The honest answer depends on which structure is causing it. Here is how to tell.

AM I A CANDIDATE?

You are a candidate if your neck pain has lasted more than six weeks without responding to first steps, travels into the arm, persists after surgery, or was dismissed on a normal scan. Being a candidate means an evaluation that identifies the structure responsible. It does not mean a procedure. The treatment follows the diagnosis.

The honest answer depends on which structure is producing your pain. Most people arrive without an answer to that question. Here is how to tell whether this is worth your time.

When should you see a specialist for neck pain?

• Your neck pain has lasted more than six weeks and has not responded to the obvious first steps.
• You have pain traveling into the shoulder, arm or hand and nobody has mapped the distribution properly.
• You have had a scan that was reported as showing degenerative change, and treatment aimed at that has not helped.
• You have a headache that starts at the back of the neck and nobody has examined your upper cervical spine.
• You have had neck surgery and the pain is still there, or a new problem has appeared since.
• You have been offered an operation and want the diagnosis confirmed before agreeing to it.
• Your imaging is normal and you have been told there is nothing wrong.

How can you tell when neck pain is serious?

You have signs the spinal cord is involved — clumsy hands, difficulty with buttons or coins, dropping things, a change in walking, or bladder disturbance. Progressive weakness rather than painful weakness. Fever with neck pain. Unexplained weight loss. A history of cancer with new neck pain. Recent significant trauma.

Those are on the urgent page. They need assessment now, not an outpatient appointment in a few weeks. Saying so plainly is more useful than booking you in.

What being a candidate actually means

It does not mean you are a candidate for a procedure. It means you are a candidate for an evaluation that will establish which structure is responsible. After that, the treatment follows from the diagnosis, not from what happens to be available.

A meaningful share of people who come through this door are treated without any injection at all. That is because the answer turned out to be muscular, postural, load-related, or a peripheral entrapment (a nerve trapped away from the spine) that responds to a splint. That is a good outcome, not a wasted appointment.

Am I too old for neck pain treatment?

No. Age does not rule anything out by itself. Degenerative change is more common with age. So is the assumption that nothing can be done about it. That is a separate thing, and a wrong one. Diagnostic blocks, radiofrequency treatment and nerve studies are not age-limited procedures.

What changes with age is the differential (the list of possible causes). Giant cell arteritis enters it over fifty. It is one of the few things on this website that is truly time-critical.

What if I have been told nothing more can be done for my neck?

That statement is almost always about a specific treatment pathway, not about your neck. It usually means surgery is not indicated. Or it means one service has run out of options within its own scope. Neither is the same as the pain being untreatable.

In people who arrive with that sentence, the most common finding is that a structure was never tested. Facet-mediated pain (pain from the small joints at the back of the neck) in particular goes years without anybody testing it with a diagnostic block. That is because it does not show on imaging, and there is no blood test for it.

What neck conditions do you treat?

Facet-mediated neck pain, tested with a diagnostic block and treated with radiofrequency ablation. Cervical radiculopathy (a pinched nerve root), treated medically. Where it is not settling, it is treated with a targeted epidural steroid injection at the confirmed level.

Cervicogenic headache and occipital neuralgia. Myofascial pain and trigger points. CRPS, including stellate ganglion blocks and, in refractory cases, spinal cord stimulation. Carpal tunnel hydrodissection. Botulinum toxin for cervical dystonia and chronic migraine.

What we assess even when we are not the ones who treat it

Shoulder pathology, jaw involvement, peripheral entrapments at the wrist and elbow, and the vestibular (inner-ear balance) part of unsteadiness after neck surgery. These are assessed because they change the diagnosis. Finding one of them is frequently the most valuable thing that happens at the appointment.

Sometimes the answer lies with another service. Then you leave with a diagnosis and a specific destination, not a general referral. That is the difference between being passed on and being directed.

How to decide whether to book

Maybe you can name the structure that is causing your pain, and the treatment aimed at it has been tried properly and failed. Then another opinion may not add much. Maybe you cannot — what you have been given is a category, a scan finding, or nothing at all. Then the diagnostic step has not happened yet. It is the step everything else depends on.

That is the whole basis on which this practice is worth your time. Not a procedure you have not tried, but a question nobody has asked yet.

If you are deciding between opinions

Ask each service which structure they identified and how they tested for it. A named structure with a test behind it is a diagnosis. A scan finding, a category, or a treatment offered without either is not. That holds however senior the person offering it.

That one question sorts out most of the confusion people arrive with. It is worth asking of us as readily as of anybody else.

If you are traveling from outside the metro

We see patients from across the St. Louis region and from Illinois. A first appointment is built to be worth a single trip. It covers history, a full exam of the neck, shoulder and arm, and a working diagnosis on the day, not after a string of visits.

Where a nerve study or a diagnostic block is needed, it is arranged promptly. Where possible it is coordinated so that a longer journey is made once rather than three times.

What a wasted appointment would look like

Being told your imaging explains your pain without an exam that supports it. Being given a category instead of a structure. Or being sent onward without anybody having tested the thing that is testable.

Those are the three failures this practice is organized around avoiding. They are fair things to hold us to.

What people ask before booking

Do I need a referral?

No. Bring your imaging, prior test results and a list of what has already been tried. What the first visit covers.

What if I do not want any injections?

That is a fair position, and it does not disqualify you. The evaluation still tells you what the problem is. A good share of what we find is managed without procedures. How treatment gets paid for.

I have had three opinions already. Will this be a fourth of the same?

It is worth asking each previous service which structure they identified. If the answer was a category instead of a structure, this is a different exercise. How the medial branch block is performed and read.

Is it worth coming if my pain is mild?

If it is mild and improving, patience is reasonable. If it is mild and has been there for a year, the question is why. That question can be answered. Why a normal MRI does not close the question.

Do you see Illinois patients?

Yes. The practice is licensed in Missouri and Illinois. What the first visit covers.

How long should I wait before seeing a doctor for neck pain?

If the pain is mild and getting better, patience is reasonable. It is time for an evaluation if the pain has lasted more than six weeks without responding to the first steps, travels into your arm, or has been there for a year. Signs that the spinal cord is involved, fever, or progressive weakness do not wait at all. Those need assessment now.

What conditions can cause long-lasting neck pain?

The structures we test include the facet joints and an irritated nerve root in the neck (cervical radiculopathy). They also include trigger points in the neck muscles and the upper neck joints that cause headaches starting at the back of the head. Some pain turns out to be a trapped nerve at the wrist or elbow, or a shoulder or jaw problem. The evaluation names which one is yours.

Can I still be seen if I have already had neck surgery?

Yes. Pain that is still there after neck surgery, or a new problem that has appeared since, is one of the reasons people come here. The evaluation works the same way. We find the structure responsible, including the ones that were never tested, and let the treatment follow the diagnosis. If an operation has been offered, we can confirm the diagnosis first.

Related reading

• What to expect at your first visit
• About this practice
• When a neck problem is urgent
• Why your MRI does not explain it
• Neck pain doctor in St. Louis
• Connect with us

Candidacy and cost are separate questions. The second is answered on how treatment gets paid for.

If an operation has been raised, these are the three questions worth asking first.