Introduction

Back and neck pain are highly prevalent in our society with contributing factors including trauma, repetitive strain, and sedentary lifestyle. They may be responsible for significant loss of work, and family time and adversely impact leisure activities and overall enjoyment of life.  Pain and disability may be mild to severe and the musculoskeletal system, nervous system, or a combination of both may be responsible for neck or back pain. Chronic strain or overuse, acute injury and degenerative disease may contribute to these conditions. When chronic, psychological sequelae can follow and can adversely impact recovery.  Treatment strategies and success depend on accurate diagnosis so specific targeted therapy can be instituted.

Symptoms

Symptoms vary from person to person and may include mild to severe pain that may or may not radiate into the extremities.  The ability to function, walk or sleep comfortably may be impacted as can mood and outlook.  Numbness and weakness of extremities may occur.  Symptoms may wax and wane.

Diagnosis

A complete medical history and neurological exam may help differentiate benign causes of neck and back pain from more severe or concerning causes.  Following this evaluation, the physician may obtain blood tests for systemic disease, EMG (electromyography) with nerve conduction studies, X-rays, computerized tomography scan (CAT scan), or magnetic resonance imaging (MRI) to diagnosis the specific problem. The design of the evaluation is individualized depending on the patient’s symptoms and findings.

Treatment

Treatment varies widely depending on the patient’s symptoms, severity of pain, disability and the findings on exam and testing. Physical measures such as posture mechanics, ergonomic workstation optimization, exercises, heat, and physical therapy are often helpful.  Anti-inflammatory and analgesic medications may be used for short term acute symptomatic relief but do not reverse underlying structural causes of the pain. Surgery is considered in patients with significant structural compromise of the nervous system or spine which do not respond to other conservative measures.

When pain becomes chronic and self-sustaining it is referred to as neuropathic pain, and acute analgesic medications, particularly opioids are problematic for long term use.  Medications that are commonly prescribed for neuropathic pain are listed below along with the most commonly encountered side effects:

• Gabapentin – dizziness, fatigue, sleepiness
• Pregabalin – dizziness, sleepiness, dry mouth, swelling the extremities, fatigue, weight gain
• Duloxetine – nausea, headache, abdominal discomfort, fatigue, nausea, insomnia
• Amitriptyline – dry mouth, sedation, weight gain
• Nortriptyline – dry mouth, sedation, weight gain