Back Pain and Neck Pain

     Backaches are often due to lumbar strain or sprain. It is the most common cause for benign symptomotology. The pain can be either acute or subacute and be superimposed on chronic back symptoms. Oftentimes the pain does not radiate below the knee which helps to distinguish it from disc disease or radiculopathy. In young adults, adolescents, and children, congenital malformations and conditions associated with rheumatoid arthritis, ankylosing spondylitis, or Reiter’s Syndrome must be entertained. Though with older adults osteoarthritis, spinal stenosis, disc herniation tend to be the more come etiologies.

     Disorders of the lumbar spine can include a significant differential diagnosis including as described lumbar strain and sprain, disc disease, congenital abnormalities, rheumatoid arthritis, ankylosing spondylitis, spinal stenosis, sarcoidosis, tumors, abdominal aortic aneurism referred pain, peptic ulcer disease referred pain to the mid back region, disorders of the kidney, reproductive organs, prostate, diverticulitis, systemic and septic arthritides, tenosisynovitis, and bursitis. Spinal cord lesions must also be considered in this differential which can be rather complex such as a conus medullaris syndrome which can present rather acutely without significant pain often painless but with associated bowel and bladder dysfunction and a bilateral sensory deficit often described as a saddle distribution. Motor weakness may be present but often is mild with increased reflexes.

     Urgent surgical consultation is recommended in these complex presentations. More common presentations would be that of spinal stenosis which presents in some patients with persistent low back pain either unilateral or bilateral oftentimes patients will describe these symptoms of pain abate when they lean over a chair or a shopping cart.
Management includes: neuro imaging and proper intervention with analgesics, physical therapy, and where appropriate surgical considerations.

     The more common symptomotology that will be encountered in most individuals when it is not strain or sprain will prove to involve a herniated disc of the lumbar region with pain in the back and often radiating down the legs below the knee commonly involving the L5 or S1 nerve roots.

      Any compression of the nerve roots will result in increased pain such as an upright position, certain postural changes, coughing, sneezing, and defecation. Numbness, tingling often referred to as parethesias and weakness will often be found on the physical examination and described by the patient involving the lower extremity. If there is bowel or bladder changes it is imperative to address this issue by alerting your Physician or Allied Healthcare professional to rule out significant compression of nerve roots in this region.

     For persistent and chronic low back pain it is important to address a comprehensive program of both pharmacologic and non-pharmacologic treatment algorhythms these may include analgesics where appropriate in conjunction with muscle relaxants and a program of physical therapy and strengthening as well as proper management of weight, possible lifestyle changes. Proper nutrition and supplements may also prove helpful in the management of the chronic pain symptomotology. Also acute pain may prove to benefit from a comprehensive pharmacologic and non pharmacologic approach.

NECK PAIN

     Neck pain is often caused by a cervical strain which is characterized by pain in the cervical area, stiffness, and muscle spasm. For patients over 40, cervical osteoarthritis is the more common cause. Chronic pain can be managed with pharmacologic and non pharmacologic agents whether over the counter or prescription as well as the utilization of physical therapy, heat, and massage therapy, and appropriate supplements for either chronic and/or acute treatment.

      The differential for the etiology for the cervical pain outside of the more common etiologies includes rheumatoid arthritis and ankylosing spondylitis as well as consideration for inflammatory causes such as septic arthritis, non-infectious arthritides, tendinitis, bursitis, and tenosynovitis. Traumatic causes depending on the history. Also consider a vascular cause such as ischemic or acute arterial dissection or subclavean steel syndrome.

    Cervical radiculopathy, the most common regions being the C5-6 approximately 20 percent of cases and the C6-7 in 70 percent of cases. Should intractable pain be present in the cervical area is important to see your Physician or Allied Healthcare professional in order to address the appropriate evaluation which may include neuro imaging and depending if there is significant concerns and symptoms associated with spinal cord compression to obtain neurosurgical evaluation as needed.

     There are important differentials including presentations of cervical radiculopathy that due include considerations for neoplasms in the cervical area, spinal cord tumors, as well as considerations for brachial plaxopathies and neuropathies involving the upper extremity when there’s referred pain into the upper extremity. Other considerations such as thoracic outlet syndrome also may need to be reviewed with the patient.

As with any chronic pain concern involving the back it is important to address a comprehensive non pharmacologic as well as pharmacologic program to control both acute and chronic pain which will involve when appropriate pharmacologic agents with physical therapy and appropriate supplements and exercise programs.

While many people suffer from this condition each year, there are simple steps that you can take to improve your quality of life. More information regarding these steps is outlined in Dr. Winner's "The 7 Steps to a Healthy Brain".