What are the conditions commonly linked to neck or low back pain?
• Muscle or ligament strain – Back muscles and ligaments may be strained due to constant heavy lifting or an abrupt movement.
• Injuries – Impacts of rear-end auto collisions can cause whiplash injuries by jerking the head backward and then forward, stretching the limits of the soft tissues of the neck.
• Bulging or ruptured discs – Discs between individual bones (vertebrae) in the spine perform as cushions to undergo any pressure on the spine. When the soft material inside a disc bulges out of place or rupture, inflammatory chemicals are released and these chemicals irritate nerve fibers to fire off pain impulses.
• Arthritis – Osteoarthritis can affect the lower back and the spine. In cases when arthritis affects the spine, the space around the spinal cord can become narrower. This condition is called spinal stenosis and the resultant pain may be due to irritation by inflammation mediators, venous congestion, or in very severe cases – compression of nerves.
• Skeletal irregularities – When the spine is curved in an abnormal way, it can cause back pain by premature wear and tear.
• Osteoporosis – When bones become porous and brittle, compression fractures can easily occur on the spine's vertebrae.
• Other Diseases – Diseases, such as rheumatoid arthritis, meningitis or cancer can also cause neck pain.
• Failed back syndrome – Previous complicated surgeries to the back may result in adhesion formation. This can further result in nerve tethering that causes pain.
Note: All of the above processes (physical trauma, all forms of inflammation) can cause myofascial pain in susceptible individuals. Painful trigger points can be felt within taut muscle bands. Present knowledge points to neuro-muscular junction dsyfunction and accumulation of excessive cellular waste products as the main generators of myofascial or trigger-point pain.
What are the diagnostics for back and neck pain?
• X-ray – The images can reveal if back pain is caused by the misalignment of the bones or other reasons such as arthritis or broken bones. Nerves or spinal cord that may be pinched by bone spurs or a bulging disc in areas of the neck may also be shown through these X-ray images.
• Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) scans – The scans and images generated may reveal herniated discs or other problems associated with the bones, muscles, tissue, tendons, nerves, ligaments, blood vessels, spinal cord or the nerves coming from the spinal cord.
• Bone scan – Bone tumours or compression fractures caused by osteoporosis may be shown through a bone scan.
• Nerve studies (Electromyography, or EMG) – Electrical impulses produced by the nerves and the responses of muscles are measured to confirm if there is any nerve compression.
• Blood tests – Evidence of inflammatory or infectious conditions that may cause neck pain can be shown through blood tests.
What are the types of treatments for back and neck pain management?
After a few weeks of home treatment, most back and neck pain will subside but if the pain continues, the following methods are likely to be recommended:
• Medications – Stronger pain relievers may be prescribed to alleviate pain. Muscle relaxants and low doses of antidepressants may also be given. Nutritional deficiencies are treated.
• Physical therapy and exercise – A physical therapist may be able to help optimize your posture and strengthen your muscles through exercises and stretches to prevent pain from returning.
• Injections – Accurate trigger point injections which elicit a localized muscle twitch, are proven to eliminate taut bands and trigger points. Anti-inflammatory and numbing medications may be injected to modulate the sensitized nerves that cause back and neck pain. Radiofrequency neurotomy, Nucleoplasty and Annuloplasty are other minimally invasive procedures on the spine that target different pain generators to improve stability and provide more lasting pain relieving effects than injections alone.
• Spinal cord stimulators – These are useful in the treatment of failed back syndrome.
• Surgery – This is rarely considered except for the relief of nerve root or spinal cord compression.