Tips for Managing Back or Neck Pain
About 80 percent of us will have back or neck pain at some point in our lives. The good news is that most of us will not need surgery or advanced imaging, such as MRI. In most cases, symptoms improve with time, movement and gentle therapies. Learn more about spine care treatment.
Ask yourself these questions and share this information with your doctor:
- Where is your pain? Does it come and go, or is it always there? Does it wake you up at night?
- Does the pain travel down an arm or leg?
- What makes your pain worse? What makes it better?
- Do you have any new numbness or tingling? If you have numbness in the saddle area (where you would sit on a horse) or when wiping with toilet paper, tell your doctor right away.
- Do you have any new weakness, such as trouble with lifting your foot, gripping things (or dropping things more often) or falling?
- Do you have any new trouble emptying your bladder or making it to the bathroom in time?
Most of the time, starting with exercises and non-opioid pain medications can help.
Here are some things you can try at home:
- Ice. Applying ice can reduce swelling and pain in the first two to three days after an injury. Use ice for 20 minutes at a time. Repeat every two to three hours as needed. Do not apply ice directly to your skin – use a pillowcase or towel between the ice and your skin.
- Heat. Applying heat can help relax your muscles and increase blood flow to the area. The latest studies show that using heat right away on a new injury can help avoid a prolonged recovery. Use heat for 20 minutes at a time. You may repeat several times a day or alternate between heat and ice. Do not apply heat over a medication patch, and avoid lying on a heating pad, which could burn your skin – especially if you fall asleep.
- Over-the-counter pain medications and creams. Acetaminophen (Tylenol) and NSAIDS (ibuprofen, Advil, Aleve, etc.) can help manage pain. Read the label to find out how much you can take safely and how often. Some patients also find relief with capsaicin cream or CBD cream.
- Pillows. When lying on your back, try putting a pillow under your knees to relieve back strain. When lying on your side, a pillow between your legs may help. For neck pain, try using a different pillow or putting pillows under your arms.
- Sleep. Try to get at least seven hours of sleep per night and keep a consistent sleep schedule.
- Do not smoke. Studies suggest that people who smoke are nearly three times more likely to develop chronic back pain, due to decreased circulation and other factors. If you smoke or use nicotine products, get help to stop.
Experts agree that movement helps decrease back pain, while prolonged sitting or lying down can make it worse – so get up and move frequently. If you have recently hurt your back or neck, gentle movement may help you feel more comfortable.
If you have not been exercising, start slowly and keep it up. You can start by walking 10 minutes at a time, riding a stationary bike or walking in a pool. As you get stronger, you will be able to exercise longer.
Strengthening your core muscles (belly, mid- and lower back) may also improve back pain. Some discomfort is normal as you start moving, but if you have a lot more pain, talk to your primary care provider or ask to see a physical therapist or physiatrist (a doctor who specializes in body movement issues).
If pain is making it hard to get moving, a physical therapist can help you get started. Your therapist will watch how you move, ask how you feel, and create an exercise plan that meets your specific needs. Be sure to speak up if you have trouble doing an exercise or if you feel pain afterward so your therapist can help you make adjustments as needed. Exercises may include:
- Aquatic exercise (exercise in a pool)
- Aerobic conditioning (walking, stationary bicycle, elliptical machine)
- Core training (special exercises for deep trunk and pelvic muscles), including home exercises
- Reactivation (working on your normal activities and body mechanics)
- Strengthening (using weights, machines, medicine balls or elastic bands)
A physiatrist, also known as a physical medicine and rehabilitation specialist, is a doctor who specializes in issues that affect body movement. This doctor can help identify the source of your pain and create an individualized treatment plan to make it easier for you to go about your daily activities.
If the treatments above have not helped, it might be time to talk to your primary care provider about other options, such as:
- Non-narcotic pain medications. Your health care provider may be able to prescribe medications such as:
- Stronger, long-acting NSAIDs
- Medications that help relieve nerve pain
- A short course of oral steroids
- Chiropractic treatments. These treatments can help improve spinal alignment, relax tight muscles and reduce pain. To maintain alignment, you will need to continue your strengthening and preventive exercises.
- Pain-relieving injections. A specially trained physiatrist or pain management doctor can inject a small amount of medicine near a nerve root to reduce or block your pain.
Surgery is usually reserved for alleviating nerve pain from nerve compression that is not responding to conservative treatment. While surgery is typically most successful for nerve pain, it also can help treat spinal instability and fractures.
A primary care provider’s referral may be required to see a spine surgeon. A recent (within the last year) MRI or CT of your spine may also be required. Your primary care provider can help you determine whether it is time to consider surgery.
During your surgical consultation, your surgeon and care team will ask about your symptoms, examine you and review your imaging tests. Your surgeon may recommend physical therapy, injections or additional imaging to better understand your pain. If surgery is recommended, it is important to ask your surgeon for a clear understanding of how much the surgery may help relieve your pain and allow you to do the things that are important to you.
Swedish neurosurgeons and orthopedic specialists are trained to perform the latest spinal surgeries, including:
- Neck and back discectomy, including microdiscectomy (for disc herniations)
- Spinal decompression (for nerve or spinal cord compression)
- Spinal fusion (for instability or severe arthritis)
- Spinal reconstructive surgery (for scoliosis)
- Spinal cord stimulators (for pain that otherwise can’t be treated with surgery or injections)
- Vertebroplasty/kyphoplasty (for fractures due to decreased bone density)
- Loss of bowel control (more than one episode)
- Difficulty urinating or controlling urine (more than one episode)
- Rapidly progressing weakness or paralysis in your arm or leg that is new or getting worse
- Fever with significant back pain
- Sudden, severe worsening of back pain
- Unexplained weight loss with back pain
- Mild weakness in one or more limbs with neck or low back pain