Back pain is a common affliction with huge implications for society through lost productivity and high healthcare costs. It is a major cause for work absenteeism and probably leads to more lost productivity at work than any other medical condition.
It is estimated that 80% of adults will experience low back pain at some point in their lives affecting their daily activities.
This is typically so the older one gets and the severity of pain increases with the age of presentation.
Neck pain is almost as common a complaint as low back pain. The neck contains as many pain sensitive structures. As the neck is quite mobile and joins a relatively heavy head to an inflexible chest area, it is subject to carrying degrees of trauma.
Some of the risk factors for these conditions include extrinsic factors such as heavy physical labour, frequent bending and lifting of heavy objects, sedentary office work and smoking. Intrinsic factors such as spinal abnormalities, being obese and tall are also risk factors.
When one sees a doctor, we first obtain a thorough medical history and physical and neurological examination. This is to exclude more ominous causes such as pain from cancer or a fracture of the spine.
Depending on what is found, further investigations e.g. laboratory or radiological tests may be ordered.
The most common cause for neck and back aches are myofascial in nature.
- Muscle strains due to overuse e.g. from sporting injuries or heavy lifting.
- Whiplash injuries from being involved in a motor vehicular accident are also a common cause for neck aches.
- Another common cause is spinal spondylosis. In this condition, there is wear and tear of the spinal discs which cushion with vertebrae bones. This leads to disc degeneration and hardening with subsequent new bone formation which may lead to pressure on the nerves exiting from the spinal cord going to the arms and legs. The spinal cord itself may also be compressed from this. If severe, this may lead to numbness and weakness in the arms and legs.
- Facet joint disease which is degeneration and inflammation of the facet joints which connect one vertebra to another is another source of neck and back pain.
- Scoliosis in where there is inborn curvature of the spine is another cause of back pain. Less common causes include infection of the vertebra e.g. from tuberculosis, abscess formation can also present with low back pain.
- Back pain may also be a presenting complaint for cancers.
- Rheumatoid arthritic patients may also present with back pain from involvement of the spine in this disease.
Medical Treatment Options
Medical treatment of neck and back pains run a spectrum from conservative to invasive.
- Therapeutic modalities include the use of soft cervical collars or lumbar supports.
- Physiotherapy is often tried with the use of therapeutic massages, ultrasound, ice and heat therapy and traction especially for neck aches.
- Anti-inflammatories such as non-steroidal anti-inflammatory medications e.g. aspirin, ibuprofen, naproxen, celecoxib and etoricoxib are often used in this respect.
If conservative treatment fails, more invasive measures e,g, myofascial trigger point have provided relief.
- Nucleoplasty, where discs are shrunk by x-ray guided probes placed into the bulging discs and removing excess disc material.
- IntraDiscal Electrothermal Therapy (IDET) uses thermal energy via a special needle is inserted into the offending disc and heated to a high temperature for up to 20 minutes. The heat thickens and seals the disc wall and reduces the inner disc bulge and irritation of the spinal nerve.
- Radiofrequency ablation of nerves to the facet joints also allows us to stop the pain coming from facet joint inflammation. On the other end of the treatment spectrum, surgical procedures e.g. spinal fusion, laminectomy and artificial disc replacements are used for severe intractable spinal disease.
(Article reproduced with permission)
About Dr Charles Siow Hua Chiang
MB, BCh, BAO, LRCPI, LRCSI
Royal College of Surgeons in Ireland
Dr Siow runs his own practice, Siow Neurology Headache & Pain Centre, at Mt. Alvernia Hospital and Mt. Elizabeth Novena Specialist Centre. As a leading neurologist for the past 15 years, he enjoys improving the lives of people suffering from neurological disorders. Dr Siow specialises in headache and pain management.