Neck pain: treatment without surgery in Buenos Aires

Neck pain treatment is staged and starts with the least invasive option: first, conservative treatment — the right medication and targeted physical therapy; if the pain persists, an image-guided diagnostic block confirms whether the source is the facet joints, a disc, the nerves or a combination; and only then is the procedure chosen to target that source. Most patients benefit from non-surgical treatments; surgery is reserved for cases with a clear indication.

What neck pain is

Neck pain, cervicalgia, what many people call "the usual stiff neck": they are different names for pain in the neck region. The cervical spine carries the weight of the head all day long and is, at the same time, a highly mobile segment; that combination makes it especially prone to wear. At each level, one vertebra articulates with the next through an intervertebral disc and two facet joints, and inside the spinal canal run the spinal cord and the nerve roots that provide sensation and movement to the arms and hands.

When the pain persists for more than three months we speak of chronic neck pain. By then it is no longer a simple stiff neck: what predominates are joint changes, secondary muscle tightness, sensitization of the nervous system and, in many cases, irritation of the nerve roots that travel toward the shoulders and arms. That is why anti-inflammatory drugs stop being enough: the mechanisms that persist — facet joint pain, neuropathic pain from nerve root irritation, myofascial pain — do not respond to them, and raising the dose only adds risks: gastritis, stomach ulcers, kidney failure, high blood pressure, cardiovascular events.

The central point is this: chronic neck pain presents differently depending on which structure is the main generator of the problem, and it pays to identify that source before trying one treatment after another at random.

I am a physician anesthesiologist with postgraduate training in Pain Medicine and Interventional Pain Management, and in daily practice I see that chronic neck pain is one of the most underestimated conditions. Many patients live with it for years as "the usual stiff neck" or "it's just my posture at work", without knowing that behind it there may be cervical facet joint pain, a cervicogenic headache or a complex myofascial pattern that requires a specific approach. Long hours on screens and desk work explain part of the phenomenon, but the bigger problem is that neck pain gets normalized until it ends up affecting sleep or concentration, or headaches start to appear alongside it.

Common causes

Cervical facet joint syndrome

The cervical facet joints wear down over time and are a very common cause of neck pain, especially after age 45. The pain is usually localized and gets worse when you hold your neck in one position (working at a computer, for example), when you look up or when you rotate your head. It usually responds very well to cervical facet joint blocks and, in selected cases, to radiofrequency ablation of the medial branches.

Cervical herniated disc and radiculopathy

When a cervical intervertebral disc herniates, it can compress a nerve root and produce pain that radiates to the shoulder, the arm and the fingers — pain that runs from the neck down into the arm, called cervicobrachialgia — often with tingling, numbness or loss of strength. That radiating component usually has the features of neuropathic pain, which is why it responds poorly to anti-inflammatory drugs. Most cervical herniations improve with medical treatment, targeted physical therapy and, when indicated, image-guided epidural or nerve root injections.

Cervicogenic headache

Many patients seek help for "headaches" without knowing that the origin is in the neck. The first three cervical vertebrae contain structures that can refer pain to the scalp, the back of the head, the temples and the area behind the eyes; the pain is usually one-sided and gets worse with neck movements or sustained postures. It is one of the indications where interventional pain management has the greatest impact. I explain headaches of cervical origin and their treatments here →

Cervical myofascial pain

Deep muscle tightness in the trapezius, the scalenes or the suboccipital muscles can create trigger points that hurt and refer pain at a distance. It is a very common cause in people who spend many hours in front of a screen. It is treated by combining physical therapy, trigger point injections and postural correction. More on myofascial pain and trigger points →

One nuance I repeat often in the office: cervical imaging in adults very frequently shows degenerative findings — disc degeneration, facet joint osteoarthritis, the occasional small herniation — that may or may not be related to the current pain. Finding a cervical herniation on an MRI is not enough to call it the cause: the symptoms have to match the compromised nerve root. In the neck, moreover, there are pain generators that MRI does not show well — the facet joints, for example — and they are diagnosed only with the clinical picture and, when needed, with specific diagnostic blocks.

