Back and neck pain is reaching what some experts call epidemic proportions worldwide, but are scientists any closer to finding a “Holy Grail” of medicines aka expert solutions for safe, long-term relief?
Treatments for Neck Pain: Expert Solutions
“Quite possibly,” says interventional pain management specialist Kaliq Chang MD of the New York and New Jersey-based Atlantic Spine Center. He cites the latest study results, released in June 2020, indicating that a new, injectable drug, Tanezumab, a monoclonal antibody, may offer an extended reduction of chronic lower back and neck pain and improve movement and function by blocking the action of a specific protein – a nerve growth factor.
“If eventually approved by the FDA, this medication could prove a welcome alternative to opioids, such as morphine and oxycodone, which are addictive with potentially life-threatening side effects, and to non-steroidal anti-inflammatory drugs like ibuprofen, acetaminophen and aspirin whose effects are often limited and may be deemed inadequate by the patient,” says Dr. Chang.
He agrees with the Agency for Health Research and Quality, that, for too long, use of opioids has been an “easy remedy” for both acute and chronic pain and has “fueled the current opioid crisis” in the United States. In fact, abuse of prescription opioids is considered a major risk for heroin use.
Dr. Chang also notes a 2018 report in the Journal of the American Medical Association indicating that chronic pain patients given opioid medications fared no better than those on non-opioid drugs. The study involved 240 randomized patients, many of whom suffered back pain.
Neck and back pain are considered leading causes globally for long-term disability, lost work days and the expenditure of literally billions of health care dollars, and the third most common reason why patients in the United States visit the doctor’s office. Among causes of such pain are degeneration of vertebrae, primarily due to osteoarthritis, osteoporosis and other effects of aging; structural problems of the spine, including herniated discs that pinch nerves, and stenosis, a narrowing of the spinal column; continuous overuse or improper use of neck and back muscles; injuries; and lifestyle issues, such as obesity and smoking.
Chronic pain, in general, affects some 40 percent of the U.S. population. Yet, experts decry the lack of new drug development for pain management and the dearth of long-term studies to find proven non-pharmacologic therapies for treating neck and back pain. As one leading researcher at the University of Rochester School of Medicine put it: there has not been a drug “in maybe 100 years developed with a new way of affecting chronic pain.”
But the medication drought could be ending, Dr. Chang says. He points to a 2019 study in Science Advances, in which scientists from the University of Bonn (Germany) announce the discovery of how opioids bind to three of the body’s pain receptors (special sensory neurons). They indicate that developing drugs targeting only one of these receptors (DOP) could prevent addiction and serious side effects, including respiratory paralysis.
Another scientific group from Thomas Jefferson University in Philadelphia has published findings identifying a physiologic process that changes the function of a pain receptor, thereby causing cellular dysfunction and a higher sensitivity to pain. The researchers suggest drugs might be developed to block this process.
Physical Therapy for Neck Pain
Physical therapy is a widely recognized and preferred treatment for neck pain. It involves a series of exercises, stretches, and manual techniques that target the neck's muscles and joints. A skilled physical therapist can tailor a personalized plan to improve flexibility, strength, and posture. Through these sessions, patients can experience reduced pain and enhanced functional abilities.
Medications for Neck Pain Relief
Of course, until some new wonder medication appears on the horizon, pain management specialists must continue relying on the pharmacologic tools at hand, Dr. Chang states. For both neck and back pain, these tools include first-line over-the-counter agents such as analgesics for pain relief, non-steroidal anti-inflammatory medications, and topical applications in the form of creams, gels, and ointments. Among prescribed medications are muscle relaxants; drugs that address nerve-related pain; anti-depressants to enhance the production of the body’s natural painkillers(endorphins); orally taken corticosteroids; and, when absolutely necessary, opioids.
If pharmacologic and physical therapy approaches fail to mitigate pain, spinal and cervical drug injections can be a non-surgical option, Dr. Chang explains. Injections may be used to target a specific spinal nerve or treat pain in the sacroiliac joint (where the spine connects to the pelvis). Injectables also may relieve pain in a facet joint (found between nearly every pair of vertebrae) or deposit drugs such as corticosteroids in the epidural spaces around the spine. Also, successful in many chronic cases is the application of radiofrequency to heat an affected nerve, creating a lesion that prevents the nerve from continuing to transmit pain.
Chiropractic Care for Neck Pain
Chiropractic care focuses on spinal adjustments and manipulations to alleviate neck pain. Chiropractors use their hands or specialized tools to gently realign the spine, aiming to relieve pressure on nerves and improve overall musculoskeletal health. While many individuals find relief with alternative therapies, such as chiropractic care, it is essential to consult a qualified professional to ensure safe and appropriate treatment.
Massage Therapy for Neck Pain
Massage therapy offers a soothing and non-invasive approach to managing neck pain. By targeting tense muscles and increasing blood flow, massage can promote relaxation and alleviate pain. Different techniques, such as Swedish, deep tissue, or trigger point massage, can be employed to address specific needs and preferences.
Acupuncture for Neck Pain
Acupuncture, an ancient Chinese therapy, involves inserting thin needles into specific points on the body to rebalance the flow of energy. When applied to neck pain, acupuncture aims to reduce inflammation and stimulate the body's natural healing processes. Many individuals report significant pain reduction and improved neck mobility after acupuncture sessions.
Surgical Options for Neck Pain
In cases where conservative treatments fail to provide relief, surgical intervention might be considered. Surgical options for neck pain include discectomy, cervical fusion, artificial disc replacement, and laminectomy. These procedures aim to alleviate pressure on nerves, stabilize the spine, and correct structural abnormalities. However, surgery is typically viewed as a last resort, and thorough discussions with a qualified surgeon are essential to weigh the potential risks and benefits.
The best medicine, of course, is prevention. That is why Dr. Chang offers these tips to avoid developing chronic neck or back pain:
- Give a painful neck time to heal. Do not make quick, sudden head movements. Wear a cervical collar if necessary.
- Use proper lifting techniques for heavy or cumbersome items. That means keep the object close to the body and lift with the knees.
- Remain active and warm up and don’t skip stretching before engaging in any exercises.
- Take frequent breaks when work requires constant stress on the back, shoulder and neck muscles
- Sleep with your head on one pillow – not elevated on two or three.
- Maintain proper body posture or engage in posture correction. Walk or sit erect, back and shoulders straight.
Follow a healthy lifestyle and use self-care tips. That means getting down to a proper weight and stopping smoking.
And, if back or neck pain does develop and fails to respond to home remedies, contact an orthopedic or interventional pain management specialist as soon as possible to avoid it becoming a greater problem in the future, Dr. Chang advises.