Column: Spine Pain: Typical or Terrible?

Back and neck pain is a common reason people seek medical help or miss work. It can range from mild, dull, annoying pain, to an unexpected, often debilitating episode that can completely disrupt one's life. An estimated 80-100% of adults will have one or many of these events in their life.

While uncomfortable, back and neck pain is typically from a benign issue. The muscles responsible for moving and stabilizing the spine and neck are very strong and when minor problems occur, these muscles contract, spasm, and can cause significant pain. Fortunately, most neck or back pain will resolve on its own within a few days or weeks, however, there are some conditions that may call for more attention.

If back or neck pain is associated with an injury, it is necessary to make sure a fracture has not occurred. In most cases, conservative treatment in addition to activity modification is sufficient to resolve the episode.

Arthritis and disc degeneration are normal processes of aging that most people will experience. They are most often treated with well-known modes such as physical therapy, over-the-counter non-steroidal anti-inflammatories (NSAIDs), heat or ice, chiropractic care, yoga or Pilates, muscle relaxers, and activity modification. Rarely is surgery considered and only in exceptional circumstances.

Another common condition is arm or leg “sciatica” pain, a type of burning numbness, tingling, or knifelike pain that is caused by nerve compression (a pinched nerve). This compression causes nerve inflammation and pain along the nerve’s path. Sciatica pain is most often caused by disc herniations in the young or arthritis in patients over 50 years old. These two problems are treated differently, though unfortunately, often occur together.

Non-operative treatment focuses on reducing inflammation in the nerve: physical therapy will focus on motions that open up the nerve and reduce the compression; over-the-counter NSAIDs will block the body's inflammation pathway and over time calm the nerve; corticosteroids (pills or injections) are similar to NSAIDs, but usually has a more powerful effect; epidural steroid injections provide a strong anti-inflammatory medication very close to an inflamed nerve where it can have maximal effect; and nerve-calming medications can help reduce symptoms of nerve pain.

Time and conservative care can resolve problems without surgical intervention if the patient can tolerate their symptoms (anyone who has experienced nerve pain can attest to how difficult this can be). If all conservative options have been exhausted, then surgery may be able to resolve nerve pain. Surgery is almost always the last resort for any spinal condition.

Pain that is severe and unremitting, especially accompanied by fever or chills, unexplained significant weight loss, or the presence of ‘night pain,’ which occurs at all times of the day but persists at night with rest, can be ‘red flag’ symptoms and may merit further investigations. Pain that is accompanied by muscle dysfunction or weakness should also be promptly addressed. Neck or back pain which is associated with a loss of bowel or bladder function is a serious symptom and also should be urgently evaluated.

For all of these concerns, your orthopedic spine team is ready to help you understand your unique spinal issues and guide you in a treatment course designed to meet your condition.

Dr. Zachary Child, Board-Certified orthopedic surgeon, and Dana Randall, PA-C, treat patients for back and neck pain at the Barton Center for Orthopedics & Wellness in South Lake Tahoe, CA and at Tahoe Orthopedics and Sports Medicine locations in Carson City and Zephyr Cove. Dr. Child and Dana’s pre-recorded Wellness Webinar, “Back and Neck Pain: Typical or Terrible?” is available at BartonHealth.org/Lecture. To learn more about foot and ankle services, call 530.543.5554 or visit BartonOrthopedicsAndWellness.com.