Neck and Back Pain

Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it hard to move. It can start quickly if you fall or lift something too heavy, or it can get worse slowly.

Who Gets Back Pain?

Anyone can have back pain, but some things that increase your risk are:

Getting older. Back pain is more common the older you get. You may first have back pain when you are 30 to 40 years old.

Poor physical fitness. Back pain is more common in people who are not fit.

Being overweight. A diet high in calories and fat can make you gain weight. Too much weight can stress the back and cause pain.

Heredity. Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, can have a genetic component.

Other diseases. Some types of arthritis and cancer can cause back pain.

Your job. If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.

Smoking. Your body may not be able to get enough nutrients to the disks in your back if you smoke. Smoker’s cough may also cause back pain. People who smoke are slow to heal, so back pain may last longer.

Another factor is race. For example, black women are two to three times more likely than white women to have part of the lower spine slip out of place.

What Are the Causes of Back Pain?

There are many causes of back pain. Mechanical problems with the back itself can cause pain. Examples are:

Disk breakdown

Spasms

Tense muscles

Ruptured disks

Injuries from sprains, fractures, accidents, and falls can result in back pain.

Back pain can also occur with some conditions and diseases, such as:

Scoliosis

Spondylolisthesis

Arthritis

Spinal stenosis

Pregnancy

Kidney stones

Infections

Endometriosis

Fibromyalgia.

Other possible causes of back pain are infections, tumors, or stress.

Can Back Pain Be Prevented?

The best things you can do to prevent back pain are:

Exercise often and keep your back muscles strong.

Maintain a healthy weight or lose weight if you weigh too much. To have strong bones, you need to get enough calcium and vitamin D every day.

Try to stand up straight and avoid heavy lifting when you can. If you do lift something heavy, bend your legs and keep your back straight.

When Should I See a Doctor for Pain?

You should see a doctor if you have:

Numbness or tingling

Severe pain that does not improve with rest

Pain after a fall or an injury

Pain plus any of these problems:

Trouble urinating

Weakness

Numbness in your legs

Fever

Weight loss when not on a diet.

How Is Back Pain Diagnosed?

To diagnose back pain, your doctor will take your medical history and do a physical exam. Your doctor may order other tests, such as:

X rays

Magnetic resonance imaging (MRI)

Computed tomography (CT) scan

Blood tests.

Medical tests may not show the cause of your back pain. Many times, the cause of back pain is never known. Back pain can get better even if you do not know the cause.

What Is the Difference Between Acute and Chronic Pain?

Acute pain starts quickly and lasts less than 6 weeks. It is the most common type of back pain. Acute pain may be caused by things like falling, being tackled in football, or lifting something heavy. Chronic pain lasts for more than 3 months and is much less common than acute pain.

How Is Back Pain Treated?

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take acetaminophen, aspirin, or ibuprofen to help ease the pain. Exercise and surgery are not usually used to treat acute back pain.

Following are some types of treatments for chronic back pain.

Hot or Cold Packs (or Both)

Hot or cold packs can soothe sore, stiff backs. Heat reduces muscle spasms and pain. Cold helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this treatment does not fix the cause of chronic back pain.

Exercise

Proper exercise can help ease chronic pain but should not be used for acute back pain. Your doctor or physical therapist can tell you the best types of exercise to do.

Medications

The following are the main types of medications used for back pain:

Analgesic medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications.

Topical analgesics are creams, ointments, and salves rubbed onto the skin over the site of pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that reduce both pain and swelling. NSAIDs include over-the-counter drugs such as ibuprofen, ketoprofen, and naproxen sodium. Your doctor may prescribe stronger NSAIDs.

Muscle relaxants and some antidepressants may be prescribed for some types of chronic back pain, but these do not work for every type of back pain.

Behavior Changes

You can learn to lift, push, and pull with less stress on your back. Changing how you exercise, relax, and sleep can help lessen back pain. Eating a healthy diet and not smoking also help.

Injections

Your doctor may suggest steroid or numbing shots to lessen your pain.

Complementary and Alternative Medical Treatments

When back pain becomes chronic or when other treatments do not relieve it, some people try complementary and alternative treatments. The most common of these treatments are:

Manipulation. Professionals use their hands to adjust or massage the spine or nearby tissues.

Transcutaneous electrical nerve stimulation (TENS). A small box over the painful area sends mild electrical pulses to nerves. Studies have shown that TENS treatments are not always effective for reducing pain.

Acupuncture. This Chinese practice uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as a part of a comprehensive treatment plan for low back pain.

Acupressure. A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for back pain.

Surgery

Most people with chronic back pain do not need surgery. It is usually used for chronic back pain if other treatments do not work. You may need surgery if you have:

Herniated disk. When one or more of the disks that cushion the bones of the spine are damaged, the jelly-like center of the disk leaks, causing pain.

Spinal stenosis. This condition causes the spinal canal to become narrow.

