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Your Head, Neck and Back Pain Questions, Answered.

04/06/2016

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Your nervous system is quite possibly the most complex, intertwined entity known to man. If you develop head pain, neck pain or back pain, it's possible the central nervous system, peripheral nervous system and spinal column are involved. If non-surgical treatments don't work, you might require surgery from a neurosurgeon.

In this Ask The Doctors series, we explore your head, neck and back pain questions. This month, our expert is Gavin Christie, P.A., a certified physician assistant in neurosurgery at the INTEGRIS Spine and Neurological Surgery Clinic within the INTEGRIS Neuroscience Institute.

1. What causes neck pain?
Neck pain can be caused from a variety of sources, such as trauma, degeneration, osteoarthritis or instability. The usual treatment is stretching, with conservative over-the-counter medications and physical therapy. If your pain continues, then proper evaluation includes X-rays and MRIs, and possibly a consultation with a neurosurgeon.

2. I feel like I’ve ‘twinged’ my neck. What causes this and how do I prevent this from happening again?
A "twinge” in the neck may represent a simple muscle spasm, or tension related to a variety of underlying causes. Preventing this from occurring is usually successful with daily stretching and an exercise regimen.

3. My neck hurts more the older I get, why?
The older you get the more likely you are to deal with advancement of degenerative disc disease and wear-and-tear, as well as osteoarthritis. Once again, staying active, getting exercise and stretching can preserve functionality as well as heal your body through increasing blood flow, oxygen and other nutrients to the discs.

4. What kinds of surgery are used for people with neck pain?
There are multiple conservative and surgical treatment options. The surgical options are primarily based on underlining symptoms and causes. These may include posterior cervical foraminotomy, anterior cervical discectomy with disc replacement, or cervical fusion, as well as posterior cervical decompression and/or fusion.

5. Will most back pain improve on its own?
Back pain has surpassed the common cold for the number one reason for a doctor's office visit. Most back pain results from a temporary flareup and will resolve on its own with conservative treatment like rest, ice or heat, over-the-counter pain relievers and exercises.

6. Is back pain a sign of a bigger issue like an infection, tumor or fracture?
Back pain is usually a flareup or an aggravation of mild, underlying degenerative disc disease. However, it can be a warning sign of another underlining problem, including possible infection, tumors or fractures. These should be further evaluated by a physician if additional symptoms are present, such as a fever, extra fatigue, numbness and tingling or weakness in arms or legs, or pain uncontrolled with over-the-counter medications.

7. My child gets frequent headaches, should I be concerned?
Your pediatrician should evaluate a child with frequent headaches and if needed would refer your child for neurologic evaluation.

8. I fell in 2008 and hit my head, resulting in two separate anterior cervical discectomy and fusion surgeries, with a total of three levels of my spine now fused. I am sure I am having a new issue (due to new pain issues) and I am scared to death I might be looking at another fusion surgery. My question is this: Is there anything new and less invasive as an option instead of more fusions?
There are a variety of issues that can continue to cause neck pain and/or arm pain. Further evaluation is needed to include a repeat CT scan and/or an MRI to rule out underlying herniated disc or adjacent level degeneration.

There are other conservative treatment options, including physical therapy and injections, and also other smaller surgeries that may be indicated. A cervical fusion is not always the only treatment option. However, it is not uncommon for patients who have had multiple cervical fusions to have adjacent level degeneration down the line showing up as symptoms years later.

9. I was diagnosed with scoliosis in my mid 20's, after having back and neck pain since my early 20's. Recently with a new scoliosis X-ray series and an MRI, I was told by my family doctor that I only have a nine percent curve and it shouldn't cause all the pain I have been experiencing. I also have been diagnosed with neuropathy, and I'm being treated for depression, but take medication for both. My doctor upped my Neurontin dose and my Effexor dose and referred me for physical therapy.
Scoliosis and degenerative back issues run in my family and I feel like there is more to my neck and upper back pain. Because of this pain I often have a hard time sleeping or doing daily tasks. I feel my doctor should have referred me to a specialist to take a closer look, or to pain management so I can get injections or treatment for some relief. I don't just want medication, I want to know what is causing this issue and get it treated. What do you think my next step should be? Should I insist that he refer me to a specialist?

A trial of conservative medication treatment options and physical therapy is a reasonable approach by your primary care physician. However, your case does sound like you have numerous factors that could be affecting you, and if you're not getting better with these conservative treatment options, evaluation by either a neurosurgeon or pain management specialist would be reasonable. Sometimes, there are interventional pain treatment options (injections) that can also alleviate some of your pain that do not necessarily include further surgical intervention.

10. I get numb fingers while sleeping on either my left or right side. So, I have to turn flat on my back and stretch my hands until numbness goes away. This is impacting my sleep. I am not so sure if this is a carpal tunnel. What should my next step be? I am 66 years old.
Numbness and tingling when you sleep that wakes you is sometimes a warning sign of carpal tunnel syndrome. This can be evaluated by your primary care physician or a neurologist, who could consider sending you for an EMG/nerve conduction study that could definitively rule this out.

11. I have considerable pain and arm/shoulder numbness each morning. Morning is the worst, but it happens throughout the day. I had a CT scan taken at a hospital about three years ago. The doctor said that I needed to have several discs removed and fused together. I feel that procedure is too extreme, and I’m afraid it would cause me a lot rigidness. I'm worried that I would not be able to drive safely, which would affect my career. If I can get a copy of that CT scan should I bring it in to an INTEGRIS neurosurgeon for another opinion?
There are multiple treatment options for neck pain and numbness. One of these does include cervical fusion surgery. A cervical fusion surgery does provide some limitation in range of motion, but usually 70 percent of the rotational range of motion is related to the top two cervical vertebra, and fusing the remainder of your cervical spine would still allow you to have functional range of motion. We do not recommend driving directly after surgery. However, once over the initial muscle spasm and tension from surgery, most patients are able to return to driving and working without negative impact. We are always happy to evaluate here for a second opinion.

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