pain-conditions


Cervical Dystonia

Cervical dystonia is the involuntary, painful contractions of the muscles of the neck. Also called spasmodic torticollis, it often results in the head twisting to one side or the other, or it may cause your head to tilt forward or backward involuntarily. This condition can occur at any age, including infancy, but it is much more common in middle age. Symptoms start out gradually, get progressively worse, and then reach a plateau where symptoms do not progress any further. No cure is currently available for cervical dystonia, but it can be treated with a combination of physical therapy, medications, and injections.

Bill was a man in his 40s when he started twitching. His head would cock to the side, drawing his chin towards his right shoulder. Sometimes, his head would flop down, his ear pressing to his shoulder. At first, he didn’t think much of it. It only happened occasionally. However, it soon started to get so bad that he couldn’t control the movements of his head. He would literally fight against the jerking movements in his neck. When he explained the problem to his doctor, he was diagnosed with cervical dystonia. A Botox injection and some medications soon had his muscle movements under control.

At SoCal Pain Center, we know how painful and frustrating cervical dystonia can be. Although it is not commonly seen, we can help you treat your condition with physical therapy and pain medications. If you need injections into the area, we can help you connect with an experienced back surgeon who can help you with this level of treatment.

Causes

Researchers generally do not know what causes cervical dystonia. However, some cases have been linked to injuries to the head, neck, back, and shoulders. In addition, anti-nausea medications and some anti-psychotic medications can lead to the involuntary spasms of the neck muscles.

In addition, you are more likely to start seeing symptoms of cervical dystonia if you are between the ages of 40 and 70, but anyone at any age can have this condition. Women are nearly twice as likely to have cervical dystonia as men, and if you have a family history of the condition, you run a higher risk of cervical dystonia.

Symptoms

The symptoms of cervical dystonia are primarily movements of the head and neck. The head can twist so that the chin points towards the shoulder, and this is the most common movement with this condition. In addition, the ear can move towards the shoulder or the chin can jut straight up or straight down. Many people experience several of these movements together or individually. The head may also jerk repeatedly in any of the directions mentioned.

Many people experience pain with this condition. The spasms in the neck are painful in themselves, and the twisting and jerking of the head can cause pain in the upper back and shoulders. Headaches are common with cervical dystonia, and some find that the constant movement of their head is tiring and painful.

Treatments

Most cases of cervical dystonia are treated with a combination of medications, therapy, and injections. Medications are usually necessary to control muscle movement and decrease pain. For instance, Parkinson’s drugs, such as levodopa, can help with the constant movement of the head and neck. Muscle relaxing agents, such as baclofen, provide some relief, but they are typically not as effective as other treatments. Even medications to ease anxiety and promote relaxation, such as clonazepam, can help with the movements seen in cervical dystonia. Finally, pain medications are an important component of treatment, and these drugs can range from the over the counter variety to morphine derivatives.

Physical therapy helps with some of the movement of the head and neck. By stretching out the muscles that spasm, it decreases the length and severity of the attacks. Strengthening exercises are also great for easing pain. You may also need talk therapy to deal with the constant movement and pain caused by the condition. Stress reduction shows some promise in decreasing attacks.

For more severe cervical dystonia, Botox can be injected directly into the muscles to paralyze them. Often, this treatment is very effective and can decrease symptoms almost immediately. In rare circumstances, a surgeon can sever the nerves that supply the neck muscles to stop the contractions. In some cases, deep brain stimulation has also shown promise as a treatment modality.

At SoCal Pain Center, we have physical therapists on staff that can help you exercise your neck muscles, and we have a pain management doctor who can help you with the regulation and efficacy of your medications. Finally, should you need more advanced care, we are affiliated with spinal surgeons who can assist you with injections and other invasive treatments. Contact us today to set up a consultation.

References

Mayo Clinic; Cervical Dystonia; January 2011

http://www.mayoclinic.com/health/spasmodic-torticollis/DS00836




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