How are neck and back pain treated?

Neck and Back Pain are treated depending on the underlying pain generator. Most commonly, this may be musculoskeletal in nature or spasmodic. Less common but still quite prevalent include neuropathic pain, radiculopathies, or arthritis within the joints of the back or neck.

I believe appropriate treatment should be conservative, multifactorial, and focused on the source or underlying issue.

That being said, if there is an inflammatory component, then Anti-inflammatory medications may help. These can be administered orally as a pill or capsule, transdermally, or as a nerve block or joint injection directly.

If there is a neuropathic component, this is often times tied into inflammation as well, for example inflammation around a nerve can cause nerve pain (or neuropathic pain). In these cases, in addition to focusing on the inflammation, additional focus on the neuropathic pain may be indicated. This can be done with nerve pain medications that come from different classes, including anti-convulsants, anti-depressants, and others. Additionally, specific, targeted nerve blocks may help.

Also, opioid therapy may be indicated, and this can range from short acting agents for immediate and short lived relief in an acute setting, or long acting agents in a more chronic pattern. Also, a combination of the two is common.

Moreover, treating the spasmodic component, if present, may also be helpful. This is typically done with muscle relaxant medications or with directed pinpoint treatment at particular “trigger" points, i.e. trigger point injections.

These are initial approaches, and depending on the cause, chronicity, past medical and surgical history, patient compliance, and family history, a custom approach is advised, and there are also additional therapies not discussed here.

Neck and Back pain affect up to 80 percent of the population at some time in one’s life. The good news is that the majority of these people will get better with NSAIDs and rest. The remaining patients often require physical therapy or chiropractic care, muscle relaxants and perhaps stronger analgesics.

Some plateau in their improvement and require a pain specialist to perform a history and physical exam, reviewing all imaging and any failed treatments in order to develop a customized a plan of treatment to determine the origin of the pain and intervene through a multidisciplinary approach. Depending on the source of the neck or back pain trigger points, fluoroscopic directed epidural steroid injections, diagnostic facet joint injections and possible rhyzotomy or nerve ablation can be used. Anti-seizure medications aimed at reducing the pain from inflamed nerves and opiates aimed at musculoskeletal pain can be titrated.

Certainly if these methods fail then a surgical solution can be reconsidered. Once some relief is achieved instituting a home exercise program and dieting if indicated must be pillars of ongoing care.

Depending on the source of the pain doctors typically begin treatment for neck and back pain with activity modification, physical therapy, and muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to help get pain and inflammation under control. Inflammation and pain are linked because chemicals that stimulate nerve endings are released during the inflammatory process; NSAIDS reduce both pain and inflammation. In some cases doctors may also prescribe narcotic pain medication, antidepressants (because some people with chronic pain are also depressed), or anti-convulsants (which help control or prevent abnormal increases in brain electrical activity that can occur in people with chronic pain).

For longer lasting or more difficult to treat pain doctors may also use:

• Epidural steroid injection and selective nerve root block, in which doctors inject an anti-inflammatory medication and pain relief directly to the source of the problem within the spine to relieve back, leg or other pain and in some cases as a treatment for specific types of disc herniations.
• Radiofrequency nerve ablation, a procedure that temporarily deactivates nerves that are often the source of back pain.
• Peripheral nerve stimulation, a technique in which doctors place electrodes along the path of peripheral nerves to control pain. If patients benefit from a temporary course of stimulation, doctors implant a permanent electrode connected to an internal battery pack.