First the Good News!
The good news is 85% of all people who experience back pain will have a resolution of the pain within the first 3 months.
What causes your neck pain or back pain?
This is a much more difficult question to answer. The vast majority of cases are considered “nonspecific” meaning we don’t know the exact cause of the back pain. Causes can include nerve, muscle, ligament, facet joint, vertebral body or disc injuries. Unfortunately, it is often difficult to tell which of these structures are causing the problem. Physicians would like to think, with all our professional training, that we are “smart enough” to know all the answers. However, there are numerous studies which demonstrate the physical exam does not always diagnose the problem. Additionally, imaging studies are not very good at diagnosing most causes of back pain. For example, most people over 40 will have abnormalities on their MRI scans such as “bulging discs” or even “disc protrusions” (better known as disc herniations) and most of these people do not have symptoms. So, how do we know whether an abnormality that we see on an MRI scan is significant or not?
You have back pain or neck pain… so what do you do?
If your pain does not go away, we do have a number of diagnostic tests that we can perform to see what is causing your pain. We can perform a discogram study which is a provocation study where we stimulate the suspected disc to see if it reproduces the pain. Another study is an EMG (which means Electromyography) study where we perform electrodiagnostic tests to see if there is nerve damage that could be causing the pain. We also can perform pain management procedures such as selective nerve root blocks or facet blocks to see if the pain is coming from the nerve or the facet joint. We don’t have quantifiable tests to evaluate for possible muscle or ligament injuries, but fortunately these injuries usually get better on their own.
Try the easy things first
Since most causes of back pain are self-limiting, we will usually try some basic treatments first such as physical therapy, joint manipulation, and medication. If these do not work, then we will do a more thorough diagnostic workup (performing some of the tests that have already been mentioned) to see if we can determine the cause of your pain. Once we know the cause, there are pain management procedures that can help relieve your symptoms and help “cure” you. Procedures such as epidural blocks can help alleviate pain that is coming from the disc injuries and facet blocks can be used to alleviate pain originating from facet injuries.
New Back Pain / Neck Pain Technologies
There are new and exciting technologic advances that are being developed such as neuroablation that can provide long-term relief from facet mediated pain problems and intradiscal procedures such as percutaneous microdiscectomy techniques that can alleviate disc-related pain problems. If these pain management techniques are not successful, there are surgical techniques such as open microdiscectomy, decompression surgery and disc replacement surgery that often times is very successful in relieving pain.
At Sierra Regional Spine Institute, we have board certified spine specialists who are trained to perform all of these procedures, thereby making us the “one stop shop” for anyone with neck or back problems. Call for an appointment with one of our experts!
Article written for “We’ve Got Your Back Magazine”
By Robert G Berry Jr, MD