Just about everyone has had a backache or neck ache from time to time. Except for chronic headaches, back pain is the most prevalent pain complaint. While information on the occurrence of neck pain is less well known, statistics show that 50 to 80 percent of people will be disabled by back pain – some more severely than others – at some point during their lives. At any given time, 1% of the United States population is temporarily disabled by back pain, while another 1% is chronically disabled (about two to three million people). For these millions of Americans, backaches are more than an occasional nuisance; they are a chronic, sometimes-incapacitating condition that gets in the way of work, school, relationships and enjoyment of life. At their worst, chronic back and neck pain can lead to loss of self-esteem, depression and serious problems with loved ones, friends and co-workers. The size and scope of the problem of disabling low back and neck pain is expected to worsen over the next decade as the average age of the work force increases.

The economic and social magnitude of neck and back pain – most frequently low back pain (LBP) – is enormous. While it is difficult to calculate exactly how much back pain costs the nation, statistics show that backaches result in the loss of approximately 175 million work days and results in a $20 billion loss in productivity. Two percent of the United States work force suffers from chronic back pain costing the U.S. economy a total of $50 billion annually. According to the National Institutes of Health (NIH), backaches are the second most common reason Americans go to the doctor (headaches are the first), and among the most common reasons for surgery.

Risk Factors

The risk of back or neck injury often is related to your type of occupation or activity. For example, you are at greater risk of back or neck pain if you are involved in certain professional sports and dare devil stunts. However, risk also may exist in other  seemingly less risky occupations. Simultaneous bending and twisting as well as exposure to excessive vibration can increase your low back pain risk. So can working at a job with heavy physical demands, such as lifting heavy materials.  Such work can affect your spinal structures, particularly if you cannot modify your movements and other body mechanics to prevent injury.  Even driving or sitting may for long periods of time lead to back pain. Occupational risk factors include:

• Heavy manual labor.
• Vibration.
• Prolonged sitting or driving.
• Confined spaces with difficulty using proper body mechanics.
• Heavy lifting.
• Twisting.
• Bending.
• Inexperience on the job (workers tend to have more injuries during their first few years on a job). 
• Job stress.

Other factors that can lead to a greater incidence of chronic back or neck pain include:

• Aging and gender – traditionally, men have increased incidence of back pain until their early 40s due to work that requires more heavy lifting; women have a substantial increase after age 40 to about 55 due to hormonal changes.
• Prior history of back pain.
• Physical deconditioning due to lack of exercise.
• Pregnancy.
• Smoking.
• Psychosocial stress factors in personal, home or work life.
• Substance abuse.
• Psychiatric illness such as depression and anxiety disorders.
• Extreme obesity.
• Job dissatisfaction.

While health professionals know what triggers certain kinds of back and neck pain, myths and misconceptions about the condition and who gets it abound. It is important to understand that low back or neck pain is a symptom. It is something that is an uncomfortable sensation reported by the patient but that cannot be seen or measured. What we do know is that if you are experiencing back or neck pain, your pain is real and that a number of treatment options exist to ease most chronic back and neck pain conditions. The key to managing back and neck pain is knowledge: your knowledge and the knowledge of your health care professionals.

Back and Neck Pain Care

Most episodes of acute low back pain do not cause significant incapacity and get better with little or no treatment.  In uncomplicated back injuries, most people experience pain relief within one to two weeks; up to 90 percent feel better within four to eight weeks, regardless of treatment.  However, the remaining 10 percent or so of back pain sufferers have a more long-term incapacity that requires more extensive diagnosis and more formal treatment.

One method of organizing treatment interventions for acute low back or neck pain is to think of your pain as being at one of three levels:

• Level One Treatment Options – Pain relief is achieved within a few days by resting from physically stressful activities and by using simple pain-relieving medications.
• Level Two Treatment Options – The pain persists beyond a few days. At this stage a differential diagnosis – one that isolates and identifies the pain problem – is needed. Additional therapies may be prescribed, such as physical therapy that includes heat, massage, ultrasound or electrical stimulation.
• Level Three Treatment Options – The pain persists after four weeks, despite appropriate treatment. Additional diagnostic tests and more aggressive treatments are in order.

Warning: Consult your physician immediately if your back or neck pain is associated with numbness or weakness, balance problems, or loss of bowel and/or bladder control, and particularly if these symptoms are worsening. You may require immediate diagnostic studies and treatment. Fever and neck stiffness may indicate an infection (eg, meningitis)

Chronic low back pain is pain that has persisted longer than the expected healing time for the identified cause of the pain, or persists after the identified cause of the pain has been treated.  While methods used to treat chronic low back pain are similar to those used to treat acute pain, the approach differs. The treatment goal for chronic low back pain is to optimize physical functioning and to ease pain symptoms, as opposed to "curing" the acute pain.

General areas of treatment include:

• Rest
• Temperature modalities
• Medications
• Exercises – physical therapy
• Traction
• Braces/ supports
• Back protection/education
• Surgery
• Nerve blocks
• Trigger point injections
• Electrical Stimulation
• Ergonomics
• Chiropractic manipulation

• Complementary medicine

Many of these options are described in detail in the Back and Neck Pain treatment continuum presented on the Back and Neck Pain treatment options site.

