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Neck and low-back pain

Experiencing neck or low back pain is a virtually universal experience. Spine pain is a common reason for seeking care and treatment from our primary care physician. This article will describe common conditions causing pain in our neck and back and an overview of treatment.

Mechanical causes for neck and back pain

Pain caused by injury or disruption of structures in the spine and surrounding soft tissue is the predominant cause of mechanical spine pain. Strains and sprains of muscle and tendon/ligaments of the spine and its surrounding support tissue is the most common cause. Less common are disc herniations and bone bruising or fractures.

Depending on the severity and location of the injury, the person can experience various levels of pain, have either localized or radiating pain down an extremity. If the person is experiencing pain, weakness or lack of feeling in both legs, this could indicate spinal cord compression and is considered an emergency.

Inflammatory low-back pain

This type of condition is not related to trauma or sprain, but rather inflammation of nerves and bone structures. This can lead to chronic pain that is not relived by traditional treatment (i.e., pain medication, therapy). A condition known as anklylosing spondylitis is an example of this type and is observed in young adults. Evaluation and treatment of this type of condition is very different than other types of back problems and usually requires subspecialist care.

Lumbar spinal stenosis (LSS)

LSS is a common cause of chronic pain, especially in older individuals. It is caused by degeneration of spine structures leading to diminished space available for blood vessels and nerves. LSS changes can include loss of vertebral height, degeneration that presses on ligaments, disk herniation or bulges, and extra bone growth that pinches a nerve or blood vessels. It is present in 47% of people over the age of 60.

Whiplash and traumatic injuries of the neck

There are many reasons for neck pain due to trauma, strains/sprains of muscle and ligaments (as in whiplash injuries) falls, lifting heavy objects, or automobile accidents. In addition to trauma, osteoarthritis can also be a source of chronic discomfort but presents as a gradual onset of pain. Again, pain can be localized to the site of injury, or pain can radiate down into the shoulder, arm or hand. If the person is experiencing neck and upper extremity pain on both sides along with a sensation of weakness in the lower extremity, this could indicate a serious emergency condition associated with compression of the spinal cord.

Occupational-related back and neck pain

Lost time from work due to spine pain is common and associated with occupations such as bus driving, health care work and police and corrections work. There can be lost time due to slips and falls, motor vehicle accidents, or repetitive-motion injuries. Adverse workplace conditions, an aging worker population, obesity, alcohol abuse and cigarette smoking all increase the chance of an occupational injury.

Is there one way to treat neck and back pain?

There are many causes of back and neck pain and treatment often depends on the diagnosis—there is no one way that works in all cases. That means the most important first step to take is to obtain the correct diagnosis. If you are experiencing back and neck pain after two to three days that does not respond to OTC (over the counter) analgesics, application of heat/ice and limiting activity (but not complete bed rest), see your doctor. The healthcare provider will determine if X-rays, laboratory, or imaging procedures are needed and when they should be performed.

An emergency exists if a person is experiencing increasing discomfort not reduced by medication; changing distribution of pain; sensation of weakness in the upper extremity; sudden change in bowel, bladder, or sexual functioning; night pain that wakens the patient; or presence of fever in association with acute onset of spine pain.

Seek out medical evaluation for new onset or long-standing neck and back discomfort. There are many treatment options available, but they should be guided by your health care provider.

Examples of treatment for various neck and back conditions:
• Medication for pain is an important part of management of acute pain, but may be detrimental for chronic long-term discomfort. Using non-steroidal medications is common, but long-term can cause significant health problems, especially in older adults. Morphine-based pain medications (e.g., codeine or oxycodone) may be appropriate for acute severe pain, but long-term can lead to addiction. 
• Physical therapy, strengthening exercises, or chiropractic treatments are often prescribed, but patients may or may not respond equally to the same treatment.
• Acupuncture and core strengthening can help some people but not all.
• Ergonomic education for lifting and transferring and workplace changes can decrease injury but cannot totally prevent spine injury. 
• Lifestyle changes such as stopping smoking, regular exercise and weight loss can help prevent or decrease the episodes of spine pain, but again this is not a universal response for all people.
• Surgery vs. non-surgical approach is an area of intense study. Depending on the surgical diagnosis, the person may have the same outcome regardless of whether there was a surgical intervention.
 

 

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