Neck and Low Back Pain

What is pain?

Pain is a protective reflex in response to an underlying injury/damage. It is only a symptom and not a disease. Treat it like a friend and not an enemy.

More about pain:

Pain is the psychological expression of underlying actual or potential physical injury.

Pain has two components: physical (injury) and psychological (expression). Stress (extreme of any emotion such as anxiety, apprehension, fear etc) amplifies pain and complicates pain.

How does pain get better?

The human body heals any injury/damage naturally, but it takes time. In 3-months, 90% of people get pain relief on their own. But, problem is that we are impatient and are offered a lot of options. We don’t let the body heal the injury naturally.

Bed rest > 2 days delays recovery – worsen psychological component of pain. Active rest is the key to early healing.

Lumbar Belts / Neck Collars > 7 days are proven to be BAD – cause wasting of neck/trunk muscles. Hence avoid their long term use.

Physiotherapy/pain killers are NOT effective in changing the natural course of healing. Analgesics can betaken on-demand basis.

In patients with >2 years of back & neck pain – the incidence of depression is >80% and antidepressants are of proven benefit.

Smoking has a direct link with back & neck pain because of its role in causation and acceleration of disc degeneration – Hence quit smoking.

Overweight increases strain on the back and thus causes backpain

MRI

Eugene Carraggee (Stanford University, USA) published a paper in the New England Journal of Medicine 2005; 352: 1891-98. He analyzed MRI’s of thousands of normal volunteers between 20-40 years of age who never had back pain. He found Slip Disc (55%), Disc Degeneration (60%), Annular Tears (30%) and High Intensity Zone (25%) in > 80% of study population on MRI.

MRI is an oversensitive and non-specific tool. It is a very tempting tool to both the doctor and the patient. Once MRI is done, it is very difficult to stop as findings in the report are usually too exaggerated. MRI findings are not used as an indication for surgery. We need to treat the patient and not the MRI. If the patient deserves surgery clinically, then MRI becomes the gold standard investigation to direct surgery to the exact pathology.

Do’s and Don’ts:

When in pain, be within its limits (listen to your body, not to anybody else) and Stay active. Don’t provoke/increase the pain by any activity, as it means that the injury or damage is being increased before nature heals it.

When do we need Surgery / MRI?

(Indications for MRI and Surgery are the same)

  1. Absolute indications (Surgeon sells surgery) – irrespective of the duration of symptoms, time is money, delay causes increased damage -cry of the dying nerves
  2. Gross weakness of limbs
  3. Lose of control over Urine/motion
  4. Relative indication (Patient buys surgery) – as pain is subjective
  5. Functionally disabling pain > 3 months (functional disability is the gap between the expectations and abilities of a person – very highly individualized)

Natural History of Neglected Back/Neck pain

Back/Neck pain has episodic occurrence. With increasing age and repeated episodes, natural healing capacity reduces and the risk of recurrence and persistence of pain increases.

Prevention of Back/Neck pain

The spine consists of 33 bones and every two bones are connected with each other by three joints (bearings). For these joints, movement is life. If they don’t move for a while, they get jammed and then they break on attempted /forced movement.

So, a flexible spine resists injury/damage while the stiff spine breaks with the smallest of jerks. The permanent solution is to keep all the joints (bearings) of the spine mobile every day and get back the flexibility by gradual stretching in the form of Iyengar Yoga. Yoga has been proven scientifically to be the best way to cure chronic back/neck pain (Williams K et al Spine 2009; 34: 2066-76). Iyengar yoga increases the flexibility of the spine as well as reduces stress. Thus it targets both (physical and psychological) components of back/neck pain. Start on Yoga once the pain subsides and continue for the rest of your life. It is a way of life and not exercise.

Consult our spine surgeon Dr.S Vidyadhara for an expert diagnosis and treatment for all your neck and spine problems.

 

Dr. S Vidyadhara

HOD & Consultant – Spine Surgery, Spine Care

Manipal Hospitals Bangalore – Old Airport Road

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