This patient should be treated with gabapentin. Her history and physical examination findings are consistent with chronic neurogenic neck pain. Features that support this diagnosis are the quality of the pain (burning and tingling), radiation to the arms, limited range of motion of the neck, and reproduction of pain with compression of the spinal nerves via the Spurling test. The findings of normal upper extremity muscle strength, the absence of upper extremity hyperreflexia and spasticity, and her imaging results make spinal cord involvement unlikely, as does the lack of evidence of a systemic process such as malignancy. Patients with chronic neurogenic neck pain frequently do not respond to analgesics, such as acetaminophen, or anti-inflammatory medications, such as NSAIDs. However, they may respond to agents such as gabapentin and tricyclic antidepressants.

Muscle relaxants such as cyclobenzaprine are sometimes used in patients with neck and back pain, particularly if muscle spasm is present. However, muscle relaxants tend to be more effective for acute than chronic pain and have considerable side effects, such as sedation. Additionally, although benzodiazepines such as diazepam have muscle relaxant properties, they have not been shown to be superior to nonbenzodiazepine muscle relaxants and also have greater potential for abuse. Therefore, they are often reserved for use in patients with muscle spasm in whom other muscle relaxants have failed. Muscle relaxant therapy, particularly with a benzodiazepine, would not be indicated in this patient without evidence of significant muscle spasm associated with her neck pain.

Data supporting the effectiveness of epidural glucocorticoid injections for chronic neurogenic neck pain are limited and inconsistent. Although they are occasionally used in patients with chronic pain refractory to other therapies, the FDA has issued a drug safety communication about epidural injection of glucocorticoids due to the potential for rare but serious adverse effects. Therefore, this would not be an appropriate intervention in this patient who has not been treated with other interventions for her pain.

Laboratory tests, such as erythrocyte sedimentation rate, are also not indicated in the absence of clinical evidence of a systemic disorder that might be the cause of neck pain. This patient is otherwise healthy, and there is no clear need for laboratory testing as part of the evaluation of her neck pain.