How it is treated: the treatment ladder

Chronic neck pain is treated in stages, always starting with the least invasive option. At the consultation we assess which structure is the main pain generator and design a personalized plan.

First step: conservative treatment

Very often the problem is not that anti-inflammatories are missing but that the right medication is: for cervical neuropathic pain, gabapentinoids and certain low-dose antidepressants usually work far better than NSAIDs (non-steroidal anti-inflammatory drugs). Physical therapy is a cornerstone, with one condition: not all physical therapy is the same. Deep cervical stabilization work, postural correction and well-applied myofascial release techniques can change the picture.

Second step: the diagnostic block

When the pain persists, the source has to be confirmed before any procedure is recommended. A diagnostic block involves placing a small amount of local anesthetic, under image guidance (ultrasound or fluoroscopy), exactly on the structure we suspect. If the pain drops markedly while the anesthetic lasts, the source is confirmed and targeted treatment can be planned; if it does not, it is better to look for another cause before moving ahead. In facet pain, this step is the single best predictor of a good result from the subsequent radiofrequency ablation. Cervical blocks are well-established outpatient procedures with a high safety profile when they are performed under image guidance and protocols are followed.

Third step: the procedure, according to the source

Once the pain generator is confirmed, the procedure is chosen accordingly. All are outpatient and image-guided:

• Facet origin → cervical facet joint block and medial branch radiofrequency ablation. Image-guided cervical facet blocks deliver the medication directly to the affected joints and usually relieve the pain for weeks to months. When the blocks confirm a facet origin, medial branch radiofrequency ablation extends the relief for 9 to 18 months in selected patients, and it can be repeated if the effect wears off. How radiofrequency ablation works →
• Radicular pain (cervical herniated disc) → cervical epidural injections. For herniated discs with intense radicular pain, they are an alternative to surgery in many cases, always within a plan that includes targeted physical therapy.
• Cervicogenic headache → greater occipital nerve block and procedures on C2-C3. They are very effective when this pattern is identified. If the upper facet blocks (C2-C3) respond well but the relief is short-lived, medial branch radiofrequency ablation is the next step. More on headaches of cervical origin →
• Myofascial pain → trigger point injections. Combined with physical therapy and postural correction. How I perform ultrasound-guided injections →

I want to be clear about this, because it is where the most overselling happens: these procedures treat the pain — they do not repair the structure. The arthritis or the wear is still there. What we aim for is to lower the pain so you can move, do your rehabilitation and get your daily life back.

Where surgery fits in

Cervical spine surgery is one more option within the range, with specific indications: myelopathy, a herniation with progressive motor deficit, instability, or cases that do not respond after a well-conducted course of conservative treatment. When degenerative changes compress the spinal cord and not just the nerve roots — difficulty coordinating the hands, unsteadiness when walking, weakness in the legs — evaluation by a neurosurgeon should be immediate. When a case needs a surgeon's perspective, we work as a team: my job is to manage the pain well at every stage of the journey.

When to see a doctor

In terms of treatment, the clearest signal is time: if your neck pain has lasted more than three months, if it radiates to the shoulder or arm with tingling or loss of strength, or if you already need pain relievers every day, it is time to identify the source and treat it in a targeted way instead of stacking more anti-inflammatories. I devote a full article to the signs that it is time to seek help: Chronic neck pain: when to see a specialist →

Where I see patients: locations in Buenos Aires

I see patients at two locations: Hepta, in San Isidro (Av. Fondo de la Legua 577, Zona Norte) and CIAREC, in Villa Urquiza (Av. Monroe 4770, CABA). I receive patients from across Zona Norte (northern Greater Buenos Aires) and the City of Buenos Aires, and I also offer virtual first consultations to point you in the right direction and organize the next steps. Phone: +54 9 11 5895-3260.

Dr. Mauricio Casarsa

Anesthesiologist. Postgraduate training in Pain Medicine and Interventional Pain Management (UBA — Fundación Dolor; UNLP — CAIDBA). Staff physician at Hospital Alemán de Buenos Aires.

MN 137.756 (Argentine medical license) · San Isidro · Villa Urquiza