It's a Pain in the Neck (and Back too!)
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Thank you to the Montclair Public Library for hosting SMG's Joanne Owsiak, MD, Interventional Pain Management specialist, for a community lecture on Neck and Back Pain. Eighty-five percent of people experience low back pain during their lifetime, and back pain has become the fifth most common reason for all physician visits. Dr. Owsiak shared with the audience the many causes of neck and back pain and the pain management options available for treating all types.
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It's a Pain in the Neck (and Back too!)
- 1. Joanne N. Owsiak, MD Pain Management It’s a Pain in the Neck (and Back too!)
- 2. Outline • Background Information • Spinal Anatomy 101 • Common Disorders of the Spine • Clinical Evaluation/Assessment • Various Treatment Options • Take Home: Proper Body Mechanics
- 3. Prevalence of the Disease • Spine related pain is a prevalent issue • Back pain has become the 5th most common reason for all physician visits • 85% of people experience low back pain during their lifetime
- 4. Risk Factors for Spinal Pain • Biomechanical Factors • Psychosocial Factors • Personal Factors
- 5. Biomechanical Factors • Spinal loading • Physical stress/heavy lifting • Asymmetry of physical tasks
- 6. Psychosocial Risk Factors • STRESS!!! • Job satisfaction
- 7. Personal Risk Factors • Familial (genes) • Tobacco use • Obesity • Spinal deformities
- 8. Definition of Terms • Acute Pain: 2-4 weeks • Chronic Pain: >12 weeks *30% of people with acute low back pain will progress to develop chronic symptoms
- 9. What is the importance of all this? • PAIN • Psychological effects • Day to day function • Substance abuse related disorders • Ability to work • Effects individuals, their families, and the entire community
- 10. Spinal Anatomy
- 11. Spinal Anatomy
- 12. Spinal Anatomy
- 13. Pathophysiology • Biomechanical properties causes structural changes in the intervertebral discs which causes then to be less pliable • Causes stress in adjacent spinal segments • Propagates arthritic changes in the spine
- 14. Etiologies of Spinal Pain • Herniated discs/sciatica • Spinal stenosis • Annular tear • Foraminal stenosis • Facet arthropathy • Muscle strain • Scoliosis/kyphosis • Infections • Inflammatory disorders • Cancer
- 15. Scoliosis
- 16. Kyphosis
- 17. Herniated Discs
- 18. Spinal Stenosis
- 19. Diagnosis of Spinal Pain • History • Physical Examination • Imaging studies (X-ray, MRI, CT) • Electrodiagnostic tests (EMG/NCS) • Blood work
- 20. Prognosis • 85% of people experience low back pain during their lifetime • 1/3 of patient seek medication attention; 70- 90% of patients improve within 7 weeks • 50% experience a recurrence by 6 months • 70% experience a recurrence by 12 months
- 21. Multimodal Treatment Plan • Heat • Massage • Acupuncture • Spinal manipulation • Physical Therapy • Medications • Minimally Invasive Procedures • Spinal Surgery
- 22. Heat vs. Ice • Heat reduces muscle spasm (chronic) • Ice reduces tissue swelling (acute)
- 23. Massage • No specific evidence that massage therapy benefits spinal pain • Increases patient satisfaction
- 24. Acupuncture • Difficult to study • Benefit investigated outcomes in patients with back pain, neck pain, and headaches in short term (1 month) and intermediate follow-up (3-6 months) • Little side effects
- 25. Spinal Manipulation • Generally safe • Not many studies to guide the duration of therapy
- 26. Goal of Physical Therapy • Reduces pain • Maintains or restores flexibility, strength, and endurance
- 27. Benefits of Physical Therapy • Neurological • Musculoskeletal • Psychological • Preventions of primary back pain and recurrent episodes of back pain
- 28. Medications • Anti-inflammatories • Muscle relaxers • Opioids - CDC has recommendations to minimize opioid use (7 days). • Antiepileptics • Topical agents
- 29. Minimally Invasive Treatments • Injections • Neuroablative procedures • Spinal neuromodulation
- 30. Minimally Invasive Treatments • Injections therapy • Epidural injections • Facet joint injections • Trigger point injections
- 31. Minimally Invasive Treatments • Neuroablative procedures • Radiofrequency ablation • Used for other joint related pain including hip and knee pain
- 32. Minimally Invasive Treatments • Neuromodulation therapy
- 33. Prevention is KEY! • Postural modification to allow a neutral spine position.
