Posts for tag: chronic pain
Neck pain is slightly more common in women, but most people experience some form of neck pain at some point in their life. There are many causes of neck pain, and generally they can be separated into acute and chronic causes.
- Acute: if the pain is suddenly occurs and lasts less than three months, then it is considered acute. Acute neck pain can be caused by facet syndrome, acute muscle strain or traumatic injury like whiplash.
- Chronic: if the pain persists more than three months, it is termed chronic neck pain. This pain can be from multiple sources, but is often due to facet joint irritation, discs, ligaments and muscular sources.
Let’s explore in detail some of the most common causes of neck pain:
Overuse of the muscles and falling asleep in awkward positions for extended periods of time often produce muscle strains. The neck muscles located in the back of the neck become tense. When the neck muscles are continuously or frequently strained, a chronic pain syndrome can develop.
A well-known cause of neck pain, referred to as whiplash, occurs after motor vehicle accidents, specifically in rear-end collisions. This hyperextension of the neck often results in stretching of the soft tissues of the neck, producing local inflammation, muscle tension and ligament strain. When ligaments and tendons become inflamed or damaged, they can cause persistent pain that intensifies with particular movements. In addition to neck muscle strains, the neck facet joints are also commonly involved in painful neck conditions.
Another frequent cause of neck pain is spinal stenosis, which is a narrowing of the central spinal canal. This narrowing can compress the spinal cord and surrounding nerves roots. This compression can cause cramping pain, shooting pain, or numbness in the legs, back, neck, shoulders or arms. The symptoms typically depend on the area of the spine that is affected. In cervical spinal stenosis, the upper extremities and shoulders are most commonly affected.
Depression, anxiety, and stress tend to exacerbate chronic pain syndromes. Worsening neck pain is a common manifestation of these emotional stressors.
Disc disease is one of the most common causes of neck pain and one of the most common reasons for surgery. Disc disease may be acute, resulting from trauma, or more commonly, chronic pain caused by degeneration. Degenerative disc disease is a process that is due to a thinning and dehydration of the discs over time that can lead to compression of other nearby structures.
Anatomy and Treatment
Understanding the neck’s anatomy is critical for properly diagnosing and treating the source of pain. The anatomy and physiological function of the neck is the key in evaluating a person with neck pain. The bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord.
Separating each individual vertebrae are discs that act as cushions to minimize the impact that the cervical spinal column receives. Since the discs are designed to be soft and provide support, they have a tendency to herniate posterior (collapse backwards) through ligaments and cause irritation to adjacent nerves, or even to the spinal cord.
Minimally-invasive procedures are numerous and can be the most helpful to control pain and improve daily functioning. In recent years, there has been an abundance of research surrounding non-surgical procedures and their effectiveness in treating neck pain.
If you’re experiencing some of these symptoms or have chronic pain from one of the conditions above, schedule an appointment with us so you can get out of pain and back to your life!
Neck pain treatment is one of the most frequently requested therapies in our offices. There are many causes of neck pain, which we discussed in our Anatomy of the Neck blog post.
Some of the current treatments for neck pain include:
- Pharmacotherapy: NSAIDs (ibuprofen-like drugs), acetaminophen (e.g. Tylenol), muscle relaxants, and membrane-stabilizing medications are often effective in treating neck pain.
- Cervical epidural steroid injections: Epidurals are frequently used for pain syndromes due to common conditions such as degenerative disc disease. The method involves injecting a steroid into the epidural space of the spinal cord where the irritated nerve roots are located. The medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation.
- Cervical facet joint injections: Facet joint injections are a minimally invasive non-surgical procedure used as treatment for many different causes of neck pain including facet joint arthritis and degenerative disc disease. They work by reducing the inflammation and irritation in the facet joints of the cervical spine that are causing you pain. The most important and greatest success achieved with the use of facet joint injections is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this, they regain the ability to resume their normal daily activities. With a minimal amount of risks, facet injections are considered an appropriate non-surgical treatment for many patients who suffer from neck pain.
- Cervical Radiofrequency Ablation (RFA): RFA is a procedure in pain medicine that uses a specialized device to disrupt nerve conduction. This pain relief technique can be used by those with back pain, neck pain, muscle pain, and multiple other pain syndromes. A probe is inserted through a needle, and controlled delivery of heat is placed along a painful nerve, disabling the nerve from conducting painful signals. RFA has been used for many years, and the technique continues to improve with better efficacy and fewer risks. Patients can experience significant pain relief with a minimally-invasive procedure that does not require a hospital stay. Radiofrequency therapy can provide pain relief for six months and up to two years.
- Cervical spinal cord stimulation (SCS): This method involves tiny electrodes being placed within the epidural space close to the spinal cord. The electrodes release a small electrical current to the spinal cord that inhibits pain transmission. This inhibition of pain signals allows for pain relief.Cervical SCS is currently used for treating chronic pain syndromes such as complex regional pain syndrome, chronic neck pain, diabetic neuropathy, post herpetic neuralgia, peripheral ischemia, and other conditions that are resistant to more conservative treatments. Patients reported significant (70-90%) reductions in neck and upper extremity pain when treated by cervical SCS. Several of the patients in this particular study also benefited from a decrease in associated headache and lower extremity pain.
