Back and Neck Pain: Diagnosis and Treatment
Determining the Cause
Back pain is not always indicative of a spinal problem. Rarely is back pain an emergency or serious medical condition. A proper diagnosis is paramount to determine the best course of treatment. A thorough physical and neurologic assessment may reveal the cause of the pain.
The examination begins with the patient’s current condition and medical history. The clinical history includes many questions such as “when did the pain start?” - “what activities preceded the pain?” - “Previous treatment” - “does the pain radiate or travel into another part of the body?” - “what makes the pain less or greater?”.
This examination includes observation of the patient’s posture, range of motion, and physical condition. Any movement generating pain is noted. The physician will palpate or feel the curvature of the spine, vertebral alignment, detect muscle and tender points. Abdominal palpation may be performed to determine if the cause of low back pain is possibly internal organ related (e.g. pancreas).
The neurological examination tests the patient’s reflexes, muscle strength, detects sensory and/or motor changes, and determines pain distribution. If nerve damage is suspected, the physician may order special tests to measure the rate at which nerves conduct impulses. These tests are termed Nerve Conduction Velocity (NCV) and Electromyography (EMG). Typically these studies are not performed immediately because it may take several weeks for nerve impairment to become apparent.
If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.
Plain radiographs (x-rays), CT scan, and/or MRI studies are performed when fracture or disc disease is suspected, or to evaluate neurologic dysfunction. An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging method of choice to study the bony elements in the spine.
Non-Surgical - Conservative Treatment
Seldom does back pain require surgical intervention. A conservative treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient’s medical condition, age, other drugs the patient currently takes, and safety.
The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to reduce the risk of stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers may be prescribed for use during the acute phase.
A cervical collar may be recommended to help a patient with neck pain. Cervical collars limit movement and support the head taking the load off the neck. Lying down has a similar affect. Limiting neck movement and reducing pressure (weight) gives muscles needed rest while healing. Cervical traction may be prescribed for home use. This form of traction gently pulls the head, stretching neck muscles, while increasing the size of the neural passageways (foramen).
Physical Therapy (PT) may be incorporated into the patient’s treatment plan once activity can be tolerated. PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise.
Therapeutic exercise can help build strength, increase range of motion, coordination, stability, balance, and promotes relaxation. Therapists educate their patients about their condition and teach posture correction and relaxation techniques. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes back maintenance through a home exercise program developed for the patient by the physical therapist.
Surgery - Seldom Required
Seldom is spine surgery required to treat back pain. Indications for surgery include, but are not limited to spinal cord dysfunction, bowel and/or bladder dysfunction, excruciating pain (more often leg pain is greater than back pain) unrelieved by non-operative measures, and prolonged pain and/or weakness.
Recovery and Prevention
First and foremost, follow the treatment plan outlined by the physician and physical therapist. Patients, who undergo a surgical procedure, may find the road to recovery a bit longer. However, that is not reason to become discouraged. It is normal to feel tired and emotionally down following surgery. During stress such as surgery, the body cranks out extra hormones - after surgery the level drops, which may result in a ‘down’ period. To enhance recovery from surgery, an episode of back pain, or to help minimize future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.
