Neck Pain

Neck pain is a common reason for patients to seek medical care. It may be caused by different disorders:

Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.

Arthritis. Just like all the other joints in your body, your neck joints tend to deteriorate with age. If you have ever had whiplash, you're six times as likely to eventually develop arthritis in your neck.

Disc disorders. As you age, the cushioning discs between your vertebrae become dry, narrowing the spaces in your spinal column where the nerves come out. The discs in your neck also can herniate. This means the inner gelatinous material of a disc protrudes through the disc's tough covering. Nearby nerves can be irritated. Other tissues and bony growths also can press on your nerves as they exit your spinal cord, causing pain.

Injury. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits.

Most neck pain responds well to home care. Neck injuries or strains often result in painful inflammation. You may want to try over-the-counter pain relievers that also combat inflammation. Ice is another good way to reduce inflammation. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution. Apply heat or ice for 15 to 20 minutes, with a 40-minute rest between applications.

For pain that doesn't get better with simple home-care measures, your doctor may recommend:

• Physical therapy. Heat, ice or similar treatments combined with an appropriate stretching and muscle strengthening program may enhance the structures that support your cervical spine. Such treatments are often all you need for neck pain.
• Pain medications. Your doctor may prescribe stronger pain medicine than you can get over the counter. Muscle relaxants or tricyclic antidepressant medications also may be prescribed.
• Traction. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation. Relief may last for hours or even days.
• Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.
• Corticosteroid medication. Although there is some evidence that corticosteroids are useful, definitive research hasn't been done. They may be administered orally or via injection into the space around the nerve roots.
• Short-term immobilization. A soft cervical collar that supports your neck without taxing your muscles may help.
• Surgery. Surgery is sometimes needed for neck pain. It is used to relieve nerve root or spinal cord compression.

Back Pain

If your back aches, you're not alone. Four out of five adults experience at least one bout of back pain at some time during their lifetime. In fact, low back pain is the fifth-leading cause of trips to the doctor in the United States.

In addition, back injuries are the leading cause of work-related disability. Even though back pain is rarely life-threatening, the annual cost in terms of lost productivity, medical expenses and workers' compensation benefits runs into the tens of billions of dollars in the United States.

Although back pain is common, it's also quite possible for you to prevent most back problems with simple steps such as exercise and adopting new ways to sit and stand. Even if you've injured your back before, you can learn techniques to help avoid recurrent injuries.

Back Pain: Screening and Diagnosis

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber hammer. These assessments help determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms.

In most cases, diagnostic tests aren't necessary to confirm the cause of your pain. However, if your doctor suspects a tumor, fracture, infection or other disease, you may undergo one or more procedures:

• X-ray. These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.
• Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
• Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.
• Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Back Pain: Treatment

Most back pain gets better with home treatment within four weeks. If home treatments aren't working, your doctor may suggest:

Medications and therapies:

• Medications. Prescription drugs such as nonsteroidal anti-inflammatory drugs and muscle relaxants may relieve mild to moderate back pain. When pain doesn't respond to simpler measures, your doctor may advise injecting cortisone — an anti-inflammatory medication — into the epidural space in your back to decrease inflammation in the area around the nerve roots.
• Heat or cold. When performed by a licensed professional, applications of heat or cold may relieve back pain caused by muscle spasms.
• Electrical stimulation. A therapist can use a small device to deliver electrical stimulation directly to the muscles of your back. This can relieve back pain from muscle spasms and strains. You may also try transcutaneous electrical nerve stimulation (TENS), a form of electrical stimulation that can suppress pain from sciatica, or a "pinched nerve." In this treatment, you place small electrodes on your skin near the area of your pain. The current isn't painful, and it may provide pain relief.
• Back schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work.
• Physical therapy and exercise. A physical therapist can use treatments and can manipulate and massage your back's tissues to reduce pain. As pain improves, you can help prevent back pain recurrence with an exercise program that increases your flexibility, strengthens your back and abdominal muscles, and improves your posture.