Dx: HNP C4-C5 by MRI and neurosurgeon Tx: NSAID s prn, Tramadol prn I am a deep tissue/sports massage therapist, unable to work for two mo s. Pn has progressively worsened over last 4 mo. First onset of pn (4 mo) only occurred upon orgasm. Assumed I had some sort of orgasm induced neuralgia, but it continued to worsen in severity and began happening with other types of movements. Went to PCP and ruled out any heart issues. Currently, I am experiencing constant burning and achy (more so) L sided, but overall unilateral neck and occipital pn. That, I can manage with NSAID’s. Any movement type activity requiring pushing, pulling, lifting (straining) immediately triggers heavy, vise grip, pressurized, spasming, and throbbing type pn; simultaneously which cannot be managed with NSAID’s. I am able to keep the pn from worsening by quickly grabbing an ice cube and vigorously rubbing it on my neck and base of skull, but this does not reduce pn. I have also discovered that applying pressure between spinous processes in same area as HNP alleviates the pn by over half, but only while applying pressure. My L cervical region ROM has decreased and muscle soreness with burning has significantly increased during this time despite stretching, massage, stem, physical therapy, accupuncture, trigger point injections, heat/ice rotation, etc. These modalities do not help even though I ve used them frequently and some make symptoms worse. There is no significant arm or hand pn, numbness/tingling, or weakness, although, R trap is partially numb and R medial scapula (dermatome) tingles almost constantly. Assuming this is from hypertonic muscles reacting to the continued pn cycle? The neurosurgeon I saw on 08/08/14 stated he was not impressed by my symptoms based on MRI and referred me to a pn clinic for epidural steroid injection. I elected to forego that procedure. I do not want Sx or any invasive Tx unless absolutely necessary. I do want to get some answers so I can get my life back and return to work. I appreciate any thoughts and/or advice on options for me to seek.