by Adam Hedaya, MD

What causes back or neck pain?
Back and neck pain can come from a number of places. The pain can be generated by the muscles that support the spine. Additionally, back and neck pain can come from deeper spinal structures, such as the joints, the discs, and the nerves of the spine. Often times, back and neck pain can be caused by more than one of the above structures.

How do you diagnose the source of back or neck pain?
Typically, the source of the pain can be determined using a combination of tools. This starts with the history of the symptoms and a physical examination. Imaging can also be a valuable tool and may include an X-ray and/or an MRI. An MRI is a radiological study that involves the use of magnets and is generally considered the gold standard for examining the physical structures of the spine.

How can I best manage my back or neck pain?
In many cases back and neck pain resolves with conservative care within a matter of weeks. This may include rest, alternating ice and heat, along with the use of anti-inflammatory medications (such as ibuprofen) and medications that help to relax the muscles of the spine. Physical therapy, chiropractic care, and massage in some cases can also be helpful. Some people find electrical stimulation and acupuncture to be of benefit as well. In many cases steroid injections under x-ray guidance can also assist in reducing back and neck pain and expedite a return to normal activity. These injections or cortisone- like shots can also help in determining the cause of the pain in some cases.

Can this pain be prevented?
Yes and no, like many illnesses the cause of back and neck pain can be the result of both our genes and lifestyle. For example, people born with scoliosis (a curvature) of the spine, may be more likely to struggle with spine-related pain over the course of their lives. Particularly if this condition is left uncorrected. Alternatively, those who have physically demanding jobs may be at greater risk to develop back and neck pain over the course of their lives. For many people as they approach their fifth and sixth decade of life, the best way to prevent spine-related back and neck pain is through moderate and consistent low-impact exercise routines. Activities such as yoga, stretching, walking, and swimming can be helpful for some. Other preventive tools include good hydration and a low inflammatory diet.

When should I be concerned about needing surgery to help with my pain?
Barring a serious injury to the spine or spinal cord, typically spine surgery is a treatment of last resort for back and/or neck pain. Generally, surgery of the spine is indicated for uncontrolled radiating pain that is not responding to less invasive treatments. In some cases, surgery is necessary because of the severity of pain and/or the progressive nature of the symptoms or the findings on diagnostic imaging. Some of the other indications for surgery include spinal instability, spinal cord compression and muscle weakness. For most patients with back or neck pain, the pain can be managed without the need for surgery.


Dr. Hedaya is the founding director of Cleveland Pain Care in Beachwood. For more information, or to make an appointment call 440-306-3200.