Addressing Back and Neck Pain, No Matter the Cause

Has a battle with back pain or neck pain disrupted your daily life? You are not alone. In the 2017 National Health Interview Survey conducted by the Centers and Disease Control and Prevention (CDC), nearly 30% of adults in the United States reported back pain and almost 15% reported neck pain.

“Back and neck pain are among the most common reasons patients visit a doctor,” says board-certified physical medicine and rehabilitation and pain medicine specialist Mark Queralt, MD, who serves as the Clinical Director of the Back and Neck Pain Center within UT Health Austin’s Musculoskeletal Institute. Dr. Queralt also serves as the Medical Director of the Musculoskeletal Institute.

“Most cases of acute back or neck pain resolve in a matter of weeks regardless of treatment,” notes Dr. Queralt. “However, a specialist can help those with persistent pain understand and address their condition.”

Identifying the Cause of Your Pain

In very rare but serious cases, back or neck pain could be caused by conditions requiring urgent medical attention, such as compression fractures, infections, neurologic compromise, and certain forms of cancer.

Seek medical attention right away if your pain is associated with the following symptoms:

• Changes in urinary or bowel function
• Fever or chills
• Numbness in the genital regions
• Severe or progressive weakness

Most back and neck pain is not linked to such an urgent condition, but determining the root cause of your pain may not be easy. “At the Back and Neck Pain Center, we approach your pain like detectives solving a case,” shares Dr. Queralt.

Just as a sleuth in a whodunit investigates suspects one by one, your care team will first search for any structural issues with muscles, ligaments, tendons, or the intervertebral discs that cushion the bony vertebra of the spine.

“By moving the patient’s body and applying stress to these different structures, we try to find patterns of pain that indicate musculoskeletal damage,” says Dr. Queralt. “An injury such as a disc herniation will produce pain in a predictable, consistent manner, as will a condition such as lumbar stenosis in which the spinal canal has narrowed, leading to low back and leg pain that aggravates with walking.”

In addition to this comprehensive physical examination, X-ray imaging is available on-site to help your care team visualize potential structural causes for your pain. Further evaluation of other potential sources of pain can be conducted using magnetic resonance imaging (MRI) or computerized tomography (CT) scans, conveniently available through UT Health Austin’s Imaging Center, located in the same convenient space as the Back and Neck Pain Center.

The Back and Neck Pain Center also coordinates with UT Health Austin’s Laboratory service, which offers on-site blood tests to diagnose conditions that may not be readily identified through imaging.

In some cases, a patient’s pain is related to a rheumatologic condition, such as ankylosing spondylitis. These conditions are caused by the body’s autoimmune or inflammatory processes rather than musculoskeletal injury or the wear-and-tear degenerative process of osteoarthritis. “Pain caused by a rheumatologic condition may behave less predictably than pain caused by a musculoskeletal structure,” notes Dr. Queralt.

Other patients may be experiencing what doctors describe as referred pain. “Referred pain occurs when pain signals from an internal organ radiate elsewhere,” explains Dr. Queralt. “For example, what may seem like back pain could be caused by a kidney condition.”

Building a Pain Management Strategy

The Back and Neck Pain Center care team can diagnose and treat a broad range of acute painful conditions. If the pain originates from a musculoskeletal structure, patients can choose from a host of well-studied treatment options based on the severity their pain and their individual preferences. Many patients respond well to conservative measures, such as physical therapy and anti-inflammatory medications, without the need for injections or surgery.

However, many patients experience chronic or chronic recurrent pain, which persists without an identifiable cause. This can be frustrating for patients as well as their primary care providers. “If we have ruled out other causes of a patient’s pain, we start the conversation around chronic pain management,” says Dr. Queralt. “It can be difficult to treat chronic pain when there is no clear mechanism to target.”

“Similar to other chronic conditions, such as high blood pressure or diabetes, chronic pain is best understood as a condition that is controlled rather than one that is cured,” adds Dr. Queralt. “Our team’s goal is to help patients understand the role of treatment for chronic pain as well as lifestyle changes that can help alleviate their symptoms.”

Lifestyle changes can help a patient address chronic pain by restoring the balance between the sympathetic nervous system, which governs the “fight or flight” response triggered in stressful situations, and the parasympathetic nervous system, which brings the body back to a resting state.

When the sympathetic nervous system is activated, the body floods with stress hormones and muscles tense to prepare for action. “In a dangerous situation, this activated state helps a person avoid harm,” notes Dr. Queralt. “However, a persistently activated sympathetic nervous system in the absence of danger is associated with negative health outcomes.”

Consequences of an overactive sympathetic nervous system may include:

• Constant muscle tension, such as in the neck or back
• Increased urinary urgency
• Irritable bowel syndrome
• Teeth grinding and/or temporomandibular joint (TMJ) dysfunction, leading to jaw pain
• Disrupted sleep patterns

Explore the relationship between chronic pain and sleep disturbances.

<br>Patients with chronic pain often experience other effects of an overactive sympathetic nervous system. “Rather than treating the symptoms of a patient’s sleep issues or pain in isolation, we can address these varied issues at the source by bringing the nervous system into balance,” explains Dr. Queralt.

Strategies for nervous system regulation include:

• Activities that promote a “flow state,” such as arts and crafts, music, gardening
• Any physical exercise, but especially activities such as yoga or tai chi that engage the body and mind
• Breathing exercises
• Meditation
• Relaxation techniques, such as diaphragmatic/belly breathing or progressive muscle relaxation

Along with physical and behavioral strategies, some patients benefit from medications that improve nervous system regulation, helping to minimize sleep disruptions and pain. With exercise and lifestyle changes, some patients can reduce or eliminate the need for medication, while others prefer to continue their medication regimen.

“There is no quick fix for chronic recurrent pain,” notes Dr. Queralt. “Educating patients and equipping them with strategies to regulate their nervous system will help them keep their symptoms at bay in the long term.”

This forward-looking philosophy informs every aspect of the Back and Neck Pain Center’s approach to patient care. “We look beyond temporary treatments to develop a sustainable care plan,” shares Dr. Queralt.

For more information about the Back and Neck Pain Center or to request an appointment, call 1-833-UT-CARES (1-833-882-2737) or visit here.