Patient Education: Back and Neck Pain FAQs
What are potential causes of lower back pain?
What are causes of neck pain?
What is Sciatica?
What is cervical radiculopathy?
What are some of the diagnostic tools for low back and neck pain?
What are some of the treatments for low back and neck pain?
When should you seek a medical opinion and what type of doctor should you see?
What is an interventional pain specialist?
What are potential causes of lower back pain?
Lumbar Sprains and Strains are very common causes of low back pain. They may be caused by injury to the muscles, tendons or ligaments of the lower back, such as a sudden twisting or pulling movement or chronic overuse of lower back muscles. The treatment is usually conservative, including rest, medications, ice or heat, or physical therapy.
Herniated / Bulging Discs — The disc is the cushion between the vertebrae of your spine. A disc can rupture and extend beyond its normal boundary. When a disc herniates / bulges out, the spinal nerves can become compressed, possibly resulting in pain or numbness down the leg. Depending on the severity, treatment may require measures such as epidural or nerve block injections or possibly surgery, including minimally invasive techniques.
Lumbar Facet Joint Syndrome — Facet joints are joints located on both sides of the spine at the back of each vertebra. Facet joints attach to the vertebrae above and below to form a unit, allowing movement of the spine. Lumbar facet syndrome is usually felt in the lower back, but pain can be referred causing sciatica-like symptoms. Facet pain can be treated with facet injections, also called medial branch nerve blocks, or radio frequency ablation, which is used for longer lasting relief of facet pain.
Spinal Stenosis is narrowing of the spinal canal or where the nerve roots exit and can cause sciatica-like symptoms if the nerve roots are compressed. Disc problems and arthritis can be causes of spinal stenosis. Possible treatment options include epidural injections or surgery if conservative measures fail.
Sacroiliitis is an inflammation of your sacroiliac joint. That's the joint where your hip joins the spine. Trauma or arthritis can lead to inflammation of the joint and give you symptoms that can mimic sciatica. One way to diagnose and treat this condition can be with an injection using x-ray guidance for more precise location.
Piriformis Syndrome is a less common, sometimes controversial diagnosis used for a cause of buttock / leg pain caused by the irritation of the piriformis muscle. This muscle is in your buttock region and usually lies above the sciatic nerve as it exits the spine and goes down your leg.
What are causes of neck pain?
Most of the conditions mentioned for low back pain are similar to potential causes for neck or cervical pain as well. Sprains and strains are the most likely causes of neck pain. Other causes include cervical disc problems, spinal stenosis, facet syndrome, etc.
Osteoarthritis of the spine (also known as spondylosis) is a common disorder causing progressive deterioration of the spine and can cause new bone formation called osteophytes (bone spurs) that decrease range of motion of the neck and lead to pain.
Spinal stenosis causes the foramen to narrow where the nerve roots exit the spine, possibly compressing and entrapping nerve roots, which can lead to neck, shoulder, and arm pain and numbness.
Whiplash can occur in a motor vehicle accident involving a hyperextension and / or hyperflexion injury of the neck.
What is Sciatica?
Sciatica is a term for pain along the sciatic nerve. It is usually a sharp, burning pain originating in the buttock that travels down the back of thigh and can go down the lower leg to the foot. Herniated discs in your back or spinal stenosis are common causes of sciatica. An MRI of the lower back or electrodiagnostic studies may help in making the diagnosis. Treatment options range from conservative measure to injections to surgical options in severe cases.
What is cervical radiculopathy?
Often called "a pinched nerve in the neck"; cervical radiculopathy is a dysfunction of a nerve root of the cervical spine which can lead to pain, numbness or weakness depending on the severity of the condition. In the younger population it is often secondary to disc bulge / herniation and in the older population secondary to degenerative changes of the joints and discs causing irritation or compression of the nerve root.
What are some of the diagnostic tools for low back and neck pain?
Obtaining a proper history and physical is critical to determine a correct diagnosis and the best course of treatment. A physical examination will include observation for posture, misalignment, examination of range of motion, palpation or feel the curvature of the spine, vertebral alignment, and detect muscle spasm. The neurological examination involves testing reflexes, muscle strength, detecting sensory and / or motor changes, and determines pain distribution.
Radiographic studies can aide in diagnosis of spine pain. An x-ray or CAT scan can reveal disc space narrowing, fractures and osteoarthritis. MRI can be used to detect bulging discs and herniations.
Electrodiagnostic studies also known Nerve conduction / EMG studies are another tool in determining cervical or lumbar radiculopathy among other diagnoses to help assist in proper diagnosis and treatment.
What are some of the treatments for low back and neck pain?
Conservative Measures include rest, ice, heat, electrical stimulation, TENS unit, anti-inflammatory medications, physical therapy.
Injections can include trigger point and joint injections done in the office to injections such as epidural and facet injections done with the assistance of X-ray to better locate and place medications under safer conditions usually done in outpatient surgical centers.
Surgery can range from less invasive procedures such as discectomy to more advance procedures to help alleviate symptoms of back and leg pain.
Advanced — there are other options beyond injections or surgery such as are spinal cord stimulators for such difficult to treat conditions as post laminectomy syndrome or reflexive sympathetic dystrophy (RSD).
When should you seek a medical opinion and what type of doctor should you see?
If you’re experiencing pain in the spine region or pain radiating to arms or the legs, numbness or weakness you should seek a spine specialist to evaluate and treat your condition. Depending on the severity of your symptoms, interventional pain specialists with a background focusing on the spine or a spine surgeon can determine what are the necessary steps needed to help diagnose and alleviate your symptoms.
What is an interventional pain specialist?
Most commonly an interventional pain specialist has a Physical Medicine and Rehab or Anesthesia residency background and then goes on to further training in an accredited fellowship pain medicine program. The additional training of at least one year focuses on pain related conditions and includes properly learning interventional procedures under experienced guidance to offer patients another option in treating painful conditions. Procedures can include epidural, facet, sacroiliac injections, radiofrequency ablation for facet pain, sympathetic blocks, spinal cord / peripheral nerve stimulators.
