Neck Pain
Neck pain is not a diagnosis — it’s a symptom. Before we treat it, we find out exactly what’s causing it.
"Neck pain" tells us almost nothing. The source tells us everything.
The cervical spine is one of the most complex structures in the human body. Seven vertebrae, dozens of muscles and ligaments, eight pairs of nerve roots, a network of small joints, and the intervertebral discs all sit within a few inches of one another — and any one of them can generate pain that feels almost identical to the others.
That’s the core problem with how neck pain is often treated. Two patients can walk in describing the same ache in the same place, and have two entirely different problems. One has an irritated facet joint. The other has a compressed nerve root. Give them the same injection, and one gets better while the other doesn’t — not because the treatment failed, but because it was aimed at the wrong target.
At National Pain Centers, we don’t guess. We work to identify the specific pain generator — the exact structure producing your symptoms — and only then do we build a treatment plan around it. This is what interventional pain medicine is supposed to be: precise diagnosis first, precise treatment second.
Our philosophy is simple: find the root of the problem, diagnose it, address it, treat it, and rehabilitate it. Masking symptoms is easy. Resolving them takes accuracy.
What can cause neck pain
Neck pain can originate from bone, joint, disc, nerve, muscle, or from changes in the nervous system itself. Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Joint-Related Causes
Cervical Facet Arthropathy (Facet Syndrome)
The facet joints are the small paired joints at the back of each spinal segment that guide motion. When they become arthritic, inflamed, or injured, they produce deep, aching neck pain that often worsens with extension or rotation, and can refer into the shoulders, upper back, or the base of the skull. Facet-mediated pain is one of the most common — and most commonly missed — causes of chronic neck pain, because it frequently does not appear on imaging.
Atlantoaxial & Atlanto-occipital Joint Pain
The uppermost cervical joints are responsible for the majority of head rotation. Arthritis, injury, or inflammation here causes pain high in the neck, often behind the ear or into the skull base, and frequently presents as headache rather than “neck pain.”
Uncovertebral Joint Degeneration
These small joints along the sides of the cervical vertebrae can develop bone spurs that narrow the openings where nerve roots exit, contributing to both localized pain and nerve-related symptoms.
Cervicogenic Headache
Headache that originates in the cervical spine rather than the head. The upper cervical joints and nerves share pathways with structures in the skull, so an upper-neck problem can present convincingly as a headache — and is often treated for years as migraine without relief.
Disc-Related Causes
Cervical Disc Herniation
When the tough outer layer of a disc tears and the inner material protrudes, it can chemically irritate or physically compress a nearby nerve root. This produces neck pain that radiates into the shoulder, arm, or hand, often with numbness, tingling, or weakness.
Cervical Degenerative Disc Disease
Discs lose water content and height with age and use, reducing their ability to absorb load. The result can be axial neck pain, stiffness, reduced motion, and secondary stress on the facet joints — a cascade in which one structure’s failure overloads the next.
Internal Disc Disruption / Discogenic Pain
Pain arising from tears within the disc itself, without frank herniation. Discogenic neck pain is typically deep, axial, and worsened by sustained postures — and is one of the more difficult sources to identify without careful diagnostic work.
Cervical Spondylosis
The broad term for age-related degenerative change across discs, joints, and bone. Spondylosis is nearly universal on imaging after a certain age, which is exactly why imaging findings alone cannot tell us what hurts. The presence of degeneration does not prove it’s the pain generator.
Nerve-Related Causes
Cervical Radiculopathy
Compression or irritation of a cervical nerve root, most often from a herniated disc or bone spur. Classic symptoms follow the nerve’s distribution: sharp or electric pain down the arm, numbness in specific fingers, or weakness in specific muscles. The pattern itself helps localize which nerve root is involved.
Cervical Spinal Stenosis & Myelopathy
Narrowing of the spinal canal. When it compresses the spinal cord itself (myelopathy), symptoms can include clumsiness of the hands, balance and gait changes, and difficulty with fine motor tasks. Myelopathy requires prompt evaluation and is one of the reasons an accurate examination matters before any treatment begins.
Occipital Neuralgia
Irritation of the greater or lesser occipital nerves produces sharp, shooting, or electric pain from the base of the skull upward over the back of the head, sometimes behind the eye. It is frequently mistaken for migraine.
