Management of Back&Neck Pain
Online Health Chat with Deborah Venesy, MD
August 24, 2012
Cleveland_Clinic_Host: On any given day, almost two percent of the entire United States work force is disabled by back pain. In people younger than 40 years old, back pain is the most common reason for the inability to perform daily tasks. It also is the direct cause of enormous health care expenses.
Pain that primarily affects the back should be distinguished from a spinal condition that results in mostly leg pain, a condition commonly called sciatica. Typically, sciatica is the result of a ‘pinched nerve’ in the spinal column. In most cases, the cause of sciatica is clearly defined, e.g. a disc problem or arthritis. The cause of back pain, however, is often more difficult to pinpoint, and may be related to the discs, joints or soft tissue supports (muscles, ligaments and tendons) of the back.
Causes of neck pain include abnormalities in the bone or joints, trauma, poor posture, degenerative diseases and tumors. Pain in the soft tissues is the most common cause of neck pain, and usually occurs as a result of an acute or a chronic muscle strain. The neck is very movable, which means it is less stable than other parts of the body and more easily injured.
For More Information
Each year at the Cleveland Clinic, we help thousands of patients with conditions of the back and neck, ranging from the most common to the most complex. Whether your goal is to get back to work, sports or just enjoying life, the specialists at the Cleveland Clinic’s Center for Spine Health can help.
MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients to portions of their personalized health information. All you need is access to a computer, an email account, and an Internet connection. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: firstname.lastname@example.org
A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult
To make an appointment with Dr. Venesy or any of the other specialists in the Center for Spine Health at Cleveland Clinic, please call 216.636.5860 or 800.223.2273. You can also visit us online at clevelandclinic.org/spine
About the Speakers
Deborah Venesy, MD, has been with Cleveland Clinic since 1999. She completed her residency in physical medicine and rehabilitation at The Ohio State University Hospitals, Columbus, Oh, after graduating from medical school at Wright State University School of Medicine, Dayton, Oh. Dr. Venesy is board certified in physical medicine and rehabilitation and by the American Board of Electrodiagnostic Medicine. Her specialty interests include electromyography, evaluation and management of back and neck pain, management of occupational conditions and illnesses, neck and back disorders, and rehabilitation of neuromuscular disorders.
Let's Chat about Back and Neck Pain
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialist Dr. Deborah Venesy. We are thrilled to have her here today for this chat on Management of Back and Neck Pain. Let’s begin with some of your questions.
marty: What is the best type of doctor to treat the condition diagnosed as compressed disks or lumbago? This diagnosis was made by an orthopedist. Should I see a neurologist who removed a lower back disc seven years ago that was pressing on my sciatic nerve, or should I see a pain management or spinal doctor?
Dr__Venesy: Specialists in physical medicine and rehabilitation, or physiatrists, like myself are great doctors to treat and manage lumbago or low back pain and disc problems. We are called ‘medical spine specialists’ at the Cleveland Clinic. We manage acute and chronic neck and back pain (cervical and lumbago). Orthopaedists and neurosurgeons also treat back and neck pain. They are surgeons, and a great majority of folks don't need surgery. Pain management specialists and neurologists are also good specialists to see in addition to your primary care physician.
Chronic Sacral Joint Pain
i_should: I had spinal fusion surgery in 2008 for L5/S1 which took care of 98 percent of my back pain. Occasionally, I still get pain in my left sacral joint that shoots into my left buttock. I mostly feel it when I work out, but sometimes it comes on even when it's not provoked by a workout. It's hard to walk and put weight on my left side. I usually take Advil® to alleviate the pain, but the pain tends to come back. Should I make an appointment with a doctor to get new MRIs of my sacral joint to make sure there's not a bigger issue, or just continue to try to manage the pain via Advil® when it flares up?
Dr__Venesy: I think it makes sense to make an appointment to see a physician, not so much for an MRI right away, but examination and assist with diagnosis. Physical therapy, manual therapy/manipulation, and/or other treatments may be helpful.
chagrin123: I had microdiscectomy in 1996, which primarily relieved most of my pain. I function well unless I overdo it, which often is using my back too much in athletics or at work. I am 58 years old, and I travel three to four times per month. I have pain down my left leg that always flares up from sitting more than 30 to 60 minutes. I have a stand-up desk at work and also use a treadmill, since walking is good. I just got back from a trip and the pain is worse. I take 500 mg of naproxen periodically. I do aerobic exercise two to three times per week, and swim briefly afterward when I am in town. I have seen Fredrick Wilson, DO, at the Cleveland Clinic three or four times since the surgery. Can I do something more?
Dr__Venesy: Please talk with Dr. Wilson about your current symptoms. I know he can direct you regarding additional care, whether you need additional testing, therapy, medications, and/or referral for injections.
