Chronic neck pain: causes, consequences and treatment

When neck pain persists for more than three months, we call it chronic neck pain - a condition that not only causes pain in the neck, but can affect your entire daily life.

Neck pain that just won't go away. Weeks turn into months, and before you know it you're a year in with the same complaints. Maybe you recognize it: headaches, stiffness, a neck that feels like concrete. Difficulty driving, sleeping, working. Treatment after treatment tried, but it doesn't get better. In this article you'll read about what can play a role in chronic neck pain, how it develops and how to learn to cope with it.

What is chronic neck pain?

When neck pain persists for more than three months, we call it chronic neck pain - or persistent neck pain. The word 'chronic' sounds definitive, as if nothing can be done about it. Fortunately, that's not the case. Chronic only refers to the duration of the complaints – not to whether they can be influenced.

Women suffer from chronic neck pain more often than men, and it most commonly occurs in people between 45 and 74 years old.¹ People with sedentary jobs – lots of screen work - also have a greater chance of developing complaints.²

Living with chronic neck pain

Chronic neck pain is more than pain in your neck. The complaints can have a major impact on your daily life and how you feel. Read more about common complaints:

Emotional consequences

Long-term pain is exhausting. Frustration, irritability, worry about the future - these are not weaknesses, but understandable reactions to a situation that just doesn't change. These emotions also play a role in how you experience the pain.

The role of headaches in neck complaints

Many people with chronic neck pain also regularly have headaches - also known as cervicogenic headache. This headache originates from the neck, often starts at the back of the head and moves forward. Typically, certain neck postures or movements trigger or worsen the headache. This type of headache often occurs in combination with migraine or tension headaches, but requires a different approach.

How does chronic neck pain develop?

The neck has to carry your head - about five kilograms - while remaining mobile for all the movements you make. That places a lot of demands on the vertebrae, intervertebral discs, muscles and ligaments.

But why doesn't the neck pain go away?

This is the crucial question.

With long-term pain, your nervous system changes. The nerves start transmitting pain signals faster and more intensely. Your brain interprets these signals and can amplify them. This is called central sensitization: your pain system has become oversensitive.

This doesn't mean the pain is imagined. The pain is real. But it does mean that the pain is no longer directly linked to tissue damage. You can still have pain while there is no demonstrable damage in your neck anymore.

What helps with chronic neck pain?

Because multiple factors play a role - physical, psychological and social - a broad approach is needed. Treating only the neck is rarely sufficient.

Stay active and move

This is perhaps the most important advice: keep moving. Taking a lot of rest and sparing your neck often makes complaints worse in the long run. Muscles weaken, joints become stiffer, and your confidence in your own neck decreases.

Movement strengthens the neck muscles, reduces stiffness, gives you more confidence in your body and helps against stress. Build it up gradually - start small and increase slowly.

Physiotherapy

A physiotherapist or manual therapist can help with exercises that strengthen your neck muscles, improve your posture and guide you in building up activities. Passive treatments such as massage or heat can provide temporary relief, but are rarely a lasting solution. The focus should be on active exercises and self-management.

Pain education

Understanding how chronic pain works is an important part of recovery. When you understand why you still have pain - even though the tissue has healed - why movement is safe, and how your pain system has become oversensitive, the pain often becomes less frightening.

Medication

Painkillers, muscle relaxants or other medication can provide temporary support, but don't resolve chronic neck pain. They don't address the underlying factors. Medication can be useful as a temporary bridge - for example to be able to move or sleep - but always in combination with an active approach. In the long term, however, the use of pain medication has negative consequences for your load capacity and your health. It is therefore important to critically examine the role pain medication plays within your overall long-term functioning.

Ergonomics: workplace and sleep

A well-arranged workplace and sleeping posture can make a big difference, for example:

• Screen at eye level, chair with good support

• Change posture regularly, take breaks

• Preferably sleep on your back or side, not on your stomach

• Keep your phone at eye level, not stooped over for long periods

Multidisciplinary approach

For many people with chronic neck pain, a multidisciplinary approach works best - where physiotherapists, psychologists and doctors work together and look at all factors that maintain your complaints. Research shows that this is effective in reducing pain and improving daily functioning.⁵

Is RealHealth something for you?

RealHealth is there for people with long-term back or neck pain who, despite various treatments, keep getting stuck in their daily lives.

In an intensive multi-day program, you work together with a multidisciplinary team to discover how to deal with your neck pain differently, so that there is space again for the things that bring you joy and what you find really important in your life.

The goal of treatment is not to become pain-free, but to be able to function again, despite the pain. You learn to understand the pain, regain confidence in your body and gradually build up your activities.

Research shows that the positive effects last a long time: even years after the program, participants still benefit from what they have learned.

Learning to cope with persistent neck pain

For many people with chronic neck pain, an important shift in thinking is: from 'my neck needs to heal' to 'I can learn to function with these complaints'.

Acceptance and self-direction

Acceptance doesn't mean giving up. It means acknowledging that the pain is there, without constantly fighting against it. Resisting pain takes a lot of energy and often makes the pain worse. By accepting what is there, you can direct your energy toward what you can do and regain control of your own life.

Pacing: dosing well

One of the most important skills with chronic neck pain is pacing: dosing your activities well. Not doing too much on good days (which leads to relapse), but also not doing too little out of fear of pain. Breaking activities into smaller parts, gradually building up, and learning to recognize where your limits lie.

References

^{1. GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050. Lancet Rheumatol. 2024;6(3):e142-e155.}

^{2. Kazeminasab S, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 2022;23(1):26.}

^{3. GBD 2021 Neck Pain Collaborators. Lancet Rheumatol. 2024;6(3):e142-e155.}

^{4. Verwoerd MJ, et al. Development and internal validation of a multivariable prognostic model to predict chronic pain after a new episode of non-specific neck pain. BMJ Open. 2024;14(8):e086683.}

^{5. Wirth B, et al. Prognostic factors for improvement following multidisciplinary rehabilitation in patients with chronic neck pain. BMC Musculoskelet Disord. 2021;22(1):316.}