm
- an unclear diagnosis or symptoms labelled simply as “neck pain” without a clearly defined target
Clinical experience
Clinical experience at PONOS
Persistent neck pain calls for more precise clinical assessment, rather than simply more treatment.
Experience in interventional pain medicine helps distinguish patients who may benefit from a targeted approach from those who need a different strategy.
The value lies in identifying the appropriate target and developing a coherent pathway based on the patient’s clinical history.
Request a specialist assessment
For persistent neck pain, specialist assessment can clarify whether there is a genuine target and whether targeted treatment is appropriate. The same principle applies to other areas, including chronic low back pain and treatment-resistant headache (in Italian).
The aim is to define a pathway that addresses the cause of pain, rather than adding another non-specific treatment.