Spondylolisthesis. This occurs when one or more bones of the spine slip out of place.

Vertebral fractures. A fracture can be caused by a blow to the spine or by crumbling of the bone due to osteoporosis.

Degenerative disk disease. As people age, some have disks that break down and cause severe pain.

Rarely, when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, surgery is needed right away to ease the pain and prevent more problems.

Neck pain

Pain - neck; Neck stiffness

Considerations

Neck pain may begin in any of the structures in the neck. These include muscles and nerves as well as spinal vertebrae and the cushioning disks in between. Neck pain may also come from regions near the neck, like the shoulder, jaw, head, and upper arms.

When your neck is sore, you may have difficulty moving it, especially to one side. Many people describe this as having a stiff neck.

If neck pain involves nerves (for example, significant muscle spasm pinching on a nerve or a slipped disk pressing on a nerve), you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere.

Causes

A common cause of neck pain is muscle strain or tension. Usually, everyday activities are to blame. Such activities include bending over a desk for hours, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising.

Traumatic accidents or falls can cause severe neck injuries like vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include:

Other medical conditions, such as fibromyalgia

Cervical arthritis or spondylosis

Ruptured disk

Small fractures to the spine from osteoporosis

Spinal stenosis (narrowing of the spinal canal)

Infection of the spine (osteomyelitis, diskitis, abscess)

Cancer that involves the spine

Home Care

For minor, common causes of neck pain:

Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

Apply heat or ice to the painful area. One good method is to use ice for the first 48 - 72 hours, then use heat after that. Heat may be applied with hot showers, hot compresses, or a heating pad. Be careful not to fall asleep with a heating pad on.

Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.

Perform slow range-of-motion exercises -- up and down, side to side, and from ear to ear -- to gently stretch the neck muscles.

Have a partner gently massage the sore or painful areas.

Try sleeping on a firm mattress without a pillow or with a special neck pillow.

Use a soft neck collar for a short period of time to relieve discomfort.

You may want to reduce your activity only for the first couple of days. Then slowly resume your usual activities. Do not perform activities that involve heavy lifting or twisting of your back or neck for the first 6 weeks after the pain begins. After 2 - 3 weeks, slowly resume exercise. A physical therapist can help you decide when to begin stretching and strengthening exercises and how to do them.

  • Avoid the following exercises during your initial recovery, unless your doctor or physical therapist says it is okay:

Jogging

Football

Golf

Ballet

Weight lifting

Leg lifts when lying on your stomach

Sit-ups with straight legs (rather than bent knees)

What to Expect at Your Office Visit

Your doctor will perform a physical examination and ask detailed questions about your neck pain, including how often it occurs and how much it hurts. Other questions may include:

Is your pain in the front, back, or side of your neck?

Are both sides of your neck affected equally?

When did the pain first develop?

Is it painful all the time or does the pain come and go?

Can you touch your chin to your chest?

What makes your neck feel worse? What makes your neck feel better?

Do you have neck weakness or neck stiffness?

Do you have any accompanying symptoms like numbness, tingling, or weakness in your arm or hand?

Do you have swollen glands or a lump in your neck?

These questions help your doctor determine the cause of your neck pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, neck pain will get better in 4 - 6 weeks using these approaches.

Your doctor will probably not order any tests during the first visit, unless you have symptoms or a medical history that suggests a tumor, infection, fracture, or serious nerve disorder. In that case, the following tests may be done:

X-rays of the neck

CT scan of the neck or head

Blood tests such as a complete blood count (CBC)

A spinal tap for a cerebrospinal fluid analysis if meningitis is suspected

MRI of the neck

If the pain is due to muscle spasm or a pinched nerve, your doctor may prescribe a muscle relaxant and possibly a more powerful pain reliever. Over-the-counter medications often work as well as prescription drugs. The doctor may prescribe a neck collar or, if there is nerve damage, refer you to a neurologist or neurosurgeon for consultation.

If meningitis is suspected, you will be sent to an emergency department for further tests, antibiotics, and hospital admission.

Prevention

  • Use relaxation techniques and regular exercise to prevent unwanted stress and tension to the neck muscles.
  • Learn stretching exercises for your neck and upper body. Stretch every day, especially before and after exercise. A physical therapist can help.
  • If you tend to get neck pain from exercise, apply ice to your neck after physical activity.
  • Use good posture, especially if you sit at a desk all day. Keep your back supported. Adjust your computer monitor to eye level. This prevents you from continually looking up or down.
  • If you work at a computer, stretch your neck every hour or so.
  • Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
  • When reading or typing from documents at your desk, place them in a holder at eye level.
  • Evaluate your sleeping conditions. Make sure your pillow is properly and comfortably supporting your head and neck. You may need a special neck pillow. Make sure your mattress is firm enough.
  • Use seat belts and bike helmets to prevent injuries.
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