Thoracic Outlet Syndrome
Compression of the nerves and vessels passing between the collarbone and first rib, causing neck, shoulder, and arm symptoms that can closely mimic cervical radiculopathy.
Muscular, Traumatic & Post-Surgical Causes
Whiplash-Associated Disorder
The rapid acceleration–deceleration of a motor vehicle collision can injure facet joints, discs, ligaments, and muscle simultaneously. Whiplash pain that persists beyond the expected healing window is usually driven by a specific injured structure — most often the facet joints — that can be identified and treated.
Myofascial Pain & Trigger Points
Taut, irritable bands within muscle that produce local tenderness and predictable referred pain patterns. Myofascial pain is often secondary — the muscle is compensating for an underlying joint or disc problem — which is why treating only the muscle rarely provides lasting relief.
Cervical Strain & Postural Overload
Sustained forward-head posture, prolonged screen work, and poor ergonomics place continuous load on the cervical extensors and facet joints. What begins as fatigue can progress to a structural problem if the mechanics aren’t corrected — which is why rehabilitation is part of every plan.
Post-Surgical & Post-Fusion Neck Pain
Persistent pain after cervical surgery, including adjacent-segment disease, in which the levels above or below a fusion take on additional stress and degenerate more quickly. These patients are often told nothing more can be done. Frequently, that isn’t true.
Central Sensitization
When pain persists, the nervous system itself can become amplified — turning up the volume on signals that would otherwise be minor. Pain becomes widespread, disproportionate, and resistant to treatments aimed only at the original structure. Recognizing central sensitization changes the entire treatment strategy, and it is an area of particular expertise at National Pain Centers.
Inflammatory & Other Causes
Less commonly, neck pain reflects inflammatory arthritis, infection, or tumor. A thorough evaluation is designed to identify these possibilities rather than assume a mechanical cause — because the rare diagnosis missed is the one that matters most.
When neck pain is an emergency
Seek immediate medical care — call 911 or go to an emergency room — if neck pain occurs with any of the following: severe pain after significant trauma; progressive weakness or numbness in the arms or legs; loss of bowel or bladder control; difficulty walking or sudden clumsiness; fever with neck stiffness; or unexplained weight loss with night pain. This page is educational and is not a substitute for evaluation.
Diagnosis is a procedure, not a guess
Imaging alone cannot diagnose the cause of neck pain. MRI findings of degeneration are extraordinarily common in people with no pain whatsoever — which means an abnormal image doesn’t prove you’ve found the culprit. Conversely, some of the most treatable causes of neck pain, including facet-mediated pain, may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Where the pain lives, what provokes it, what relieves it, how it refers, and what the neurologic exam reveals. This is where most of the diagnosis is made — and it’s why our visits are longer than the industry norm.
02 — Correlated imaging
X-ray, MRI, or CT interpreted against your symptoms and exam, never in isolation. The question is never “what’s abnormal?” but “what’s abnormal and explains this patient’s pain?”
03 — Virtual MSK Movement Assessment
Our proprietary, wearable-free remote assessment measures how your body actually moves — objective data on range, control, and compensation patterns that a static image can never show. It gives us a functional baseline and lets us track real improvement over time.
04 — Diagnostic nerve blocks
The definitive step. By anesthetizing a specific nerve that carries pain from a specific structure — and observing whether your pain temporarily resolves — we can confirm the pain generator with a level of precision no scan can match. A diagnostic block that works tells us where to treat. One that doesn’t is equally valuable: it rules a structure out.
This is the difference between treating a picture and treating a patient. We use diagnostic blocks to prove the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure below is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Cervical Medial Branch Blocks
The medial branch nerves carry pain signals from the facet joints. Anesthetizing them serves as the diagnostic test for facet-mediated neck pain — and confirms whether radiofrequency ablation is likely to help. This is the necessary step before any ablation is considered.
Cervical Radiofrequency Ablation (RFA)
For confirmed facet-mediated pain, RFA uses controlled heat to interrupt the medial branch nerves’ ability to transmit pain, often providing relief that lasts many months to years. It is one of the most effective options available for the right patient.
Dr. Joshi developed and performs a single-needle lateral approach to cervical medial branch blocks and RFA. He uses smaller-gauge needles — where many providers reach for far larger ones to compensate with an oversized lesion — and a longer-duration, lower-temperature, tissue-sparing lesion. The result is a targeted treatment with less trauma to surrounding healthy tissue.
