An Overview of Back and Neck Pain

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Neck and back pain is the experience of unpleasant sensations in one or more areas of your neck, mid and upper back, or low back. Spine pain can be brought about by any number of causes and may bring on symptoms in other areas of your body.

Spine-related pain is very common, with low back pain affecting up to 80% of the population at some time in their lives. There's almost twice as much low back pain as neck pain, and the amount of low back pain and knee pain are about equal.

Symptoms

There are many ways to describe spinal pain, many of which will depend on the cause. Some common ones include:

  • Muscle ache
  • Muscle spasm
  • Shooting pains
  • Pain radiating down your leg
  • Pins and needles sensations
  • Numbness in your leg
  • Neck or back dysfunction (i.e., can't stand straight or twist neck)
  • Pain gets worse with activity
  • Pain gets better when lying down
  • Stiffness of back or neck
  • Loss of bowel or bladder control

Recent pain is called acute, while pain lasting longer than three months is known as either chronic or persistent pain. Acute and chronic pain are treated very differently from one another.

Location

Back and neck pain occurs where it does because of the specific area of the spine that is affected. The location of your symptoms is often a good place to start when considering a possible cause.

The neck is defined as that part of the spine extending from your first cervical vertebra (which is approximately at the level of the bottom of your earlobe) down to the seventh. The seventh cervical vertebra is located at the top of your shoulder and upper back.

The mid and upper back is next, extending from just below the seventh cervical vertebra down to the bottom of the 12th thoracic vertebra, which lines up approximately with the tenth rib (the third from the bottom).

The low back is the area corresponding to the lumbar spine, which starts below the 12th thoracic vertebra and extends down to the top of the sacrum bone, almost mid-way down between the two back hip bones.

Sacroiliac and coccyx pain are also types of spine pain; sacroiliac pain mainly takes the form of sacroiliac joint dysfunction. The coccyx bone is your tailbone. It is the last bone of the spine; it hangs down off the bottom of the sacrum.

Causes

With the complexity of the neck and spine, there are many causes of back and neck pain, including the following.

Habits and Aging

Degenerative changes in spinal structures that occur from wear and tear over tim are a very common cause of chronic back and neck pain. These may lead to spinal osteoarthritis and possibly spinal stenosis. Osteoporosis can lead to compression fractures of the vertebrae.

If the pain seems to set in slowly, it may also simply be due to habits like poor posture.

Trauma or Strain

An accident or trauma can lead to neck and back pain, including herniated disc, muscle sprain, ligament strain, spinal fracture, or spinal cord injury.

Structural Problems

The disks that cushion your vertebrae can rupture or bulge (herniate) and may press on the spinal nerves. The irritation is called radiculopathy and can result in pain, weakness, numbness and/or electrical type sensation that goes down one arm or one leg.

Arthritic (degenerative) changes in the spine, such as facet joint hypertrophy, spinal stenosis, and bone spurs may also cause these symptoms.

Genetic and Congenital Conditions

Genetic and congenital causes are also possible. Examples of congenital spine conditions include spina bifida and congenital torticollis (torticollis means "twisted neck"). And Scheuermann's kyphosis, a deformity that affects some teen boys, is an example of a genetic spinal condition.

Scoliosis, which has some genetic underpinnings, can also cause back and neck pain.

Systemic Problems

More rarely, neck or back pain is caused by systemic problems such as diseases, tumors, or cysts. Your diagnostic workup will likely include screening for "red flags," which are signs that may cause your doctor to suspect a systemic, rather than a structural, problem.

Risk Factors

You may be at a higher risk for spine pain if any of the following apply:

  • You are female
  • You're overweight or obese
  • You smoke
  • You have osteoporosis
  • You either get too much exercise or not enough

Other risk factors include a lower education level, living in an urban area, being under 50 (for neck pain) and under 65 (for low back pain), higher stress levels, and emotional difficulties (anxiety or depression).

On-the-job factors play a big role in neck and back pain risk, too. If you're dissatisfied with your job, you lack support from your co-workers or bosses, or your job involves subjecting your body to vibration (for example, operating a jackhammer), you may have a higher likelihood of spine-related pain. Office workers tend to get more neck pain than do other types of workers.

Diagnosis

Your doctor will look at your medical history and do a physical exam. For mild cases that are likely to resolve on their own, that is often enough to determine the right treatment.

Diagnostic imaging is such as magnetic resonance imaging (MRI) and X-rays are done if the doctor feels the need to dig deeper. However, this full workup may be an unnecessary expense if it isn't warranted.

Interestingly, a 2016 study published in the Permanente Journal found that people with public insurance got spine MRIs more frequently than those with either no insurance or private insurance.

Blood tests are often done to assess general health and management of existing conditions and to uncover developing health problems or infections.

Bone scans may be done to look for suspected compression fractures or tumors. If there are symptoms of radiculopathy, electromyography (EMG) nerve studies might be done.

Treatment

For acute back pain, the general guidelines are to continue your normal activities as well as you can. Over-the-counter pain relievers should be the first choice, and heat on the back may help with relief. If it doesn't get better in a few weeks, or if the type of back pain warrants it, your doctor may advise other forms of treatment.

Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) or a muscle relaxant might be suggested. There are also topical pain relievers that you can put on the location where you feel the pain.

A short course of narcotic pain relievers might be tried for acute pain, but these don't work well for chronic pain. This type of medication comes with a risk of addiction. Before consenting to the prescription or taking the drug, it's best to weigh its potential for addiction as well as other side effects (such as constipation) against pain relief that you could possibly get through other means.

A 2016 systematic review and meta-analysis found that most people taking narcotic pain relievers for back pain (also known as opioids) did not get "clinically important pain relief" in the dosage range evaluated. The review/meta-analysis concludes that people who tolerate opioids may get "modest short-term relief" at best and that there's really no evidence to speak of for long-term pain relief.

Antidepressants can help relieve some types of chronic back pain. Cortisone injections in the spine can also help reduce inflammation around the nerve roots, which may provide some short-lived relief.

Back surgery is often not necessary and is mostly used to correct spinal stenosis or a herniated disk that hasn't had effective treatment by other means. Generally, research recommends trying physical therapy and other conservative treatment first. If the therapy (and your participation in it) fails to relieve the pain, surgery may then be a possibility.

A Word From Verywell

While neck and back pain is rarely, if ever, life-threatening, it can be quite bothersome and in some cases can seriously disrupt your quality of life for a long time. That said, most cases turn out to be minor episodes that people recover from by reducing their activity and letting the problem take its course. Whether you have just tweaked your back or you have persistent pain, it pays to take an active role in your care. Work with your doctor and ensure you are getting the physical therapy and treatment is right for you.

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Article Sources

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