Grannyscott: I have been diagnosed by a doctor at Cleveland Clinic Center for Spine Health with cervical spondylosis, for which lidocaine patches were recommended, and sometimes help. I have a lot of trouble standing for any length of time, and recently had an attack of sciatica that was not relieved by prednisone, and followed by several weeks of pain going down my right leg and knee. I had total knee a replacement 12 years ago, but the x-rays are OK. Is a spine condition likely to be causing these problems?
Dr__Venesy: It may be contributing to your leg pain (sciatica). Feel free to contact your spine medicine physician about your new low back and leg problem.
dorcie: My husband has been treated for spinal stenosis in the lumbar area. He has had many forms of treatment from physical therapy to epidurals, acupuncture, and foraminotomy. He suffers with pain in the buttock radiating to the great toe. His right great toe has twitched constantly for many years, even at rest. What do you recommend?
Dr__Venesy: I'd suggest a second opinion. We have a number of excellent physicians both in medical spine and pain management. Combined they would be able to recommend the best treatment. You can contact 216.636.5860.
Degenerative Disk Disease and Exercise
garchinh: I am 62 years old and swim laps for exercise three times per week, and swimming a total of about two miles per week. About six months ago, I was diagnosed with degenerative disc disease in four of five discs in my lower back. I swim freestyle primarily mixing in some backstroke and some breaststroke. Is it possible that my condition is related to swimming, or can be made worse by swimming? I have a history of arthritis with bad knees, including a total knee replacement in 2005. Also, what are the best physical therapy exercises that I can do for my back?
Dr__Venesy: It is great that you are swimming. It is a great form of exercise, and swimming will not cause any harm. We encourage cardiovascular exercise (like swimming, walking, etc.) in addition to stretching and core strengthening exercises. The best type of physical therapy for you depends on your history and examination. You can work with a spine physical therapist to develop a home exercise program.
second_chance: I have had coccyx pain for seven years and have had several different treatments for it with no success. Do you have someone there that treats this condition?
Dr__Venesy: Yes. All of the ‘medical spine’ or non-surgeon spine specialists treat coccydynia— or pain in the coccyx (tailbone). There are special sacral/coccyx seating cushions that help decrease tailbone pain while one is seated, too.
Chronic Back Pain and Spinal Treatment
so_what: Hello, I am a 54-year-old male who has suffered with chronic back pain for a number of years. A work injury and degenerative disc disease, arthritis, and other problems have resulted in numerous injections, ablations, installation of a neurostimulator and, most recently, a triple laminectomy. The laminectomy was performed last October, and the pain in my left leg and back was greatly reduced. However, in the past six weeks, the right side of my lower spine has become increasingly irritated and has reduced my after work activities to a near standstill again. Along with my neurostimulator, I take Percocet®, Motrin®, and a couple types of muscle relaxers. Now my pain management doctor has suggested the need for more injections. I find this quite objectionable as my situation seems to be a pattern of the same old thing. I would like to know if this is the best current medicine has to offer me, as I must consider my future. I ask you hoping that you may be aware of some cutting edge medical technology may have an alternative to offer.
Dr__Venesy: Please consider making an appointment in the pain management department and the Center for Spine Health. Everyone is different, and a complete evaluation would provide additional information.
abno: I have multiple back problems. I get around on one crutch, or sometimes a cane or walker, but can walk only short distances before lower back pain seizes up my stride. My doctor, an orthopaedic surgeon who operates on pediatric scoliosis and also some adults, advises against surgery. He wants me to get epidurals in my back from a pain specialist he recommended. My question is what are the possible complications of epidurals in the back, and how often do they occur? My conditions ranked by severity are: stenosis, scoliosis, kyphosis, lordosis, degenerative disc disease, various ruptured and displaced discs (the , lower-most disc is almost completely gone with much pain in that quarter), compression fractures of the spine (three that were evidently spontaneous from years ago, with no accident or trauma of note), severe arthritis everywhere, and also osteoporosis.
Dr__Venesy: Complications of lumbar epidural steroid injections will be reviewed with you by the specialist during your consultation appointment. Please talk with the pain management specialist or spine interventionalist about the potential complications of the procedure.
Joanna: I am 39 years old, and have no disc left on L5/S1 and L4/5 and also have massive osteochondrosis, I can only walk, sit or stand for brief periods of time. Are there other options to help me other than surgery, I have already had two surgeries for my herniated disc?
Dr__Venesy: Yes, there are always different options to manage chronic back pain: exercise, yoga/stretching, acupuncture, chronic pain management and rehabilitation programs, and different medications.
