| Introduction |
 More than 80% of all adults
will experience spinal pain at some stage of their
lives.- It has been estimated that in 90% of these
cases the cause of the pain is simply muscular, and
that about 90% of all episodes resolve without
treatment within 6 weeks. Therefore for most people
the message is simple:-
- The cause of the pain is likely to be much
less complicated than you think i.e. muscular
pain is very common.
- The body has tremendous powers of healing
and can resolve the pain without the need for
external interference. Staying active and
avoiding excessive bed rest is the key to a
rapid recovery.
- In the majority of cases no damage has been
done, and therefore there is no need to be
concerned or over anxious.
- Before you read on, please look at Royal College Report and
The Back Book for essential information on back
pain. Although these 2 links are about back pain,
the same principles apply to those with neck and
thoracic pain, and therefore everybody with spinal
pain should read these first.
- Simple Spinal Pain
is often caused by Simple Sprains, Postural Problems, and Mechanical
Imbalance. The cause of the pain is
thought to be muscular and not due to an obvious
pathological process. Investigations are usually
normal or may show normal age related changes in
the spine. Episodes are usually self/limiting,
although some people may need treatment with
Spinal Manipulation and
Exercises. Osteopaths
often call this form of back pain Segmental Spinal
Dysfunction, meaning that a segment or segments of
the spine have areas of muscle spasm associated
with restricted joint movements. Dysfunction
implies that the area is not functioning properly
without implying that there is overt pathology i.e.
muscle spasm rather than spinal arthritis.
Segmental Spinal Dysfunction can frequently cause
referred pain to other parts of the body mimicking
other medical complaints (see below).
- Complex Spinal
Pain on the other hand may have a variety of
causes. Investigations often show relevant
abnormalities in the spine. This type of spinal
pain is often more severe and long lasting than
simple back pain. There are often associated
psycho/social problems surrounding the pain issues,
which make treatment difficult. The exact cause of
the pain is not always known, and this can cause
difficulty with predicting the outcome of treatment
for it. For most people complete relief of complex
spinal pain is not possible. Click on the other
links above for more information. See Referred Back Pain where the
cause of the back pain is not the spine, being
referred from other areas of the body. See below
for referred pain patterns to other areas of the
body.
- Referred Pain -
Components of the spine like muscle, joints,
ligaments, discs and nerves can cause referred pain
to another part of the body. This is because the
part of the spine affected shares the same sensory
or sympathetic nerve supply as the part of the body
to which the pain is being referred, causing the
brain to misinterpret the source of the pain. Look
at this dermatomal map
 showing the different segments of the
spine and the areas they refer pain to. Below is a
more detailed description of the conditions
mimicked:-
| Spinal Region |
|
Referral Area |
|
Condition
Mimicked |
| Upper Cervical Spine (neck)
C1-C4 |
 |
Back of the head (occiput), back
of the shoulders, angle of the jaw,
face |
|
Headaches, migraines, jaw
problems, trigeminal neuralgia, tension in
the shoulders |
| Middle / Lower Cervical Spine
(neck) C5-C8 |
|
Arms, forearms, hands and
fingers |
|
Pinched nerve in the neck,
tennis elbow, golfer's elbow, frozen
shoulder |
| Upper Thoracic Spine (above the
bra-strap) T1-T4 |
|
Pain in the arms, front of the
upper chest, upper ribs |
|
Pinched nerve in the neck,
angina, breathing difficulties and other
chest complaints |
| Middle Thoracic Spine (at the
bra-strap) T5-T8 |
|
Upper abdomen, middle
ribs |
|
Stomach ulcer, gall bladder
problems, intestinal gas, indigestion,
breathing difficulties and other chest
complaints |
| Lower Thoracic Spine (below the
bra-strap) T9-T12 |
|
Lower abdomen, lower ribs,
pelvis and sexual organs |
|
Irritable bowel disorder, pelvic
pain, period pain, pain in the sexual
organs |
| Upper Lumbar Spine
L1-L3 |
|
Groin, front of the upper
thigh |
|
Pinched nerve in the back, groin
and thigh problems, hip and knee
problems |
| Lower Lumbar Spine
L4-L5 |
|
Front of the inner and outer
shin bone, top of the foot |
|
Sciatica, shin and foot
problems |
| Sacrum S1-S4 |
|
Buttocks,
perineum |
|
Pelvic pain,
coccydynia |
- Biopsychosocial
Assessment is important in those with
complex spinal pain (Royal College Report) to
examine the medical causes of the pain, associated
psychological problems (abnormal pain beliefs,
pain/avoidance behaviour, anxiety and depression,
financial and emotional secondary gain), and
contributions from the patient's immediate
environment (abnormal family / work reenforcement
and attitudes, socio/economic problems).
-
Treatment should be
aimed at three different areas:-
- Reducing the pain to an acceptable level
using medications, physical therapies,
exercises, injections, or surgery
- Addressing the psychological problems
including anxiety and depression, abnormal pain
beliefs, pain-avoidance behaviour, abnormal
coping mechanisms
- Improving patient / family / workplace
education and attitudes to the pain and it's
management.
- Outcomes -
Addressing all three treatment areas together will
give the best results. Many pain clinics judge
success as 50% reduction in pain, 50% reduction in
pain killer use, and 50% improvement in general
functioning (return to work, activities of daily
living).
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