Back & Neck Pain

In addition to sprains and strains of the supportive soft tissues, some of the most common causes of lower back pain include:

• Myofascial Pain
• Herniated disc
• Osteoarthritis
• Compression fracture
• Degenerative disc disease
• Lumbar spinal stenosis (spinal canal narrowing)
• Spondylolisthesis (slipped disc)
• Lumbar radiculopathy (compressed nerves)

If your back pain is caused by a compressed nerve, you may develop pain, tingling, and numbness anywhere along the affected nerve. This is most likely to occur when the sciatic nerve in your lower back is pinched, causing severe pain that radiates down through your buttocks and leg.

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. During the exam, Dr. Prywes will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment.

Under certain circumstances, imaging studies such as X-rays and MRI may be ordered to rule out specific causes of pain. X-rays look for broken bones or an injured vertebra. Magnetic resonance imaging (MRI) can evaluate muscles, ligaments, tendons, and if infection, tumor, disc herniation or rupture, or pressure on a nerve is suspected. MRI is a noninvasive way to identify a condition requiring prompt surgical treatment. However, in most instances, unless there are “red flags” in the history or physical exam, an MRI scan is not necessary during the early phases of low back pain.

Electrodiagnostics are procedures that, in the setting of low back pain, may also be requested to confirm whether a person has lumbar radiculopathy.

Treatment:

Conventional treatment for lower back includes:

Hot or cold packs to ease pain and reduce inflammation for people with acute, subacute, or chronic pain, allowing for greater mobility among some individuals.

Activity: Bed rest should be limited. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain.

Medications: A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription.

Trigger point Injections: Myofascial trigger points causing lower back pain and sciatic-type symptoms can be deactivated by injections of lidocaine, and a spray and stretch technique provided by Dr. Prywes.

An integrative approach to back pain focuses on empowering the patient to assume an active role in their care, decreasing pain and improving function and quality of life. If these goals are attained, the resultant effect will be to maximize the possibility of preventing chronic disability as well as avoiding harm to the patient.

The American College of Physicians (ACP) and the American Pain Society (APS) jointly created one of the most widely accepted guidelines for back pain in 2007 which were updated and expanded by the ACP in 2017 . These guidelines include many of the non-drug Integrative Medicine approaches provided at The Center for Pain Rehabilitation including:

Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.

Manual Therapy, incorporating spinal manipulation and spinal mobilization are approaches in which professionally licensed specialists (medical doctors, physical therapists, and chiropractors) use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues.

Medical Acupuncture is often effective for chronic low back pain. It involves the insertion of thin needles into precise points throughout the body to relieve pain and restore function.

Low level laser therapy (LLLT) is a valuable tool in the treatment of neck and back pain and musculoskeletal pain.

Therapies such as yoga, Pilates, massage, tai chi, cognitive behavioral therapy, and progressive relaxation have gained enough scientific support that they are now also recognized as scientifically validated approaches in the management of low back pain.

When Is Surgery Necessary?

When conservative forms of treatment for severe spinal disorders do not provide adequate benefit, and there is severe pain with neurological loss of function, surgery may be considered an option to relieve the pain caused by serious nerve compression. Dr. Prywes works very closely with spine surgeons in the community to provide appropriate referrals, when necessary, and to coordinate the post-operative rehabilitation.