FMDAdvocate: I have had radiculopathy in my big toe for the past three years following L3-4, 4-5 laminectomy and decompression done as an emergency surgery, due to sudden onset foot drop. I have had five steroid injections since surgery without pain relief. I take gabapentin 1500 mg, and I am unable to tolerate a higher dose due to drowsiness. My doctor is hesitant to prescribe Lyrica® due to risk of leg swelling. I do have fibromuscular dysplasia, and it is now thought to be the cause of my foot drop due to possible spinal artery infarct. Do you feel Lyrica® would be worth trying since gabapentin isn't controlling pain? I have no other cardiovascular risk factors.
Dr__Venesy: Lyrica® is just one option you and your doctor may try. There are other ‘membrane stabilizer’ types of medications you can discuss with your doctor and/or spine specialist. Medications are just one aspect of managing chronic radiculopathy, or a chronic ‘pinched nerve.’ Exercise and therapy are also important components.
pattyarn: A physician in my area has suggested that I now see a pain specialist, since nothing I have tried as treatment for or symptom relief from numerous low back problems has worked. I have an upcoming appointment at Cleveland Clinic Center for Spine Health for an evaluation. Would it benefit me to also make an appointment with the pain clinic at the same time or not at all? I live in western New York, and I would like to avoid many trips for evaluation.
Dr__Venesy: Yes, I think that this a great idea. We have an excellent service that will help you with the logistics of making an appointment. Use the following link. http://my.clevelandclinic.org/patients-visitors/prepare-appointment/travel-assistance.aspx
cspringer: How successful are anterior lumbar interbody fusions (ALIF)? My neurosurgeon wants to perform this surgery on me in an outpatient facility, with a stay of only 23 hours. What do you think of this idea?.
Dr__Venesy: This is a question that one of the spine surgeons would need to address. My suggestion would be to contact our Center for Spine Health at 216.636.5860.
sinaihospital: I have had back pain for many years. I've tried therapy shots and medicines. It does not work. Can surgery help for my back problems?
Dr__Venesy: Sometimes surgery can help. Every individual is different, and having a full evaluation would provide more detailed information for surgical and nonsurgical recommendations.
Pedaler: I had lower leg pain and stiffness, which I rate about six out of 10 in severity, when I am standing up, but not laying down. My doctor attributes this to stenosis in L4-L5 . My lumbar pain is rated generally between a 0 to 2. I walk about 3.5 mile every other day. What conditions would you recommend surgery for stenosis in L5-4. Most of the pain and stiffness is in the lower legs, and the severity of pain is six out of 10.
Dr__Venesy: This question is best answered by a spine surgeon. In general, spine surgery for stenosis is an option for decreasing leg pain and improving a person's ability to walk further distances.
Innovative and Alternative Therapies for the Back
lanisha1: Can you please provide more information about radiofrequency ablation? This was mentioned by my pain specialist.
Dr__Venesy: I do not perform radiofrequency ablation (RFA). We have spine interventionalist specialists and pain management specialists at the Cleveland Clinic who are better able to answer questions about RFA.
no_rules: I have lower back disk pain. Is it true that you are doing stem cell treatments?
mustang: What are some of the promising technologies or innovations for treating chronic back pain?
Dr__Venesy: We are constantly researching ways to treat chronic back pain. I am not aware of any new promising technologies for chronic back pain. Some people respond to acupuncture. Exercise is one very important aspect of managing chronic back pain.
bill: I have two herniated disks that are affecting my neck. Do you do noninvasive endoscope spinal laser surgery? I wish to avoid the invasive spinal surgery that was recommended.
Dr__Venesy: No, the spine surgeons here do not perform laser spine surgery.
Curly: This spring, I went to a chiropractor who specializes in DRS (decompression reduction stabilization) spinal decompression. I have sciatica, with a slightly bulging disc at L4-L5, spinal stenosis, scoliosis and degenerative disc disease. The treatments have helped, but part way through them I developed, ear pain, headaches and dizziness. I was put on vitamins and herbal supplements by the chiropractor. One product that was recommended is Formula 303®. I stopped all supplements myself to try to figure out if one of them was causing my problem. These pains come and go and are on the left side of my head. My sciatica and other problems were on the right side. I researched Formula 303®, and I feel the valerian root in it has caused my problems. It shows that this herb should not be taken longer than four to six weeks and should be slowly stopped. They never told me to do this. Do you feel this herb can be causing nerve problems in my head, or do you feel I have another problem?
Dr__Venesy: Please consider consulting with Tanya Edwards, MD, in our Cleveland Clinic Wellness Institute.
Chronic Neck Pain Treatment
time_machine: I have had neck pain on my right side for nine months. I went to a chiropractor for about five to six months. He took x-rays, and said I had arthritis. I went to an arthritis doctor who took x-rays, and agreed with the chiropractor I am allergic to Advil®. Several years ago he did not want to put me on anti-inflammatory medicine . He tried steroids, but it didn't help. He put me on a muscle relaxer at night, but it hasn't helped. He gave me steroids again, but they do not help. I am in pain and I do not know what to do. I have been a patient of Cleveland Clinic before. Could it be something with my neck?
