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Back Pain, Neck Pain
Back pain and Neck Pain are rather symptoms than diseases. Meaning there can be various causes for your back pain or neck pain. Therefore the most important step is to find the right diagnosis by appropriate examinations. Only then the treatment can follow. To overlook serious underlying diseases and start treatment could have fatal consequences. In this article we give an overview of the most common forms of neck pain and back pain, with a special focus on disc herniation as a neurological disease.
Definition
Back pain is one of the most common symptoms presented in primary care. Up to 84 percent of adults experience back pain at some time in their lives. Back pain could occur at all ages with a peak around 40-50. Back pain is worldwide the most common cause of disability in persons younger than 40. These statistics are international not Dubai or UAE specific due to the fact that meta-reviews are not available for the UAE yet. However, the clinical work here in Dubai, UAE presents the same picture.
Causes
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.- Osteoarthritis, spondylolisthesis, fractures, osteoporosis, Spinal stenosis, Spondylolisthesis
- Muscle strain
- Cancer like bony metastases and others
- Infection likeosteomyelitis, tuberculosis, diskitis, epidural abscess and others
- Vascular like abdominal aortic aneurysm, epidural hematoma and others
- Rheumatologically diseases like arthritis and others
Risk factors
- Obesity
- poor physical health
- poor nutrition
- Smoking
- Heavy manual labor
- Psychological reasons like depression, work related problems and others.
- Pregnancy
- Weather? No! Lower back pain is commonly associated to weather changes. But this seems to be untrue. This notion was now refuted by a new back pain study from Australia. The researchers from the George Institute for Global Health at the University of Sydney agreed that temperature, humidity, wind direction, precipitation and air pressure do not trigger the onset of lower back pain or its severity. Dr. Daniel Steffens, the back pain study’s lead author, states in Arthritis Care & Research that people with lower back pain often do believe that their pain correlate with the weather. The researchers did examine whether there is a link between the two and analyzed data from 1000 adults with lower back pain from the Sydney area for one year. The result is that they found no connection between weather and back pain symptoms. Read more
Symptoms / Signs
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 symptoms.
- Back Pain
- Pain in the back, buttock or leg (sciatica)
- sensory loss, numbness or tingling of the skin
- Muscle weakness of the legs
- The pain could lead to muscle strain or spasm of the back muscles. Thus the movement is impaired and the posture affected.
- 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.
- Neck pain
- Pain in the neck, shoulder, arm, chest, Headache
- Vertigo, dizziness, giddiness, Tinnitus, Visual disturbances
- numbness in arm and hands
- weakness in arm and hands
- The pain could lead to muscle strain or spasm of the back muscles. Thus the movement is impaired and the posture affected.
Diagnostics
Which diagnostic procedures are indicated for your neck pain or back pain depends on your specific symptoms. Only after the consultation and physical / neurological examination the neurologist can advise which tests are necessary. If it is a simple form of neck pain or back pain mostly no further investigations are needed.
- Consultation
- Physical examination
- Neurological examination
- Laboratory: blood count, ESR, parameters of infection
- Radiology, CT, MRI
- Electromyography (EMG)
- Nerve Conduction Velocity (NCV)
Treatment
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. Moreover the treatment of chronic back pain or neck pain differs from treatment of acute pain.
There should never be a treatment without a proper examination. Only if the neurologist is sure about the diagnosis the treatment can follow. To overlook serious underlying diseases and start treatment could have fatal consequences. Before going into detail, we will answer the most common questions patients will ask:
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.
Medications
- Common 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. Moreover the addictive potential of opioids must be taken in consideration.
- Muscle relaxants help to release muscle spasm. Thus the vicious circle of pain – muscle spasm – impaired movement and posture – pain – could be stopped.
- Antidepressants are commonly used and very effective for chronic lower back pain.
- Anti-convulsants (medications to prevent seizures) are successfully used in the treatment of chronic back pain.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (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.
Acupuncture
Acupuncture may be useful as adjunctive treatment for low back pain
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)
Surgical therapy
Surgical therapy including Lumbar microdiskectomy,Spinal stabilization, Laminectomy, Endoscopic therapy, percutaneous arthroscopic diskectomy
CBT (Cognitive Behavioural Therapy)
CBT (Cognitive Behavioural Therapy) 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
Lifestyle adjustments
Lifestyle adjustments to eliminate the risk factors, such as obesity, poor physical health, poor nutrition, smoking, heavy manual labor
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
For psychology and psychiatrist related problems, you can always consult a psychologist, psychiatrist or for counseling our psychotherapists are always available to help you.
