Conquer Back and Neck Pain - Walk It Off! (12 page)

• I cannot button or unbutton my shirt.	Yes No
• I cannot climb up a curb or steps without help.	Yes No

I had been working hard as Chief Resident of Orthopaedic Surgery, on call every other night, and trying to scrub in on every interesting surgical case that I could. A young man came into the emergency room with a severed nerve on the side of his knee, and he could not lift his foot up off the floor. In order to repair the nerve I had to stand in an awkward position bent forward over the operating room table for almost two hours, stitching the nerve with the aid of magnifying lenses.

In the surgeon’s lounge following the operation, I bent over to put on my shoes and was struck with such a severe back pain that I almost fell to my knees. A fellow resident helped me to the emergency room, and there I was evaluated by another colleague who suspected that I was passing a kidney stone. He ordered an x-ray of my kidneys, and when the x-ray came back normal, we both realized that the pain was coming from my back. I went home and rested for a few hours with a heating pad and then got out of bed and walked it off over the next few days. I finally understood why my father was so incapacitated when he had attacks of back pain and how he recovered from what seemed to be a devastating condition by simply walking it off!

This attack was brought on by no apparent injury and went away without any real treatment except walking it off. To this day, we medical scientists have not been able to pinpoint the exact reason for such attacks of low back pain. Therefore we label the condition as idiopathic low-back pain, meaning the exact cause of the back pain is not known. I suspect such attacks of back pain represent the first complete tears in the side wall (annulus fibrosus) of a degenerated disc, tears that reach the sensitive nerve endings adjacent to the disc.

Whatever the exact reason, the vast majority of acute, severe attacks of low-back pain are way out of proportion to the seriousness of the condition that causes them, and they go away just as mysteriously — but unfortunately not as quickly — as they came. How do we know when to seek help for such an attack?

There are some simple questions you can ask yourself in order to determine whether you should seek immediate help or just walk it off like my father and I did from our attacks of back pain.

The first thing to do is lie down, relax and calm down, and try to analyze the situation. The good news is that the vast majority of acute attacks of neck and back pain are not serious enough to require emergency care. The bad news is that there are some rarely occurring serious disorders that can cause acute and severe spine pain. Therefore, if the attack of back pain is so severe that it is difficult to walk and the pain does not subside to some degree within a few hours of bed rest, then common sense dictates that you call 911 and seek emergency attention.

Benign low-back pain, also known as idiopathic low-back pain, lumbago, low-back sprain, or low-back spasm, is the most common reason for acute severe attacks of back pain. It is self-limiting, not serious, and usually will begin to subside within a few hours of onset with rest and control of the anxiety that is associated with it. You should be able to walk, although slowly, and you should be able to go to the bathroom and urinate. After the initial crescendo of pain it should begin to subside, to some degree, almost immediately.

If the pain continues to get worse, makes you faint, light headed and sweaty, and comes in spasms, you may have some other more serious condition that may endanger your life or limbs. Some conditions may not be from your back, but that you should be aware of, are described below. Even if you have had a previous attack of severe back pain that you walked off, you should be aware of these conditions and the symptoms they produce, as they are not something to ignore if they occur.

Massive disc herniation in the low back can cause cauda equina syndrome. The cauda equina (literally means horse’s tail in Latin) is the term applied to the multiple nerves that go from your brain to your legs, your bowel, and your urinary bladder. If one of the lower spinal discs completely blows out, it can squash the nerves in your cauda equina, causing severe back and leg pain. If the attack of back pain is unrelenting; you experience numbness in your groin, around your rectum, genitals or legs; weakness in one or both legs; inability to urinate; or any combination of these symptoms, you should seek emergency treatment immediately! Prompt diagnosis and surgical treatment of this condition can result in a complete recovery. Fortunately, this horrible condition is responsible for less than one in 10,000 cases of severe back pain and fewer than one in 1,000 cases of disc herniation. In more than 30 years of surgical practice I have had to operate upon fewer than 10 patients with this condition, two of whom were pregnant. I will describe these two patients’ cases in the chapter on disc herniation.

The passage of a kidney stone can cause acute severe back pain. One morning my wife complained to me of acute severe back pain while holding her side in an attempt to alleviate waves of spasmodic pain. It was obvious that she was in severe pain because she was lightheaded, sweating, and nauseous. The pain was localized to one side of her back, over her kidney just below the rib cage, and radiated into her groin area. I recognized her symptoms as those seen with passage of a kidney stone, so I took her to our emergency clinic where she was treated with medication that helped her pass the stone. Later she told me it was the most severe pain she had ever experienced, worse than giving birth. If you experience any of these symptoms, you should be seen in an emergency room. If the pain is making you lightheaded and no one is available to drive you to the emergency room, call 911. Do not try to drive yourself, as you may faint and end up in a car accident.

Fracture of the vertebrae in the low back can cause acute severe back pain. Normal vertebrae require a significant injury to fracture (fracture and break mean the same thing), such as a fall from a ladder — one that you are sure to remember and associate with the back pain. However, there are cases in which people do not remember injuring their back, such as during a fainting attack, seizure, or while under the influence of alcohol or drugs. In instances such as these, a person may not associate severe back pain with an injury. Once again, if the pain does not subside within a few hours of resting to the point where you can get up and walk around, you need to seek help.

There are also circumstances in which one may not suspect that back pain is from a fractured spine. A defective vertebra can break from a trivial insult such as a sneeze or riding over a speed bump. Older women with soft and/or brittle bones (osteoporosis), people with unsuspected tumors in their spine, and those with chronic diseases may have defective vertebrae that are susceptible to breaking from a minor injury, thus causing severe low-back pain. For this reason, the source of any acute back pain in a frail and/or chronically ill individual should be determined by a qualified medical expert.

Shingles is caused by the chicken pox virus. The chicken pox virus can stay dormant in your spinal nerves for years and then suddenly, within a matter of a day or two, trigger a burning, itching, acute, and chronic pain syndrome that radiates along the course of a spinal nerve anywhere in your body (head, neck, arms, trunk, legs). The pain associated with shingles may be mistaken for a herniated disc in your neck or anywhere in your back, depending on the spinal nerve affected. Shingles is characterized by a painful weepy skin rash that occurs at the site of the pain. If this occurs to you, seek immediate help from your primary care physician, a neurologist, or a dermatologist (skin specialist). There are medications available for this disease that, if given early enough, will shorten the painful course of the rash and prevent the chronic nerve pain that can develop with it.

Do not touch or scratch the rash because you can spread the virus that causes it to others or to other places on your body. It is particularly dangerous if it gets in your eye because it can injure your cornea and cause blindness! Whenever you develop burning pain associated with a skin rash, think of shingles and seek immediate help.

Bacteria from your bloodstream can spread to your spine, causing a spine infection and severe back pain. Since it is rare and may not cause fever, chills, and sweating that you would expect from an infection in other parts of your body, an infection of the spine may not initially be suspected as a cause of the pain. Diabetic patients, those undergoing chemotherapy for cancer, people who have had an organ transplant or other chronic disease, and people on steroids are more susceptible to spinal infection and should seek expert medical advice for an attack of pain involving the spine.