Integrated Pain Care
A Pain Management Clinic of Excellence
Phone: (510) 758-7462
Fax: (800) 806-5602
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There are many different causes of neck and lower back pain. Some of these causes arise from the anatomy of the back or neck itself, while others originate from other areas of the body, also called referred pain. Descriptions of the type of back or neck pain experienced may vary from person to person, and depend upon the source of the pain. These descriptions may be characterized as throbbing, aching, stabbing, burning, tingling, constant, or intermittent. At times, there may be numbness or weakness accompanying the pain, or it may radiate to the extremities of the body. There are several sources of back or neck pain such as fractures, spinal bone or soft tissue tumors, kidney problems, and certain vascular or arterial diseases that may signal serious problems, so it is important to see a doctor if the pain has not resolved within a few weeks or increases in intensity. At this stage, imaging studies such as X-rays, CT scans, or MRIs may be ideal diagnostic exams to pinpoint the source of the pain. The most common causes of back and neck pain include sprain or strain injury, spinal stenosis, facet joint syndrome, discogenic pain, and nerve pain due to one or more bulging discs compressing the nerve roots exiting the spine.
Sprain and strain injuries display symptoms of back or neck spasm, stiffness, and pain, and are the most common cause of back pain and neck pain. Sprains are injuries to the spinal ligaments, while strains are injuries to the muscles associated with the spine. The symptoms of these injuries usually become apparent within 24 hours of the injury, and normally resolve within six weeks. Strain and sprain injuries are frequently the result of lifting a heavy object or repetitive motion. Treatment during the first few days after the sprain or strain occurred may include the application of ice packs, anti-inflammatory medications, and rest. After three days, the ice packs may be replaced with warm compresses, and rest should be replaced with physical therapy and strengthening exercises to prevent further damage.
Spinal stenosis is another name for narrowing of the bony portion of the spinal canal, which is where the spinal cord and nerves are located. As the canal narrows, it impinges on the spinal nerves, causing an aching or tingling pain through the upper or lower extremities. Although there are both congenital and acquired causes of stenosis, congenital occurs from birth, and is considered very rare. The majority of stenosis cases affect people as they age, and the symptoms include pain that increases with standing or walking, weakness, and tingling, cold, or numb sensations in the extremities. Some causes of spinal stenosis include osteoarthritis from disc collapse that creates bone spurs or cause thickening of the vertebral ligaments, both of which result in narrowing of the spinal canal. Unlike other types of back and neck problems, stenosis pain tends to worsen over time. Treatments for spinal stenosis include both conservative and surgical approaches, depending on the severity of the pain and degree of narrowing in the spinal canal. Conservative treatments use rest, anti-inflammatories and other pain relievers, exercise, and possibly a supportive back brace to relieve symptoms. If these methods fail, surgical intervention may be the only method of achieving pain relief. Spinal decompression surgery widens the spinal canal by either removing or trimming the lamina portion of the vertebra, or widening the foramina, which is the exiting canal. This procedure may or may not include fusion of affected vertebra, and have a high rate of success.
The spine articulates with the help of small joints that allow the spine to flex and rotate. Facet joint syndrome occurs when these tiny joints become inflamed, causing pain, tenderness, and some loss of spinal flexibility. This condition is most often the result of degeneration of these joints, and tends to occur in acute episodes that come and go several times a year. During flare-up episodes, either mechanical joint stress from movement of joint bones over one another or the shrinking of disc space due to the drying up of the discs themselves cause the facet joint nerves to transmit pain signals. Symptoms tend to also include aching or radiating pain into the extremities, and can mimic the symptoms of a herniated disc. The symptoms tend to be worst when waking up in the morning and improve after moving around, only to return again at the end of the day. Aside from using X-rays or CT scans to diagnose this condition, the most accurate way to diagnose facet joint syndrome can be made with a facet joint block injection, where the area is injected with a combination of X-ray contrast material, local anesthetic, and cortisone. Post-injection pain relief is considered a positive diagnosis for this syndrome. Several conservative treatment options are available, such as exercises, hot compresses, anti-inflammatory medications, chiropractic care, and posture support, although these only offer temporary pain relief during flare-ups. A more invasive permanent treatment is called radiofrequency thermolysis, which is permanent destruction of the nerves serving the affected joints through the use of a heated needle.
Discogenic pain is directly related to the intervertebral discs themselves, and is caused by the aging process. As we age, the fluid from the outer fibrous layer of the discs is slowly lost, leaving them brittle. If these brittle discs crack, they may release chemicals from the center of the disc that causes irritation and pain. The process of water loss and damage to the disc is called disc degeneration, and it can cause the nerves surrounding the disc to become irritated and radiate pain to the extremities. Pain from discogenic pain may be treated using conservative methods such as ice or heat packs, anti-inflammatories and analgesics, and rest. Most painful episodes heal on their own, with little treatment needed. Rest, nonsteroidal anti-inflammatories, analgesics, physical therapy, epidurals, and exercise are usually sufficient for the pain during healing, but sometimes further intervention is necessary if the discomfort continues. Epidural injections, nucleoplasty, annuloplasty, and spinal cord stimulation are more invasive treatments, but sometimes surgery to remove the disc and/or fuse the vertebra to another neighboring one is the only solution.
Nerve pain caused by bulging intervertebral discs compressing exiting nerve roots can cause symptoms of aching, tingling, or shooting pain in the extremities, and possibly numbness. This pain may come and go when the nerve becomes irritated, which may be conservatively treated with analgesics, anti-inflammatories, anticonvulsants, and painkillers. This may be enough to calm the irritation of the nerve enough to allow it to heal for the time being, but usually returns intermittently. Nerve pain in the back that runs down the back of the thigh is called sciatica, and is a common form of nerve pain related to the back. If the problem becomes too painful, surgery to remove all or part of the damaged disc (discectomy) and either fuse the vertebrae affected or replace the disc with an artificial one may help, or the surgeon may opt to widen the opening the nerve passes through (foraminotomy). They may also remove some of the lamina of the vertebra (laminectomy) to create more space for the nerve. All of these surgical options are meant to prevent the irritation of the nerve and prevent the painful symptoms that accompany it.