Simple "First Line" Treatments

Perhaps the simplest "first line" treatment for back and neck pain is rest, which reduces the natural pressure of upper body weight on the spine.  In the past, it was common for physicians to prescribe two weeks of bed rest for back pain.  We now know that three to four days of rest are optimal. After this period, movement and exercise are more important to relieving pain symptoms and to prevent loss of muscle tone and flexibility. However, strenuous work should be avoided for two to three weeks while healing occurs. As long as there is no numbness or weakness in the legs or arms, this process can be completed without undergoing any special diagnostic testing. If the back pain has not resolved within six weeks, consult your physician.

Another simple treatment — one you can do easily at home — involves applying heat and cold to ease pain.  Apply cold packs to the affected area in the first few days (up to 72 hours), than switch to applying heat for 20 to 30 minutes, three to four times a day.  This may help ease pain by relieving muscle spasm or cramping.  Cold stimulation, such as icing, can also activate the body's mechanisms that shut down pain signals as they enter the spinal cord.   Applied warmth also decreases stiffness and prepares muscles for stretching.  Deeper heating treatments, such as ultrasound, can be applied for six to eight sessions in conjunction with physical therapy. These techniques prepare the muscles for stretching and may break the pain-tightness-pain cycle.

Traction

Traction — or pulling parts of the body apart — is another at-home therapy prescribed for certain types of neck and back pain. 

Neck Pain. Traction is especially beneficial for neck pain and, when used correctly, often will relieve not only pain but also associated numbness or weakness.  Traction is applied using a halter-type device that is fastened to a doorframe and connected to a weight. A certain amount of weight — typically seven to 10 pounds — is used for one-half hour two to three times a day.  Traction often is most effective when used after heating the affected area or after using a muscle relaxant.

Low Back Pain.  Aside from immobilization, traction is not routinely recommended for low back pain. This is because the lower back muscles and those responsible for moving the legs are so strong that a great deal of weight would be needed to provide proper traction.  This makes the procedure itself painful as well as difficult to successfully accomplish. However, in some cases, supervised traction, in which the upper body is suspended in warm water while 15 pounds of weight is gradually applied with a belt, has been used successfully.

Braces and Supports

In the past, a wide variety of corsets and braces have been popular for the treatment of back and neck pain. However, the current recommendation is to avoid these support devices for other than a brief period of immobilization at start of acute pain symptoms. Long-term use of support devices tends to weaken certain muscles and can cause difficulties rehabilitating the spine. A corset used short term may serve as a warning to be careful with bending and twisting activities. The corset also increases the abdominal pressure thereby decreasing the lumbar disc pressure that can contribute to low back pain. 

Back and Neck Pain Prevention

When dealing with back and neck pain, it's important to do all that you can to help the healing process. This means eating right, getting the necessary amount of sleep, keeping the stresses and strains on your system to a minimum, and doing regular, non-traumatic exercises.  It also means avoiding unhealthy habits, such as smoking and drinking alcoholic beverages, especially during the early healing period. (Suggested reading: The Healing Response by Michael W. Loes, M.D.)

Eat Well. Good nutrition helps the healing process. This means eating plenty of fresh fruits and vegetables, and taking food supplements if you are not used to eating the high amounts of B vitamins and enzymes that may be necessary for healing.  (Suggested reading: Foods that Fight Pain by Neal Bernard and The Circadian Prescription by Sydney Baker.)

Don't Smoke. Nicotine slows your body's healing process. It causes spasms, reduces total body water, and interferes with your sleep. 

Avoid Alcohol.  Alcoholic beverages cause problems with your sleep and usually reduce the body water needed for healing. Alcohol, especially beer, has diuretic properties; it makes you go to the bathroom a lot.  The resulting dehydration can cause more pain.  (Suggested reading: The Body's Many Cries for Water by Dr. Batmanangedi.)

Work Safe. Increasingly, companies are recognizing the need to prevent or at least minimize painful injuries through ergonomics, the science of the workplace environment. Many have installed adjustable workbenches, computer workstations, chairs and other workplace alterations that reduce the need for bending, lifting, stooping and twisting activities that can aggravate spinal problems. If your workplace environment cannot be modified, an occupational therapist or occupational physician can show you how to do the job in a more efficient (and pain-free) manner through proper body mechanics.

Get Educated - Go to Back School

Knowing how to lift things properly and the effects of back and neck posture on pain symptoms can help you avoid further back injury and the recurrence of spine problems. In Back School, an education program offered as part of many physical therapy programs, patients are taught to carry objects close to the body rather than away from it. They learn to minimize back and spinal column stress while lifting by using strong leg muscles, rather than back muscles.  Commonsense techniques such as pushing rather than pulling, using foot rests and avoiding overhead reaching by using stepstools are taught to alleviate low back or neck pain. These simple techniques make a significant difference for low back pain patients when incorporated into their lifestyle and workplace.

Other simple techniques for lower back pain management include weight reduction, physical exercises to maintain flexibility, general conditioning and mobility, good posture and using proper body mechanics during daily activities.

A major goal of the National Pain Foundation is to provide back and neck pain sufferers, their families and friends with accurate, useful and up-to-date information. Explore this site for information on how to manage back or neck pain.