Back pain and neck pain are some of the most common symptoms presented in our clinic. Up to 84 % of adults experience back pain at some time in their lives. Back pain is worldwide the most common cause of disability in persons younger than 40.
Symptoms could occur after lifting heavy items or other physical exercise. However, it can also occur without any previous activity, out of the blue. Nerves are having 3 functions: Pain, sensory and motor function. This explains the following symptoms.
1) Back Pain
2) Pain in the back, buttock or leg (sciatica)
3) sensory loss, numbness or tingling of the skin
4) Muscle weakness of the legs
5) The pain could lead to muscle strain or spasm of the back muscles. Thus the movement is impaired and the posture affected.
6) A very serious symptom is called cauda equina compression. Neurologists define it as numbness of the legs, bladder / bowel dysfunction and impotence. This requires urgent surgery.
7) Neck pain
8) Pain in the neck, shoulder, arm, chest, Headache
9) Vertigo, dizziness, giddiness, Tinnitus, Visual disturbances
10) numbness in arm and hands
11) weakness in arm and hands
12) The pain could lead to muscle strain or spasm of the back muscles. Thus, the movement is impaired and the posture affected.
Back pain and Neck Pain are rather symptoms than diseases. There can be various causes for the pain. Depending on the cause or underlying disease the treatment changes. Therefore, the most important first step is that an experienced doctor finds the right cause and diagnosis. Here some common causes:
1) Disc diseases. With age the disk starts to degenerate and lose its flexibility. Thus the inner part of the disk, which is still more flexible, breaks thru the outer part and herniates the nerve roots nearby. Neurologists call this prolapsed intervertebral disk. Most common locations are the lower back, L4-L5 and L5-S1 or the neck, C5-6 and C6-7.
2) Osteoarthritis, spondylolisthesis, fractures, osteoporosis, Spinal stenosis, Spondylolisthesis
3) Muscle strain
4) Cancer like bony metastases and others
5) Infection like osteomyelitis, tuberculosis, diskitis, epidural abscess and others
6) Vascular like abdominal aortic aneurysm, epidural hematoma and others
7) Rheumatologically diseases like arthritis and others
90% of acute back pain cases will fully recover. Patients with subacute or chronic back and neck pain (3 month>) still have a favorable prognosis, however not as positive as acute back pain.
Do I need to get surgery? Any surgery is a potential harm to the patient. Therefore, there must be a clear indication. Luckily only less than 2% of patients suffering from neck or back pain need surgical intervention.
Do I need to stay in bed? If the pain is acute, you will most probably lay down anyway. If your muscles cramp and the movement is impaired you don’t have much other possibilities. After the treatment started there is no beneficial effect of prolonged bed rest. Moreover other problems like thrombosis could occur.
1) Pain killers are reducing pain, swelling and inflammation. They are commonly used for the treatment of acute back pain. However, new studies found that these drugs are inadequate in many chronic pain scenarios, while anti-depressants and anti-convulsants can have remarkable effects on many forms of chronic bone and joint pain.
2) Muscle relaxants help to release muscle spasm. Thus, the vicious circle of pain – muscle spasm – impaired movement and posture – pain – could be stopped.
3) Antidepressants are commonly used and very effective for chronic lower back pain.
4) Anti-convulsants (medications to prevent seizures) are successfully used in the treatment of chronic back pain.
5) Transcutaneous electrical nerve stimulation (TENS). TENS is a FDA approved, commonly used method in up-to-date pain management. It’s used for many forms of acute and chronic pain.
6) Acupuncture. Acupuncture may be useful as adjunctive treatment for low back pain
7) Physical therapy, Massage, Occupational therapy. Physical therapy, Massage, Occupational therapy can be used to alleviate pain and restore function (but this treatment is not encouraged in the early phase of injury)
8) Surgical therapy. Surgical therapy including Lumbar microdiskectomy, Spinal stabilization, Laminectomy, Endoscopic therapy, percutaneous arthroscopic diskectomy
9) CBT (Cognitive Behavioural Therapy). CBT was underestimated for a long time but as new studies prove, they are highly effective. In some cases even more effective than medication, with less side effects. A recent study published by the American Psychological Association showed when it comes to chronic pain, psychological interventions often provide more relief than prescription drugs or surgery without the risk of side effects, but are used much less frequently than traditional medical treatments
10) Lifestyle adjustments. Lifestyle adjustments to eliminate the risk factors, such as obesity, poor physical health, poor nutrition, smoking, heavy manual labor
11) Support groups. Support groups are monthly meetings of 5-10 people, having one thing in common, impaired quality of life due to a chronic disease. more