Cervical Interlaminar Epidural Steroid Injection
For cervical radiculopathy and disc-related nerve irritation, an interlaminar epidural delivers anti-inflammatory medication into the epidural space to reduce inflammation around the affected nerve root, relieving arm pain and improving function.
National Pain Centers does not perform cervical or thoracic transforaminal epidural steroid injections. Although some practices offer them, the transforaminal approach in the neck and mid-back carries a risk of catastrophic injury that we do not consider acceptable. We use safer approaches to achieve the same goal. Declining a procedure we could easily bill for is exactly the kind of decision that defines how we practice.
Occipital Nerve Blocks
For occipital neuralgia and cervicogenic headache, targeted blocks of the greater and lesser occipital nerves can both confirm the diagnosis and provide meaningful relief from headache that originates in the neck.
Atlantoaxial & Third Occipital Nerve Procedures
For pain arising from the uppermost cervical segments — a common and commonly missed source of headache and upper neck pain — precise injections and ablation of the third occipital nerve can be highly effective when correctly targeted.
Trigger Point Injections
For myofascial pain and taut muscular bands, trigger point injections can relieve local pain and referred symptoms. We treat muscle as part of a larger picture — usually alongside the joint or disc problem driving the muscular compensation, not instead of it.
Regenerative Medicine & Orthobiologics
For appropriate candidates, platelet-rich plasma (PRP) and orthobiologic approaches aim to support the body’s own repair of injured tissue rather than simply suppressing inflammation. We are physician-led early adopters in this space — and we are candid about what the evidence supports today and what remains emerging.
Ketamine Infusion Therapy
When neck pain is driven or amplified by central sensitization, treating only the neck will not be enough. Ketamine infusions can reduce the nervous system’s amplified pain response. National Pain Centers built America’s first surgery-center-based outpatient ketamine program and has delivered thousands of infusions.
Rehabilitation & Whole-Person Care
A procedure that relieves pain without correcting the mechanics that caused it invites the problem back. Our multi-disciplinary team — including chiropractic and musculoskeletal expertise — builds rehabilitation into the plan, because the goal is not a good week. It’s a durable result.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list “cervical radiofrequency ablation” on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For a condition treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Procedures we decline to perform
We don’t offer cervical or thoracic transforaminal epidurals, and we don’t reach for implants early. What a practice refuses to do tells you as much as what it offers.
Neck pain, answered
The patterns differ. Facet-mediated pain tends to be a deep, axial ache that worsens with extension or rotation and refers to the shoulders or skull base without following a specific nerve path. Radicular pain from a compressed nerve root typically travels down the arm in a defined distribution, often with numbness, tingling, or weakness in specific fingers or muscles. History and examination narrow it, and a diagnostic block can confirm it.
Because ablation should only be performed when we’ve proven the facet joints are the source. A diagnostic medial branch block temporarily anesthetizes the nerves that carry pain from those joints. If your pain resolves during that window, ablation is likely to help. If it doesn’t, we’ve learned something equally valuable and saved you an unnecessary procedure.
Because the risk profile is not acceptable to us. The transforaminal approach in the cervical and thoracic spine carries a risk of catastrophic injury. Safer approaches can accomplish the same therapeutic goal, so we use those instead. We would rather decline a procedure than expose a patient to a risk we wouldn’t accept for ourselves or our families.
No. Dr. Joshi has never prescribed OxyContin or oxycodone in over three decades of practice, and he warned of the opioid epidemic before it was widely acknowledged. Our approach is built around identifying and treating the source of pain, not suppressing the signal with opioids. Even our procedural sedation is non-opioid.
Not necessarily. Degenerative changes are extremely common in people with no pain at all, and they become more common with age. An imaging finding only matters if it explains your specific symptoms and examination. This is exactly why we correlate imaging with the clinical picture and, when appropriate, confirm with diagnostic blocks.
Persistent pain after cervical surgery is common and treatable. It may stem from adjacent-segment disease, untreated facet-mediated pain, nerve irritation, or central sensitization. Many patients are told nothing more can be done. In our experience, that is frequently not true — it usually means the actual pain generator was never identified.
For appropriately selected patients whose diagnostic blocks confirmed facet-mediated pain, relief commonly lasts many months and often longer. Nerves can regenerate over time, and the procedure can be repeated when needed. Individual results vary.
Find out what's actually causing your neck pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.