Back and Neck Pain

Back pain is the third most common reason for patient visits to physicians' offices, and affects up to 80% of the adult population at some time. The precise cause of low back pain is poorly understood and only 10-20% of all patients have their pain attributed to an accepted, definable diagnosis. In the majority of cases low back pain tends to disappear with time. In about 90% of patients symptoms resolve within 3 months of onset.

True low back pain is defined as pain located between the lower rib cage and the buttocks. This pain may occasionally extend down to the level of the knee but not beyond. If back pain is associated with numbness, tingling or weakness in the legs then it is possible that irritation of neurologic structures is present (see herniated disc, spinal stenosis).

Back or neck pain in children

In general, children do not complain of significant back pain, therefore it is to be taken seriously when a child complains of back problems. Although falls and minor injuries may cause mild discomfort temporarily, significant pain and any severe injury requires medical attention. In children pain is not always related to injury, and a more serious underlying problem may be at hand. Therefore, pain without clear injury must also be taken very seriously and prompt an evaluation by a physician.

Pain related to an injury

After any back injury it is recommended to note the accident (time and circumstances), as far as recollection allows and seek consultation with an orthopedic specialist. The physician will investigate all anatomic elements of the spine to assess for injury and direct appropriate treatment. If there is neither fracture nor dislocation/subluxation there may be a sprain/strain the magnitude of which can vary in severity. Sprain or strains involve stretched muscles or ligaments and partial tearing may cause pain of variable intensity. In the hours following an injury application of a cold ice pack may help relieve local pain. Cold causes the constriction of small blood vessels around the site of injury thereby limiting further swelling and inflammation.

Spontaneous pain

When a child complains of back pain, not related to a specific injury, which is persistent, medical evaluation is essential. Although rare, it is important to ensure that a serious problem is not going untreated (infection, systemic diseases, tumors of the bone or nerve tissues, inflammatory conditions, fractures). After a thorough evaluation, which may include blood tests, x-rays, MRI or CT scan, and when no underlying serious condition is present, then the treatment of pain may include medication (anti-inflammatory, pain medication, sometimes muscle relaxant). Pain modalities may also be prescribed, including such things as: hot/cold treatment, massage, ultrasound, TENS.

Pain related to a deformity

In children, a deformity of the spine such as scoliosis is unlikely to be a cause of pain. Deformity related to an injury (fracture, dislocation) can be very painful and requires immediate attention. Other spinal deformities such as an increased kyphosis (ex. Scheuermann's disease) may be painful and medical attention is necessary particularly since brace wear can be a very simple and effective treatment option in some cases.

Back or neck pain in adults

In adults, back and neck pain is often not directly related to a significant accident or injury. The cause in most cases is not clear and although symptoms may be quite disabling at first, they mostly disappear over time on their own. In some cases an accident may be the direct cause of neck and back pain. Common injuries include heavy lifting, motor vehicle accident or a fall. A thorough medical evaluation is important to ensure no significant injury to bone, discs or other spinal structures. Even if no major structural injury is noted, significant and long-term pain may develop. This pain is sometimes amplified by psychological components such as the fear of ensuing complications, disability and interference with work.

Due to the fact that it can be difficult to make a clear diagnosis on a cause for back pain patients may receive different types of treatment according to which specialist they consult. A chiropractor may recommend some form of spinal manipulation, a therapist may recommend pain modalities (massage, ultrasound, TENS), and a physician may suggest a combination of medication, short-term rest and guided exercises.

Pain related to injury

Motor vehicle accidents, recreational sports injuries and work related accidents are the most frequent cause of severe back problems. In a motor vehicle accident if there is neither fracture nor dislocation or subluxation visible on X-rays, a soft tissues injury may be present (ligament, muscle, tendon? that can cause mild to severe pain. Whiplash, or cervical sprain, may be due to a number of possible mechanisms: hyper flexion or hyperextension of the neck, rotation and lateral flexion or a combination of the above. Even when a medical evaluation reveals no obvious injury, severe and persistent pain with disability may be present. Some physicians may give injections and/or prescribe medications as well as a neck brace or collar. None of these treatments will usually cure the problem completely but may give temporary relief. A gradual return to normal activity with occasional medication is often the best way to deal with the pain while the injured muscles and ligaments heal. Exercises that are performed by the patient (sometimes guided through a physical therapist) may offer some relief and help in the rehabilitation. Low back pain resulting from lifting something or being jolted in a fall can also be a source of persistent pain. Although no severe injury may have taken place, the pain can be persistent and sometimes quite disabling. An evaluation by a physician is important to obtain a proper evaluation. Most commonly pain in these circumstances is due to muscle spasm or strain. Other causes may include: fracture in patients with weakened bones (such as osteoporosis), a herniated disc, a facet joint injury.

Treatment

In order to properly direct treatment in the setting of back pain, an evaluation with a physician is important. If a clear cause of pain is identified, then treatment can be directed appropriately (ex. disc herniation, fracture?. Often, though no clear source of pain is identified and all spinal structures appear healthy. Therefore, to help relieve symptoms in a patient with mild or moderate low back pain, the first form of treatment frequently consists of a brief period of rest (one to two days) followed by gradual return to regular activities. Some patients feel that heat (heating pad, warm bath/showers) applied to the lower back gives some relief. An abdominal binder or semi-rigid brace can also alleviate some of the pressure and pain in the lower back. Medications such as anti-inflammatories (nonsteroidal anti-inflammatory medication) are frequently also helpful. Over the counter analgesics may offer relief and rarely stronger medications, such as narcotics, are prescribed by a physician. In some circumstances, physical therapy is recommended.

In most cases back pain resolves on its own. Signs, which should prompt immediate, and detailed evaluation, include neurologic symptoms (numbness, tingling, weakness, poor bladder/bowel control, burning sensations), as well as night pain, associated fevers, weight loss or systemic symptoms. When an episode of low back pain has subsided it is recommended to begin a program of gradual conditioning involving aerobic-type exercises (ex. Walking, bike, swimming). Improved aerobic conditioning has been found to reduce the risk of recurrent low back pains. Poor physical condition and repeated twisting or lifting as well as activities involving vibrations (driving, certain manual labor) can set the stage for repeated episodes of low back pain.

Frequently Asked Questions