Neck and Back Pain

Neck and back pain are common, especially with aging. Low back pain affects about 50% of adults older than 60 years. The pain is usually caused by muscle tension or stiffness in that particular area of the back or neck which can be with or without neuro-motor deficits.

The neck and back pain can either be:

1. Non-specific or

2. Specific.

1. Most of the back pain symptoms are non-specific, and they are the result of overuse or injury of the ligaments and muscles that hold together the neck and low back vertebrae.

2. Specific mechanisms leading to pain in both neck and lower back or specific for each region individually:

a. Specific mechanisms causing neck pain only:

1. Atlanto-axial subluxation (subluxation at the level of first and second neck vertebrae).

2. Referred pain from carotid or vertebral artery dissection (Dissecting aneurysm affecting those arteries).

3. Angina pectoris referred pain.

4. Myocardial infarction referred pain.

5. Meningitis.

6. Herpes zoster.

7. Temporo-mandibular joint disorder.

8. Torticollis. (twisting of the neck to one side that results in abnormal carriage of the head and is usually caused by muscle spasms).

b. Specific mechanisms causing lower back pain only:

1. Lumbar spinal stenosis.

2. Osteitis condensans ilii (iliac sclerosis adjacent to the sacro-iliac joint which usually develops in some post-partum women.)

3. Referred pain from hip, buttock, or pelvic disorders.

4. Referred visceral pain from aortic dissection or aneurysm, renal colic, pancreatitis, retroperitoneal tumour, pleural effusion, pyelonephritis.

5. Sacro-iliac osteoarthritis.

6. Sacroliliitis.

7. Sponylolysis (A defect of the vertebral arch).

8. Spondylolisthesis (slippage of all or part of a vertebra on another).

c. Specific Mechanisms affecting either neck or lower back.

1. Ankylosing spondylitis (usually lower back but can also be thoracic.)

2. Arthritis (Osteoarthritis and rheumatoid arthritis which rarely affects the lower back).

3. Congenital abnormalities (e.g. spina bifida, Lumbarization of S1 which is an anatomic anomaly in the human spine characterized by the non-fusion of the first and second segments of the sacrum.Therefore, the lumbar spine subsequently appears to have six vertebrae or segments, not five and the sacrum appears to have only four segments instead of its designated five segments).

4. Fibromyalgia (illness that causes chronic pain in muscles and ligaments).

5. Intervertebral disc disease.

6. Infection. (e.g. Osteomyelitis, diskitis, spinal epidural abcess, infectious arthritis).

7. Injury. (e.g. Dislocation, subluxation or fracture).

8. Muscle or ligament srain.

9. Paget’s disease.

10. Polymyalgia rheumatic.

11. Tumour ( Primary or metastatic).

12. Spinal cord compression.

Treatment:

1. For acute musculoskeletal pain oral analgesics like Tylonol, Advil or Asprin will do the job of relieving the pain. 2. Acute muscle spasms can be relieved by ice or heat.

3. Treatment of the cause of neck or back pain and the best who can judge is your doctor.