Dr__Venesy: This is difficult to say without seeing you in person. Please consider making an appointment in the pain management department and the Center for Spine Health. Everyone is different, and a complete evaluation would provide additional information
every_one: I am 68-year-old female. I did physical work on a farm for many years. I have arthritis in my neck. Last week I started getting a sharp pain on the left side of my head when I look down, such as when reading a paper on a table or writing. It feels like something catches in my head. The pain goes away when I rub muscle very hard on the back of my neck. It feels like it clicks back into place and then gets better. The doctor gave me muscle relaxers. They have helped some, but I still have the pain, but not as bad. The whole left side of my head feels different, as if it were plugged up. Sometimes I have pain in the ear area, or it feels like my ear is plugged, but it isn't. This goes away sometimes as fast as it comes on. Sometimes it hurts when I turn over in bed. I don't really want a MRI, but do you think I should have more tests? I had an x-ray of my neck, and they said it is arthritis. It also feels like I have a cold on that side of head. Usually in morning, I have a lot of phlegm in my throat and mouth. Could it be some kind of infection?
Dr__Venesy: I would recommend a complete evaluation with your primary care doctor first
rwhealth: Please recommend exercise to counteract ‘computer neck’
Dr__Venesy: Get up and stretch often; look at the set up of your computer work station and chair. There is a nice book, ‘How to Treat Your Own Neck,’ by Robin McKenzie, which has good pictures of neck exercises. If you have trouble, working with a spine physical therapist will help you develop your own individual exercise program.
rwhealth: I have sleep apnea and use continuous positive airway pressure (CPAP) while sleeping. I sleep on my side. Do you have any suggestions for avoiding stress on my neck?
Dr__Venesy: Use a good neck pillow.
scottie: My question relates to neck pain. I am 52 years old and get intermittent left-sided neck and shoulder pain. It occurs daily, but can be variable in intensity. I have had it for three years, and it coincided with left cervical artery dissections (which were managed conservatively). The pain feels like muscle spasms. Could this be related to my arterial dysplasia? Any suggestions on management? I presently use tramadol, having had no real benefit from physiotherapy or acupuncture. Is a TENS (transcutaneous electrical nerve stimulation) machine of use in this type of situation?
Dr__Venesy: I don't think that the neck pain you describe is related to your arterial dysplasia. I suggest a full neuromuscular evaluation as there are many treatment options for neck pain related to mechanical and degenerative, or wear and tear, changes in our neck.
Surgery for Neck Pain
juno: My doctor said I need surgery on my neck. Several years ago I had a similar surgery on my lower back that left me in more pain due to scar tissue. My body likes to make an abundance of scar tissue. I know I need the surgery because I'm losing strength and feeling in my arms and hands, but I'm reluctant because of the scar tissue issue. Is there anything that can be done to reduce the formation of scar tissue after surgery?
Dr__Venesy: Any type of surgery will produce some scar tissue. The amount certainly varies depending on the individual person.
Innovative Neck Therapy
eBandit: Are there any new breakthrough treatments for neck pain or back pain? What is a person to do if they have lived in pain for over 10 years after suffering from a broken neck and are losing hope for getting out of pain? Are there any ways to partially block pain signals in certain areas (outside radiofrequency ablation)? What nonprescription medications are out and work to treat neck pain (outside epidurals, trigger points, etc.)?, If all hope is lost on finding a solution to better pain management, where does a person go next?
Dr__Venesy: We have a wonderful chronic pain rehabilitation program. The multidisciplinary chronic pain program teaches patients how to manage chronic pain conditions like the one you describe.
Ms__Gloria: Here is my question for the chat: I have multiple back problems. I get around on a crutch, or sometimes a cane or walker, but can walk only short distances before the lower back pain seizes up my stride. My doctor, an orthopedic surgeon who operates on pediatric scoliosis, also some adults, advises against surgery. He wants me to get epidurals in my back from a pain specialist he recommended. My question is what are the possible complications of epidurals in the back, and how often do they occur? My Conditions - most ranked severe Stenosis Scoliosis Kyphosis Lordosis Degenerative Disc Disease - various ruptured and displaced discs - lowermost disc almost completely gone - much pain in that quarter Compression fractures of the spine  - evidently spontaneous, years back, no accident or trauma of note Severe arthritis everywhere, also osteoporosis.
Dr__Venesy: Please talk with the pain management specialist or spine interventionalist about the potential complications of the procedure.
Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic specialist Deborah Venesy, MD is now over. Thank you Dr. Venesy for taking the time to answer our questions today about Management of Back and Neck Pain.
Dr__Venesy: It was my pleasure!
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