Chronic neck pain is neck pain that has lasted three months or longer. When it spreads into the shoulder, arm or hand, often with tingling, numbness or weakness, it usually means a nerve root in the neck is irritated. Doctors call this cervical radiculopathy, and it is sometimes described as brachialgia. Most neck and arm pain can be managed without surgery. Treatment begins with finding the source, then moves through rehabilitation, medicines and targeted nerve treatments, with neuromodulation kept for carefully selected people who have not improved enough.
What causes chronic neck and arm pain?
- Facet joint pain. The small joints at the back of the neck can become irritated with age, injury or whiplash, causing neck pain that can spread to the shoulder blade or head.
- Disc herniation or wear (cervical spondylosis). A bulging disc or bony spurs can narrow the space where a nerve root leaves the spine and cause arm symptoms.
- Foraminal narrowing. The exit channels for the nerve roots can narrow, causing arm pain and tingling in a specific pattern.
- Whiplash and injury. Persistent neck pain can follow a road accident or fall.
- Muscle tension and trigger points. Tight muscles in the neck and shoulders can cause pain that spreads and can make other sources of pain feel worse.
- Other causes. Shoulder problems, carpal tunnel syndrome and nerve entrapment at other sites can mimic neck-related arm pain, which is why examination matters.
Symptoms to look out for
Neck stiffness and aching are common. Signs that a nerve root is involved include a burning or shooting pain into the arm, pins and needles or numbness in particular fingers, and weakness in the arm or hand. Coughing, looking up or turning the head towards the painful side can make symptoms worse. Pain often affects sleep, and many people notice that tension makes it worse.
How we assess neck and arm pain
Dr Poply takes a detailed history and examines your neck, shoulders, arms and hands, testing strength, sensation and reflexes. She reviews any scans and asks how the pain affects sleep, work and mood. If the source is unclear, a diagnostic block may help identify whether the facet joints or a particular nerve root is responsible. Where there are signs of spinal cord compression, she will arrange urgent surgical assessment.
Treatment options
Rehabilitation and posture
Physiotherapy, gentle strengthening, and attention to working position and sleep support often form the core of treatment. Regular breaks from screens and adjusting your desk and pillow can reduce daily strain on the neck.
Medicines
NICE recommends specific medicines for neuropathic pain, such as amitriptyline, duloxetine, gabapentin or pregabalin, as initial options that can be tried when arm pain has a nerve quality. These help some people and not others, so we review benefit and side effects and stop medicines that are not working. NICE advises against opioids for chronic primary pain.
Nerve root injections and epidurals
For arm pain from an irritated nerve root, an image-guided injection of local anaesthetic and steroid near the nerve can reduce inflammation and provide relief while rehabilitation progresses. Rare but serious complications can occur with cervical injections, which is why fluoroscopic or ultrasound guidance and an experienced operator are essential.
Medial branch blocks and radiofrequency ablation
When neck pain comes from the cervical facet joints, a small injection near the medial branch nerves can confirm the source. If it helps for the expected period, radiofrequency treatment can be used to interrupt those nerves for longer, often for many months. The evidence for facet radiofrequency in the neck is less extensive than in the lower back, so we set out clear expectations first.
Trigger point and botulinum toxin injections
Some people have painful muscle spasm that keeps neck and shoulder pain going. Targeted injections, including botulinum toxin in selected patients, can relax these muscles. Evidence is mixed, so this is not usually a first step.
Neuromodulation
For arm pain of nerve origin that has not settled with other treatments, spinal cord stimulation can be considered, and dorsal root ganglion stimulation is an option when pain is concentrated in a defined area. Evidence for stimulation in the neck and arm is largely from smaller studies, and we do not promise results. Where there is a clear surgical cause, a spinal surgical opinion comes first. NICE guidance on spinal cord stimulation applies: pain of neuropathic origin lasting at least 6 months despite conventional management, a multidisciplinary assessment and a successful trial.
Surgery
Surgery is considered for spinal cord compression, progressive weakness or arm pain that stays severe despite good non-surgical care and matches clear findings on imaging. We coordinate referral to a spinal surgeon when needed.
Risks and what to expect
Every treatment carries risk. For injections, these include temporary soreness, bleeding, infection and, rarely, nerve or spinal cord injury. For implanted devices, risks include infection, lead movement, device discomfort and the possibility of further procedures. Your consultation includes a plain discussion of the benefits and risks of each option that applies to you, so you can decide what fits your priorities.
About your specialist
Dr Kavita Poply is a Consultant in Pain Medicine and Neuromodulation at St Bartholomew’s Hospital, London, and a Reader at Queen Mary University of London. Her clinical interests include neck pain with or without arm pain, brachialgia, occipital and cervical neuralgia, and complex regional pain syndrome. She performs medial branch blocks, radiofrequency treatment and neurostimulation procedures, and she teaches on the postgraduate neuromodulation programme at Queen Mary University of London.
Frequently asked questions
Q.1 What causes neck pain that spreads down the arm?
Ans. The most common cause is irritation of a nerve root in the neck, called cervical radiculopathy, often from a disc bulge or age-related narrowing where the nerve exits the spine. Referred pain from facet joints can also spread into the shoulder or upper arm. Pain, tingling or numbness that reaches the hand suggests a nerve root is involved.
Q.2 How long does cervical radiculopathy last?
Ans. Many people improve over weeks to a few months with simple measures, although recovery varies. If your arm pain is severe, if weakness is developing, or if symptoms persist beyond about six to twelve weeks despite treatment, a specialist assessment is sensible. Earlier assessment is needed if you have red-flag symptoms.
Q.3 When is neck and arm pain an emergency?
Ans. Seek urgent help for clumsy or weak hands, difficulty walking, new bladder or bowel problems, sudden severe arm weakness, or neck pain with fever or after significant injury. Chest pain, breathlessness or pain spreading to the jaw or left arm may be a heart problem, and you should call 999.
Q.4 Are cervical injections safe?
Ans. Most are performed without complication, but neck injections carry rare serious risks, including bleeding, infection and nerve or spinal cord injury. Using image guidance and an experienced specialist reduces these risks. Dr Poply explains the specific risks and benefits before any procedure so you can make an informed decision.
Q.5 Can spinal cord stimulation treat neck and arm pain?
Ans. It can be considered for selected people with arm pain of nerve origin that has lasted at least 6 months despite conventional treatment. The evidence is more limited than for lower back and leg pain, so we discuss this candidly. A trial period with temporary leads lets you test the effect before deciding on a permanent device.