Have you ever experienced back or neck pain and wondered how the pain will occur? In fact, it is a signal that certain part of your spine is injured. To a neurologist or orthopedist, they are experienced enough to determine what the pain is trying to tell us since each anatomical structure has its own voice. Symptoms such as tingling, weakness and urinary problems also contribute to the voice of pain.
Each anatomical part also has a distinctive localization, quality, radiation and associated symptoms such as weakness, numbness, bowel or bladder incontinence. The anatomy of pain is what your doctor uses to diagnosis the cause or origin of your pain.
9 Different Types Of Back And Neck Pain
Nerve Radicular Pain
Nerves have the most intricate anatomy and the most distinctive voices and symptoms. When irritated or crushed, a nerve produces a stabbing, knife-like pain. Onset of pain is sudden and the feel is like stabbing, electric shock or deep aching pain which can be a score of 10, based on a scale of 1 to 10.
When injured, the sensory fibers produce a tingling sensation that feels like pins and needles in a nerve root pattern, less often causes weakness in a nerve root pattern. In severe case where the entire bundle of spinal nerve roots (cauda equina) is injured, it causes bowel and bladder problems and may cause severe neck or back pain.
Localized neck or low back pain is often felt below the shoulder or the buttocks in a narrow band-like distribution. Extremity pain can be more severe than spine pain. The pain can be worsened by lifting, or twisting, extension of neck or back, or activity during flare-ups.
The pain radiates along nerve path (down the arm or leg). It is often associated with tingling along a specific, well-defined path. However, the pain can be eased by resting or lying on one’s side with legs bent. Ice application and anti-inflammatory medication can also helps.
Joint Or Facet Pain
The facet is a joint. The facet joint has a superior (above) part and an inferior (below) part that includes facet from adjacent vertebrae. It has a covering, or membrane, that has many small blood vessels and fluid in between so that the joint flows smoothly.
This allows the bending, twisting and extending movements that are vital to swinging a golf club, bending forward to brush your teeth, or extending to put that light bulb in the ceiling fixture. The facet is also well innervated, meaning that it has sensation nerves going to it that connect it to other parts of the spine, usually one level above the affected area and two levels below it.
Quite often, the pain is gradual over several months even though it can be sudden. The pain is deep to dull aching, occasionally a sharp catch in the neck or back, stiffness after walking or after sitting for a long time. Based on a scale of 1 to 10, it starts from 5-8 and then generally 2-4.
Facet pain radiates differently than nerve pain. Facet back pain never goes below the knee and rarely goes below the buttocks. Also, facet neck pain never goes below the trapezius or shoulder. It is always localized in the neck or low back and may radiate to the trapezius or shoulders. In the low back, may radiate to the buttocks. However, it does not radiate below shoulder or buttock.
Aggravating factors for facet pain in the low back and neck are activities such as lying down or sitting for 15 minutes or more. The pain is worsened by extension of neck or back, or twisting. Forward bending also may be troublesome and the pain can comes on when resting after activity. In most cases, the pain is worse in the morning and can be eased by movement and exercise, especially stretching.
The facet is often injured while playing golf or participating in other twisting activities such as working at your desk, gardening or house-cleaning. Facet pain is also commonly known as the pain of long-earned wear and tear.
Over a period of time, normal wear and tear and bleeding into the facet joint cause inflammation or the formation of bone spurs can stab into the nerve, causing tingling and loss of strength. This bony arthritis is an inflammation in the joint. This inflammation also can narrow the central canal of the lumbosacral or cervical spine.
The pain comes on slow over several months or years. Dull ache to severe deep ache pain can be felt in neck or back after standing or walking. Tingling in the legs (pseudoclaudication), heavy feeling or weakness as well as clumsiness in the arms can be experienced, Generally, the pain score is 2 to 5 initially but worsens to 9 or 10 on a scale of 1 to 10.
The percentage of pain in spine or neck versus arm or leg varies depending on the cause. Extremity pain worsens with progression. Quite often, the pain radiates bilaterally down to the arms or legs. However, the pain may be worsened by extension of neck or back while looking up, standing or walking. It is eased by bending forward, sitting or riding a stationery bicycle.
Some associated symptoms such as bilateral arm or leg numbness and weakness, bowel and bladder problems because of genital and anal numbness can be experienced.
Muscle Tear Or Pull
Sudden , localized sharp or deep ache can be experienced after injury. Initially , the pain is severe, being 6 to 8 on a scale of 1 to 10, then eases from 3 to 5. The pain stays in the injured area and will be worsened by use of the injured muscle or movement that requires muscle contraction. The pain can be eased by rest and extension activities.
The vertebral disc consist of 2 parts. The annulus fibro-cartilaginous, which is made of dense fibers and cartilage, surrounds a soft yet dense liquid-like mass called the nucleus pulposus (NP). The NP acts as a cushion or shock absorber to the spine so that when you land on your rear end, you do not injure your spine. The NP takes the thrust and torque and change shape, giving elasticity to the spinal column.
Think of the annulus fibrosa (AF) and the nucleus pulposus as a hard rubber tire (AF) and an inner tube (NP). Sometimes, the tire splits and the inner tube pushes out. This occurrence is called a herniated disc. The nerve fibers of the annulus fibrosa create a dull ache localized to the injured disc.
The pain usually started gradually although it can be sudden. It may stay local to spine or radiate into arm or leg. By bending, lifting, twisting or looking down, it will worsen the pain. However, the pain can be eased through extension activities or rest.
