An Overview of Back and Neck Pain

In This Article

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 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.


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, 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 control of bowels or bladder

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.


The neck (and therefore neck pain) 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, which is 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; mainly sacroiliac pain 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.


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

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.

Habits and Aging

But if the pain seems to grow on you slowly, it may be due to poor posture or spinal deformity, such as scoliosis. A very common cause of chronic spine pain related to aging (and to a lesser degree long-standing injuries) are the degenerative changes in spinal structures that occur from wear and tear over time. These may lead to spinal osteoarthritis and possibly spinal stenosis. Osteoporosis can lead to compression fractures of the vertebrae.

Bulging or Ruptured Disks

The disks that cushion your vetebrae 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.

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 to your doctor that may cause her to suspect a systemic rather than a structural problem.

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 spinal condition related to genetics.

Risk Factors

You may be at a higher risk for spine pain if you're female, you're overweight or obese, you smoke, have osteoporosis and/or 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, or having 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 a painful spine. Office workers tend to get more neck pain than do other types of workers.


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

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, management of existing conditions, and 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.


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) might be suggested, or a muscle relaxant. 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, at that point surgery may 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.

Was this page helpful?

Article Sources

  1. Noormohammadpour P, Mansournia MA, Koohpayehzadeh J, et al. Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran: A Population-based National Study. Clin J Pain. 2017;33(2):181-187. doi:10.1097/AJP.0000000000000396

  2. Wong AY, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017;12:14. doi:10.1186/s13013-017-0121-3

  3. Janwantanakul P, Pensri P, Moolkay P, Jiamjarasrangsi W. Development of a risk score for low back pain in office workers--a cross-sectional study. BMC Musculoskelet Disord. 2011;12:23. doi:10.1186/1471-2474-12-23

  4. Shipton EA. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther. 2018;7(2):127-137. doi:10.1007/s40122-018-0105-x

  5. Peul WC, Bredenoord AL, Jacobs WC. Avoid surgery as first line treatment for non-specific low back pain. BMJ. 2014;349:g4214. doi:10.1136/bmj.g4214

Additional Reading