- Occipital nerve blocks: This method involves an injection of local anesthetic and corticosteroid over the occipital nerves (back of head). The blocks can dramatically improve pain and increase the quality of life.
- Occipital nerve stimulation: This method involves tiny electrodes being placed close to the occipital nerves (back of head). The electrodes release a small electrical current that inhibits pain transmission and causes pain relief.
- Transcutaneous electrical nerve stimulation (TENS): This is a technique that relieves pain by applying mild electric current to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that were previously painful.
- Trigger point injections: These injections can be an effective treatment for muscle spasms. The procedure involves injecting a local anesthetic and steroid into a “trigger point.”
- Botox: Used in treating neck pain, this is an exciting more recent treatment that is widely accepted among modern medical practitioners. In 2005, “Botulinum toxin Type A (BtA) became the first line therapy for the treatment for cervical dystonia. Although a single injection of BtA is effective, multiple injection cycles seem to work better for patients. Botox injections have also been found to be effective in patients with whiplash injuries. Along with reductions in pain, patients were found to have improved range of motion.
- Biofeedback: This is a treatment for neck pain that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature, and heart rate control). This method enables one to gain some conscious control of these processes, which can influence and improve the level of pain. A better awareness of one’s body teaches one to effectively relax, and this can help to relieve pain.
- Physical therapy: In order to decrease or prevent functional limitations, physical therapy and occupational therapy are recommended as well as medical treatments. Physical therapy for neck pain aims to increase range of motion and muscular strength.Please visit our physical therapy page to learn more about our PT facility in Victoria, our staff and treatment options.
- Nutrition and exercise: Exercise improves neck pain by increasing flexibility and range of motion. Another benefit is the release of hormones called endorphins that are your body’s natural pain relievers. Nutrition and healthy eating may be powerful treatments to combat nutritional deficits.
- Massage: Gentle focal rubbing of tender areas may help relieve muscle spasms or contractions and improve the discomfort associated with it. Massage can also help you relax, decreasing stress and tension.
Clearly, many treatment options are available for chronic pain, headaches, reduced range of motion and more. If you have additional questions about options for your neck pain treatment, please call and schedule an appointment with our staff. We want you to feel better and get back to your life!
Recently on our blog, we’ve discussed general neck pain symptoms and neck pain treatments; now, we’re taking a deeper dive, into the lower back.
Low back pain is one of the most frequent musculoskeletal complaints. Pain may arise from damage or irritation to structures of the lower back including the vertebrae (bony spine), facet joints, discs between the vertebrae, vertebral ligaments, muscles of the lower back, spinal cord, and peripheral nerves, as well as internal organs of the pelvis and abdomen (spleen, kidney, pancreas, and liver).
Acute vs. Chronic Lower Back Pain
Typically the symptoms of low back pain resolve within four weeks – acute pain – depending on the pathology associated with the complaint. However, the pain often returns, leading to a high percentage of the U.S. population with a chronic condition that requires lower back pain management.
Acute low back pain typically comes on abruptly and occurs during a specific activity. Acute lower back injury is more commonly due to overuse by excessive exercise, lifting of heavy objects, motor vehicle accidents, or any trauma involving the lower back. The anatomy typically involved in acute low back pain is the muscles and surrounding ligaments. Vertebral body fractures, ruptured discs, and spinal cord compressions can also be seen acutely with pre-existing osteoporosis, cancer, or spinal stenosis. Acute pain due to ligament and muscle injury typically responds to activity and NSAIDs (ibuprofen-like drugs). Acute back pain should be evaluated by a physician to rule out other causes like kidney stones, kidney infection, and acute pancreatitis.
In some cases of acute back pain, a specialist and proper imaging is required for immediate evaluation (emergency room, pain specialist, spine surgeon). These cases might include:
- Acute vertebral compression fractures
- Acute disc herniation
- Fever or chills
- Weakness or paralysis
- Loss of bowel or bladder control
- Spinal cord compression
Chronic low back pain is defined as pain over three to six months in duration. Typically the symptoms are more gradual and occur over an extended period of time. With chronic low back pain a person may experience pain in their back as well as down either leg. Causes of chronic low back pain are numerous and include:
- Arthritis in the facet joint
- Sacroiliac joint disease
- Spinal stenosis (narrowing of the spinal canal)
- Degenerative disc disease
- Disc protrusion
- Disc herniation
- Disc extrusion
- Facet joint osteoarthritis
- Nerve root irritation or compression (sciatica)
- Central sensitization
- Excessive breast size
- Poor posture
- Psychological and emotional factors
- Vertebral body fractures
- Ankylosing spondylitis
In our next blog, we’ll discuss the anatomy of the lower back, and how chronic conditions can arise from disk disease and more.
In the meantime, if you’re experiencing some of these symptoms or have chronic pain from one of the conditions above, schedule an appointment with us so you can get out of pain and back to your life!