Spinal Cord Injury
The spinal cord carries all the pain, motor and coordination fibers of the body but does not have any pain receptors itself to speak of. What it does not say in pain, it says in action and sensations. An injury at the cervical level results in quadriplegia, weakness or paralysis of all four extremities.
Spinal cord impairment may occur slowly over months or years. At first, only segmental sensory loss or motor loss occurs. This means loss of sensation below the level of the injury.
Generally, the pain can both be sudden or gradual which varies by spinal stenosis, fracture or herniated disc problems. It gets worsened with flexion or extension movements and can be eased by resting. Symptoms such as paralysis or sensory loss below level of injury and bladder or bowel problems may occurred with time goes by.
The spine has several ligaments. The anterior and posterior longitudinal ligaments are mainly for support. These ligaments are poorly innervated, which means they give little pain but are anatomically important. When the disc space is normal size, these ligaments are stretched out.
However, as the disc dehydrates, which usually occurs after 25 years old, the disc begins to shrink, reducing the tautness of the ligaments. This leads to buckling of the ligaments, decreasing the size of the canal.
As we age, we lose height due to de-hydration of the nucleus pulposus and the collapse of a disc space. The buckling ligament goes into the central canal and can create narrowing, causing spinal stenosis. In the neck, spinal stenosis puts pressure on the spinal cord and can result in paralysis or weakness from the neck down, which is a real medical emergency. If the narrowing occurs in the lumbosacral spine, you might lose strength in both legs.
The pain is gradual, dull and aching with rating of 2 to 4 on a scale of 1 to 10. It is worsened with movement or end range position that creates tension in ligament. Ligament pain is usually associated with joint symptoms.
The vertebral bone has an outer shell called the periosteum, which has many pain nerve fibers. The inner part, the cancellous is a network of dense calcium bridges that reinforce the outer bone covering. Inside the cancellous is the nutrition network that keeps the bone healthy. The inner cancellous has no nerves, so when injured, it does not give the sensation of pain.
The pain is sudden and piercing with rating of 8 to 9 on a scale of 1 to 10. Though the pain stays localized over the injured area, it often causes secondary muscle spasm as well. Localized of pain is over the spinous process, the steeple of spine.
It can be worsened by lying down, or when bending or twisting. Besides, it can also cause symptoms of nerve pain of the spinal cord or nerve root. Bone pain is always a danger sign for possible severe spinal disease, such as severe osteoporosis or, rarely a spinal tumor.
Bone pain does not have sensory loss or motor loss or loss of bowel or bladder function, unless it causes narrowing and puts pressure on the spinal canal. In those with osteoporosis, fractures can occur without any acute trauma such as fall or an accident.
Quite often, the brain is not included as part of the anatomy of the spine but it is a major contributor to all pain, especially chronic pain that lasts more than 6 weeks. Extensions from the brain, called axons reach into the spine. All doctors know that without the brain, there is no pain. For that reason, doctors anesthetize people before any surgical procedure.
Any health care professionals will tell you that the brain has volume control when it comes to pain. Having a dull ache and stiffness in your back from a joint is one thing, but if your brain interprets it as a malignant tumor that will soon paralyze you, that dull ache takes on a new severity including dread, anxiety and even panic.
The psyche is often controlled by neuro-transmitters such as dopamine, serotonin, neuradenaline, glutamine, gabamine, cytokinins and many others. Cytokinis are notmkind since these hormones are extremely painful. Kinins, prostaglandins, leukotrenes and other factors such as substance P can stimulate pain receptors in the skin and elsewhere, markedly increasing pain.
Therefore, the brain especially the brain stem and spinal cord pathways can modulate the perception of pain. The pain can be sudden or gradual which will diffuse over entire neck or back, depending on the origin of pain.
Relationship Between Sleeplessness And Pain Perception
Any person with pain will tell you that after a good night’s sleep, pain is less. On the other hand, for those who had a bad night’s sleep, the pain gets worse. Why is that so?
Serotonin, a neurotransmitter as well as other neurotransmitters block pain perception in the thalamus, the middle part of the brain and ascending pathways in the spinal cord. Serotonin actually reduces the pain messages received by the conscious brain.
Morphine dulls consciousness, whereas serotonin increases consciousness and the feeling of well-being. Norepinephrine, another neurotransmitter has also been shown to decrease pain perception. Quite often, sleeplessness is self-induced, although many suffer from sleep disorders such as sleep apnea. Sleep apnea interferes with the stages of sleep that replenish the stores of serotonin, norepinephrine and other neuro-transmitters.
In fact, obstructive sleep apnea is a major cause of chronic pain and fibromyalgia. If you snore, feel tired or have headaches when you wake up in the morning, fall asleep easily during the day, have high blood pressure or are overweight, check with your doctor to discuss if you might have sleep apnea. Proper sleep of 7 to 8 hours is essential for pain control and neurotransmitter levels.
Those neurotransmitters determine pain threshold. Those who have slept well and have high serotonin levels can tolerate a lot of pain. This is because the brain is not receiving the pain message because serotonin and other neuro-transmitters are blocking it.
People with chronic pain often sleep poorly and consequently have low levels of serotonin. A low level of serotonin is associated with depression and low levels of adrenaline. This makes the pain threshold low and pain perception high. This condition is particularly true for those who have chronic pain that lasts 6 weeks or more.