Neck & Back Pain
Neck & Back Pain simple (acute), complex (chronic)
About 8 out of every 10 people will suffer from back pain at some point in their lives. There are many structures that contribute to back pain; nerves, muscles, jointsand ligaments.
Symptoms and Causes
Complex Spinal Pain Persistent pain beyond 3 months. Any pain that lasts beyond three months with no underlying cause is persistent pain and likely due to sensitive nerves and ‘wrong’ messages sent to the brain. In general, complex spinal pain can occur in the lower back part of the body or radiates past the knee. It can be also caused by failed back and neck surgery.
Pain in lower back In the lower back the following can cause persistent pain:
Discs
- Discs separate vertebral bodies in the spine.
- Age related changes causes thinning of disc, reduction in fluid.
- Ligament damage, nerve entrapment, spinal stenosis, sciatica.
- More likely in those with history of heavy manual labour, family history of’ bad backs’, obese, smokers.
Facets
- Joints that allow spinal bones to twist and flex.
- Can undergo arthritic changes.
- Can be injured in trauma or from strain.
- This pain may be accompanied by stiffness and limitations in movement.
- The pain is most easily provoked by bending backward and twisting, or tilting the head back and twisting.
Sacroiliac joint
- Connects the spine to the pelvis.
- Acts as a shock absorber.
- Dysfunction can arise due to age related degeneration , high impact sports, pelvic injury and particularly during pregnancy.
Muscles (myofascial)
- Constant muscle contraction and tension.
- Tender muscles and aching in the area. (lumbago in lumbar regions)
- Cervicalgia in the neck. (neck and shoulder pain)
Pain that radiates past the knee It is usually related to a disc herniation or spinal stenosis. It is possible to have both facet arthritis causing back and buttock pain, and sciatica related to a disc herniation causing leg pain, numbness, and tingling.
- Numbness in the buttock and urinary region
- Urinary or faecal incontinence
- Loss of sensation in legs or arms
NEEDS urgent medical opinion.
Persistent Post operative Pain (Failed Back and cervical surgery syndrome)
Every surgery will cause tissue, muscles and nerve damage.
90% of patients recover well from their procedure with no long lasting effects and apart from reasonable post operative short term pain which, with excellent current new medications, are well controlled.
Evidence is growing that at least 10% of patients have persistent pain post surgery. Malaysians are very stoical and adapt to this pain perhaps thinking the surgery has not been successful, when in actual fact continued pain afterwards is a risk that exists with every procedure. There are many new advances to treating these sorts of pain. It is a chronic disease.
Diagnosis and Treatment Options
If pain persists beyond that they should see a pain specialist, if there is history of cancer, night pain, weight loss or neurological problems they should seek medical advice sooner.
- 2 weeks: Simple analgesia, Non steroidal anti-inflammatory medications. Continue usual exercises. Might need short course of stronger analgesia.
- 2-4 weeks: Physical therapy recommended, possible trigger point release.
- Beyond 4-6 weeks: Full medical advice to be sought, sooner if underlying concurrent medical problems; further investigations and minimally invasive procedures- spinal injections can be both diagnostic and therapeutic.
Treament options for complex spinal pain
- Disc- -40 % of cases – treatment: epidural +/- nerve root injection.
- Facet joint – 20 % of cases – treatment: facet joint injections OR radiofrequency denervation
- Sacroiliac joints -15% of cases – treatment: sacroiliac joint injection
- Muscles-treatment: tender point injections, acupuncture (medical dry needling), heat treatment, physiotherapy.