Neck Pain

Pain can occur anywhere in the neck, from the bottom of the head to the top of your shoulders.  Neck pain is very common affecting about half of all individuals at some point in their lifetime. 

Symptoms vary and can include:

  • stiffness
  • a feeling of tightness or a “muscle knot” in the neck, upper back and/or shoulders,
  • headache
  • pain that shoots down the arm

There are different types of neck pain profile, some people have only one type of neck pain while others can have a mix. 


  • Central neuropathic pain

    Rare condition can occur when there is an issue with the spinal cord itself.

  • Neuropathic neck pain

    Pain resulting from an irritation or injury of the nerve roots that are found in between the neck joints.  This could result from conditions such as a disc herniation, or spinal stenosis. 

  • Mechanical neck pain

    Pain coming from the spine and it’s supporting structures such as the ligaments, muscles, facet joints (spinal joints), or discs. 

Risk Factors

Neck pain affects people of all ages.  It is more common in women than in men, and occurs more often in people aged 40-69 years of age. 

People in occupations that involve computer work, manual labor and health care are more likely to develop neck pain. Those reporting low job satisfaction and poor workplace environment are most likely to have neck pain. Genetics is also said to play a role.

Risk factors for developing neck pain  

  • Smoking
  • Being overweight or obese
  • Sedentary lifestyle
  • Sleep disorders

Specific factors can lead to neck pain such as:

  • Whiplash injuries
  • Rheumatological conditions (for example arthritis)
  • Sports injuries


Diagnosis of Neck Pain

Chronic neck pain is diagnosed by a primary care provider.  To assess your neck pain, your clinician will:

  1. Get your history of neck pain to rule out other causes.
  2. Perform a physical exam to determining whether your pain is related to muscle, joint, or ligament structures and to determine treatment options. This will include an assessment of your neck movements and the strength and sensation felt in your neck and arms.

Your primary care provider may order diagnostic testing if they need to rule out certain medical conditions (such as infection, fracture, or tumour). Other tests could include nerve conduction tests and procedures that block nerve impulses from a selected nerve to see if the symptoms could be improved through a procedure.


For new or acute episodes of neck pain (pain less than three months) the majority of people recover without any treatment, although about 50% of people will have pain that returns again.  Evidence does not support the use of strong pain relievers such as opioid medications.

For patients with chronic or persistent neck pain (pain longer than three months) research recommends these effective treatments

  • Self-management programs
  • Psychological therapies such as cognitive behavioural therapy and mindfulness based stress reduction
  • Physiotherapy
  • Yoga

Neck collars have been used in the past to support the neck but have been found to be ineffective for improving neck pain and are not recommended.


  • Medications

    Medications may help manage neck pain, however research to support their use is mixed.  Non-steroidal anti-inflammatory medications (NSAIDS) (ibuprofen, naproxen, Advil, Aleve) and acetaminophen (Tylenol) may be considered, weighing the possible benefits with the side effects.  Some NSAIDs can be applied in cream form (Voltaren).  Muscle relaxants may also be used, but more often in acute than chronic pain.

  • Interventions

    Interventions include various techniques performed by an Anesthesiologist to either inject a pain relieving medication into the affected joints or nerves, or to burn the nerves to relieve the pain temporarily (12-18 months). Other therapies with mixed evidence include botox injections for neck pain include procedures such as trigger point injections or dry needling into tight bands of muscle; the evidence for this treatment is mixed.  Botox injections for muscle pain also have inconclusive evidence. 

    For people with neuropathic pain originating in the neck, injections including a steroid and a pain reliever may be beneficial, especially if done in combination with active treatments such as physical therapy.  There is some weak evidence that ablation (burning) of the nerves that supply the neck joints may provide benefit for pain and function in the intermediate term.

  • Surgery

    Can be considered an option when there is pain and weakness. Non surgical options such as self-management, physiotherapy and psychological treatment may have better outcomes.


No treatment has been scientifically proven to cure chronic neck pain. Even common treatments such as injections, acupuncture, medications, and surgery all have conflicting evidence around their effect on pain and function. When people actively manage their pain on a daily basis, through self-management and exercise they get the best results.  Don’t feel pressured to pay for treatments that you can’t afford as there is no evidence that they will have any lasting improvements on your pain.

There are many self-management strategies that can help reduce pain.

  • Becoming knowledgeable about chronic pain and what is happening in your body.
  • Staying active every day by stretching and walking to improve your pain levels.
  • Pacing your activities throughout the day to reduce your risk of flare up.
  • Practicing daily relaxation techniques.
  • Learning how to communicate with family, friends, and care providers.
  • Learning how to cope with the emotions of having chronic pain including depression and anxiety.
  • Improving your sleep so you can get more rest and cope better with your pain.
  • Listening to your body to learn which treatments work best for you and to better manage flare ups.

Physiotherapy & Exercise

Physiotherapy will help you improve your posture, physical function and quality of life as you become more active.  A physiotherapist can advise you about different relaxation techniques as wells as exercises to improve muscle strength and endurance.

Active physiotherapy involves using movement-based treatments requiring the active participation of the patient such as flexibility, strengthening, and breath work. 

Passive physiotherapy involves treatments that do not require the patient to use energy. These include massage, therapeutic ultrasound, traction, and the TENS machine. 

For chronic pain patients, active physiotherapy is preferred as it will lead to long-term improvements in function.

  1. Complete a self-assessment to see if you are eligible for a TAPMI referral.
  2. Connect yourself to physiotherapy and exercise groups in your community.
    Internet key word search:
    Neck group physiotherapy in [Community]
    Neck exercise groups in [Community]
    Exercise groups in [Community]
    Chronic pain self management programs with physiotherapy in [Community]

    When calling clinics or programs ask about:
    Exercise based physiotherapy
    Self management programs with physiotherapy
    Graded exposure physiotherapy
  3. Visit TAPMI's self help module for chronic pain to help you with strategies to manage your pain.


Psychological approaches to pain management address the emotional aspects of pain and fibromyalgia, such as feeling sad or depressed, feeling anxious or worried, feeling hopeless and being angry or irritable.

Therapies such as Cognitive Behavioural Therapy, Mindfulness-Based Stress Reduction, and Acceptance and Commitment Therapy can help you focus on how to deal with your pain and the emotions that come with it. These therapies will teach you how making even small changes can start to improve your pain.

  1. Complete a self-assessment to see if you are eligible for a TAPMI referral.
  2. For free information regarding Mental Health Services in Ontario visit specialist will answer your call, email or web-chat 24/7. Services are free and confidential.
  3. If you are in crisis:
    Gerstein Crisis Centre: 416-929-5200 (downtown Toronto, York). Telephone crisis intervention and mobile crisis team.
  4. Visit TAPMI's self help module for chronic pain to help you with strategies to manage your pain.

76 Grenville St. Toronto, ON M5S 1B2 Canada

TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday


Dr. Tania Di Renna, Medical Director Sandra Robinson, Administrative Director