More than 80% of all adults will experience spinal pain at some stage of their lives. It has been estimated that in 90% of these cases the cause of the pain is simply muscular, and that about 90% of all episodes resolve without treatment within 6 weeks. Therefore for most people the message is simple:-
- The cause of the pain is likely to be much less complicated than you think i.e. muscular pain is very common.
- The body has tremendous powers of healing and can resolve the pain without the need for external interference. Staying active and avoiding excessive bed rest is the key to a rapid recovery.
- In the majority of cases no damage has been done, and therefore there is no need to be concerned or over anxious.
A message to all healthcare workers involved with spinal pain
Before you move on, I would recommend reading the following:-
Although these links are about back pain, the same principles apply to those with neck and thoracic pain, and therefore everybody with spinal pain should read these first.
Aberdeen Low Back Pain Scale
- If you would like to score your lower back pain, please click on the Aberdeen Low Back Pain Scale button below.
- You can also use this score to assess your response to treatment as time goes by.
Complex Spinal Pain
- This is often caused by Simple Sprains, Postural Problems, and Mechanical Imbalance. The cause of the pain is thought to be muscular and not due to an obvious pathological process. Investigations are usually normal or may show normal age related changes in the spine. Episodes are usually self-limiting, although some people may need treatment with Spinal Manipulation and Exercises for back pain.
- Osteopaths often call this form of back pain Segmental Spinal Dysfunction, meaning that a segment or segments of the spine have areas of muscle spasm associated with restricted joint movements. Dysfunction implies that the area is not functioning properly without implying that there is overt pathology i.e. muscle spasm rather than spinal arthritis. Segmental Spinal Dysfunction can frequently cause referred pain to other parts of the body mimicking other medical complaints (see below).
- This on the other hand may have a variety of causes. Investigations and tests often show relevant abnormalities in the spine. This type of spinal pain is often more severe and long lasting than simple back pain. There are often associated psycho-social problems surrounding the pain issues, which make treatment difficult.
- The exact cause of the chronic back pain is not always known, and this can cause difficulty with predicting the outcome of treatment for it. For most people complete back pain relief is not possible. Click on the other links above for more information. See Referred Back Pain where the cause of the back pain is not the spine, being referred from other areas of the body. See below for referred pain patterns to other areas of the body.
- Examples of complex spinal pain include annular tear, disc prolapse (bulging disc), spinal stenosis, foraminal stenosis, and spondylolisthesis.
- Components of the spine like muscle, joints, ligaments, discs and nerves can cause referred pain to another part of the body. This is because the part of the spine affected shares the same sensory or sympathetic nerve supply as the part of the body to which the pain is being referred, causing the brain to misinterpret the source of the pain.
- Look at this dermatomal map showing the different segments of the spine and the areas they refer pain to.
- Below is a more detailed description of the conditions mimicked:-
|Upper Cervical Spine (neck) C1-C4
||Back of the head (occiput), back of the shoulders, angle of the jaw, face
||Headaches, migraines, jaw problems, trigeminal neuralgia, tension in the shoulders
|Middle / Lower Cervical Spine (neck) C5-C8
||Arms, forearms, hands and fingers
||Trapped / pinched nerve in the neck, tennis elbow, golfer's elbow, frozen shoulder
|Upper Thoracic Spine (above the bra-strap) T1-T4
||Pain in the arms, front of the upper chest, upper ribs
||Trapped / pinched nerve in the neck, angina, breathing difficulties and other chest complaints
|Middle Thoracic Spine (at the bra-strap) T5-T8
||Upper abdomen, middle ribs
||Stomach ulcer, gall bladder problems, trapped wind, indigestion, breathing difficulties and other chest complaints
|Lower Thoracic Spine (below the bra-strap) T9-T12
||Lower abdomen, lower ribs, pelvis and sexual organs
||Irritable bowel disorder, pelvic pain, period pain, pain in the sexual organs
|Upper Lumbar Spine L1-L3
||Groin, front of the upper thigh
||Trapped / pinched nerve in the back, groin and thigh problems, hip and knee problems
|Lower Lumbar Spine L4-L5
||Front of the inner and outer shin bone, top of the foot
||Sciatica (sciatic nerve), shin and foot problems
||Pelvic pain, coccydynia
- Biopsychosocial assessment is important in those with complex spinal pain (Royal College Report) to examine the medical causes of the pain, associated psychological problems (abnormal pain beliefs, pain-avoidance behaviour, anxiety and depression, financial and emotional secondary gain), and contributions from the patient's immediate environment (abnormal family / work re-inforcement and attitudes, socio-economic problems).
Treatment in the pain management clinic should be aimed at three different areas:-
- Reducing the pain to an acceptable level using pain treatments such as medications, physical therapies, exercises, injections, or surgery
- Addressing the psychological problems including anxiety and depression, abnormal pain beliefs, pain-avoidance behaviour, abnormal coping mechanisms
- Improving patient / family / workplace education and attitudes to the pain and it's management.
- Addressing all three treatment areas together will give the best results. Many pain clinics judge success as 50% reduction in pain, 50% reduction in pain killer use, and 50% improvement in general functioning (return to work, activities of daily living).