Back and Neck Pain

Back pain is so common that almost everyone experiences it during their life. Often back pain will go away by itself, but when it persists for longer than several days, or if you feel numbness, tingling or weakness, you should see a doctor.

Back and neck pain is usually caused by a problem with the bones and/or discs in the spine including:

Spinal Stenosis: Spinal stenosis narrows the spinal canal space surrounding the spinal cord within the spine. The narrowing puts pressure on the spinal cord and nerves. This in turn causes constant pain and pressure. Spinal stenosis can radiate pain into those parts of the body to which the nerves of the spinal cord are connected.

When stenosis occurs in the lower spinal cord, the pressure on nerves can create pain and/or numbness in the legs. Stenosis in the upper spinal cord may trigger pain and numbness in the neck, shoulders, or even the legs.  Symptoms include:

• back or neck pain
• pain, weakness, cramps, or numbness in the arms or legs
  
• “sciatica” – pain radiating down the buttocks and legs
• problems with bowel movement, urination, balance, and sex in advanced cases

Men and women over 50 years old are more likely to get spinal stenosis due to arthritis or simply to aging, although it also affect younger people who suffer injury or were born with a narrow spinal canal.

Spinal Stenosis

Disc problems:  Problems with the discs in the spinal column can be a source of pain in the back, neck, arms, and legs. Spinal discs are the “cushions” between each vertebra in the spine.

As we age, degenerative disc disease (DDD) can weaken and shrink the discs so that they no longer cushion the nerves adequately.

Sometimes the outside wall of the disc weakens and internal disc contents spill out (disc herniation), pressing on the spinal canal and surrounding nerve roots.

Disc Problems

Failed back surgery syndrome (FBSS):  FBSS occurs when a patient has decompression or fusion surgery and still has remaining or increased pain after the surgery site has fully healed.  FBSS is most common after a discectomy for back pain (vs. discectomy for leg pain, which is usually successful) and a lumbar fusion for multi-level degenerative disc disease.  Sometimes pain can return even after a successful surgery if a disc herniates again or if bone grows back and causes a recurrence of stenosis.

Failed Back Surgery Syndrome

Treatment Options

• Medications
• Procedures
• Other Options

• Dr. Rubin may recommend prescription or over-the-counter anti-inflammatory drugs like aspirin and acetaminophen (Tylenol), ibuprofen (Motrin and Advil), naproxen sodium (Aleve), or ketoprofen (Orudis KT and Actron).
  
  For severe pain you may safely use prescription narcotics like hydrocodone with acetaminophen (Vicodin) or oxycodone with acetaminophen (Percocet) for a short time only.
  
  When back pain is caused by muscle spasms or arthritis, applying creams and ointments directly on the skin helps. Over the counter products are Bengay, Zostrix, and Icy Hot. Prescription examples include Pennsaid and Voltaren Gel.
• • Nerve Root Blocks, Epidural Injections, and Transforaminal Injections place long acting steroids around the spinal nerves and surrounding tissues to reduce inflammation and irritation and relieve pain.
  • SI Joint Injections place steroid medications into the sacroiliac joints on either side of the tailbone to reduce inflammation and relieve pain.
  • Facet Joint Injections treat the facet joints that connect your spine's vertebrae. Injecting steroids or anesthetics into the facet joints can relieve pain.
  • Trigger Point Injections use a local anesthetic or steroid to treat a specific area of muscle spasm that can radiate pain to other areas.
  • Radiofrequency Ablation (Neurotomy) uses radio waves to inactivate painful nerve signals from the facet joints.
  • External Electrical Stimulation uses a mild, painless electric current on the skin to stimulate nerves to relieve the perception of pain. The patient relaxes on a table and the doctor attaches stick-on electrode pads near the painful area, and a low-voltage current stimulates the nearby nerves. How and why electrical stimulation works isn't fully known but some studies suggest that stimulating the nervous system increases endorphins, the body's chemicals that relieve pain. Transcutaneous electrical nerve stimulation (TENS) is one form of electrical stimulation that can treat back pain.
  • Spinal Cord Stimulation treats pain by using painless electric signals from a small implanted battery to disrupt pain signals sent from the spinal nerves to the brain. Patients can “try out” the stimulator for a few days without surgery to see if it relieves their pain.
• • Physical Therapy: Applying hot and cold packs can relieve chronic back pain, although it won't cure the cause. Heat widens blood vessels and improves blood flow to your back. Cold constricts vessels which can reduce inflammation that creates pain, and the cold numbs pain. Flexion exercises have you bend forward to help widen spaces in your spine and stretch and strengthen your back muscles. Extension exercises have you bend the spine backward, such as when lying on your back and lifting your legs. Stretching your back can relieve stiffness.
  • Changing Your Lifestyle: Your doctor may recommend changes in your daily routines to help reduce chronic pain. You may need to learn how to move your body properly when doing daily work or activities, or have proper posture when sitting all day using a computer. Changes in your diet can help reduce pain.