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Back and neck pain
Spinal degenerative disease and related disorders
How is spinal pain treated?
Most episodes of spinal pain are short-lived and will settle down rapidly without specific treatment. Doctors refer to such conditions as being selflimiting. If the pain is particularly intense or persists then more specific treatment may be needed.
Tablets
Many people are reluctant to take tablets for fear of becoming dependent upon them, but simple pain killers such as aspirin or paracetamol, taken for short periods, are often very helpful. Another group of pain killers known as nonsteroidal anti-inflammatory drugs, are particularly effective in dealing with spinal and muscular pains. Some of these are available over the counter at pharmacies, but others require a prescription from a doctor. You should be careful when using this type of pain killer if you suffer from indigestion or asthma.
Rest
In the past, prolonged periods of rest were prescribed for acute spinal pain. The current approach is to limit this period, because it is now appreciated that prolonged rest leads to stiffening of the facet joints and wasting of the muscles which support the spine. Short periods of bed rest, perhaps four or five days, are appropriate for severe episodes of lower back pain. Likewise, for acute neck pain, a collar may be used for a few days. Note that it is unsafe to drive a car or motorbike while wearing a collar and people doing this may have difficulties with insurance claims in the event of an accident. The use of external supports (corsets or collars) for long periods is undesirable.
As the acute pain subsides it is best to begin moving the affected parts again. If this proves difficult or painful then specialist consultation or further
investigation may be required.
Physiotherapy
Physiotherapy has been the main way of treating spinal pain for many years, despite occasional questions about its effectiveness. Most people feel much more confident about managing their spinal pain if they first receive expert tuition from a physiotherapist. Physiotherapists can also make very competent clinical assessments and will refer people to specialists if necessary. Physiotherapy exercise regimes, if followed regularly, can prevent an acute spinal problem from developing into a chronic and disabling condition.
Manipulation
Various manipulative techniques are used by physiotherapists, chiropractors and osteopaths. Pain relief may be achieved by the small joints of the spine being moved, but it is unlikely that these techniques will have any immediate or direct effect upon disc prolapses. People often apologise to doctors about having seen osteopaths or chiropractors. There is no need for this because there is no doubt that such techniques can be valuable in treating acute spinal pain. A responsible practitioner will know when manipulation is inappropriate and will then refer a patient on to a medical specialist.
Injections
A number of injection techniques can be used to relieve spinal pain. Local anaesthetics and anti-inflammatory agents (steroids) are injected, either into the epidural space or around the spinal facet joints. These injections aim to reduce inflammation and lessen acute pain while natural healing deals with the underlying problem, which may be a torn annulus, a bulging disc or an inflamed (arthritic) facet joint.
Do’s and don’ts
Once acute symptoms have subsided it is important that measures are taken to reduce the likelihood of further episodes of pain and to prevent the acute problem becoming a chronic one. Lifting excessive loads should be avoided, particularly when the problem is lower back pain. Twisting and loading the lumbar spine at the same time is particularly likely to cause problems. Any awkward movements of the back or neck may bring on symptoms. Active measures should also be taken to strengthen the muscles of the spine. Good physiotherapy tuition will include a programme of specific exercises for the back or neck, and maintaining strong spinal muscles will take some of the strain off the discs, joints and ligaments, making them less vulnerable to physical loads.
Many people are reluctant to take tablets for fear of becoming dependent upon them, but simple pain killers such as aspirin or paracetamol, taken for short periods, are often very helpful. Another group of pain killers known as nonsteroidal anti-inflammatory drugs, are particularly effective in dealing with spinal and muscular pains. Some of these are available over the counter at pharmacies, but others require a prescription from a doctor. You should be careful when using this type of pain killer if you suffer from indigestion or asthma.
Rest
In the past, prolonged periods of rest were prescribed for acute spinal pain. The current approach is to limit this period, because it is now appreciated that prolonged rest leads to stiffening of the facet joints and wasting of the muscles which support the spine. Short periods of bed rest, perhaps four or five days, are appropriate for severe episodes of lower back pain. Likewise, for acute neck pain, a collar may be used for a few days. Note that it is unsafe to drive a car or motorbike while wearing a collar and people doing this may have difficulties with insurance claims in the event of an accident. The use of external supports (corsets or collars) for long periods is undesirable.
As the acute pain subsides it is best to begin moving the affected parts again. If this proves difficult or painful then specialist consultation or further
investigation may be required.
Physiotherapy
Physiotherapy has been the main way of treating spinal pain for many years, despite occasional questions about its effectiveness. Most people feel much more confident about managing their spinal pain if they first receive expert tuition from a physiotherapist. Physiotherapists can also make very competent clinical assessments and will refer people to specialists if necessary. Physiotherapy exercise regimes, if followed regularly, can prevent an acute spinal problem from developing into a chronic and disabling condition.
Manipulation
Various manipulative techniques are used by physiotherapists, chiropractors and osteopaths. Pain relief may be achieved by the small joints of the spine being moved, but it is unlikely that these techniques will have any immediate or direct effect upon disc prolapses. People often apologise to doctors about having seen osteopaths or chiropractors. There is no need for this because there is no doubt that such techniques can be valuable in treating acute spinal pain. A responsible practitioner will know when manipulation is inappropriate and will then refer a patient on to a medical specialist.
Injections
A number of injection techniques can be used to relieve spinal pain. Local anaesthetics and anti-inflammatory agents (steroids) are injected, either into the epidural space or around the spinal facet joints. These injections aim to reduce inflammation and lessen acute pain while natural healing deals with the underlying problem, which may be a torn annulus, a bulging disc or an inflamed (arthritic) facet joint.
Do’s and don’ts
Once acute symptoms have subsided it is important that measures are taken to reduce the likelihood of further episodes of pain and to prevent the acute problem becoming a chronic one. Lifting excessive loads should be avoided, particularly when the problem is lower back pain. Twisting and loading the lumbar spine at the same time is particularly likely to cause problems. Any awkward movements of the back or neck may bring on symptoms. Active measures should also be taken to strengthen the muscles of the spine. Good physiotherapy tuition will include a programme of specific exercises for the back or neck, and maintaining strong spinal muscles will take some of the strain off the discs, joints and ligaments, making them less vulnerable to physical loads.
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Page 10 of 19
Contents
- Introduction
- What causes spinal pain?
- Why do I experience different types of pain?
- What other symptoms can develop?
- How common are spinal problems?
- Could it be something serious?
- What will happen if the pain is not treated?
- What do the various words used by doctors mean?
- What tests can be performed?
- How is spinal pain treated?
- When is an operation necessary?
- What do you recommend, doctor?
- Who should perform my operation?
- What are the drawbacks of surgery?
- What is the recovery period?
- What is surgery fails?
- What advances are likely in the future?
- Conclusions
- Other organisations that may be able to help