- 35. Neutral Spine Alignment: Sitting
- 36. Neutral Spine Alignment: Driving
- 37. Neutral Spine Alignment: Sleeping
- 38. Neutral Spine Alignment: Working at a Computer
- 39. Neutral Spine Alignment: Talking on the Phone
- 40. Neutral Spine Alignment: Carrying a Briefcase/Purse
- 41. Neutral Spine Alignment: Lifting Heavy Objects
- 42. Recap • A majority of American will experience spinal pain at some point in their lives. • There are many different causes of spinal pain with a variety of treatment options. • It is important to remember proper body mechanics when performing daily tasks in order to prevent muscle tension which can lead to other spine related pain disorders.
- 43. Questions
Editor's Notes
- Prevalence of neck pains similar to back pain
- *Decreased ability to return to work with increasing pain duration. 6 months with LBP -> 50% return to work 1 year -> 25% 2 years -> 5 %
- Cervical -7 Thoracic - 12 Lumbar -5 Sacral - 5 Coccygeal 3-5 Intervertebral discs as the “shock absorbers in the spine” Together the spinal column house several important elements including spinal cord and nerve roots
- Neurological - level of the brain and spinal cord Musculoskeletal - reduces inflammatory mediators Psychological - reduces stress and anxiety and depression; people who suffer from chronic pain have a fear of re-injuring themselves and have a fear of movement (kinesophobia) - an old theory that “rest” was critical in the healing process
- A neutral spine begins with the position of the feet. When you stand, your hips should be aligned with your ankles, shoulders should be aligned with your hips, and ears should be aligned with your shoulders. Your shoulder should be relaxed (not rounded/slouching) in a tensed position. Your head/chin should be in a neutral position - not tilted forward or backward. If your spine is not properly aligned, the muscles that are activated fatigue easily, leading to muscle pain, soreness, stiffness, and even headaches.
- While you work at your desk - the natural tendency is to round/shrug your shoulders and crane your neck forward. It is important to recognize poor body mechanics and reset the factors to avoid muscle tension - supportive chair that has lumbar and mid-back support (a lumbar cushion may be needed) sit with your hips as far back in the chair as possible keep your shoulders down, back, and relaxed (not slouched or tensed) center your chair so you avoid turning your head to the side for an extended period of time limit the time spent sitting - make an effort to stand and walk frequently/stretching
- Same sort of concepts while driving
- For sleep: head and neck should be aligned with the body (best accomplished with a small pillow under the neck). Helpful sleep position is to lie flat on your back with thighs elevated on pillows.
- - position the top of the monitor slightly below your line of eyesight (even lower if wearing bifocals) keep your head in a neutral position with your chin parallel to the floor or slightly tilted downward Keep the monitor centered in front of you Adjust the keyboard height so that your shoulders are relaxed, your elbows are at an approximately 90-degree angle, and your wrists and hands are in line with the keyboard keep the computer mouse as close to your body as possible so your shoulders stay relaxed
- TEXT NECK! - be mindful of your neck position (do not tilt your head to the side, backward, or too far forward) - keep your shoulders down, back, and relaxed (not slouched or tensed) - consider a headset or other hands-free option if needed
- - try to keep your spine centered despite the uneven weight you are carrying - consider regularly switching the briefcase or purse from side to side if carrying multiple items, evenly disperse them between both of your hands if using a backpack, place both straps over both shoulders to evenly distribute the weight keep your shoulders down, back, and relaxed
- Thank you for your attention.