What You Need to Know About Neck and Back Pain Management

Physiatrist Dr. Clark Smith explains how to manage neck and back pain, and offers tips on prevention and promising new treatments.

Neck and back pain are some of the most common reasons for medical visits, and chronic spine pain is on the rise. Over the next three months, 30% of Americans will suffer from low back pain, and 10% to 20% will report neck pain at any given time. More than 80% of Americans will experience low back pain at some point in their lives. Many people assume that neck and back pain are a fact of modern life and that there’s little they can do to prevent or treat it.

Health Matters spoke with Dr. Clark Smith, an attending physiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center and the John A. Downey Associate Professor of Rehabilitation and Regenerative Medicine at Columbia University Vagelos College of Physicians and Surgeons, about neck and back pain management, promising new treatments, and how to know when it’s time to seek professional help.

Why do so many people suffer from neck and back pain?
We’re one of the few mammals that walk upright, and that takes a toll on our backs. So in part, it’s due to how our bodies are constructed. Modern lifestyles also accelerate the rate at which people develop neck and back problems. Using mobile devices, sitting in front of a screen — these activities promote bad posture and can lead to pain.

Is there a reason it’s on the rise, and are there any groups that experience a higher incidence?
Back and neck pain are on the rise because people are living longer and because of our modern lifestyle. I have an office in midtown near several financial companies. A lot my patients there are young professionals who, for the first 22 years of life, were active throughout the day but are now sitting at the same desk for 10-plus hours. That abrupt change in lifestyle for young people can cause them to suddenly develop back pain.

However, even people who exercise, limit sitting and screen time, and don’t work 10 hours a day can experience pain. While exercise is usually helpful, it’s important to be careful when exercising, especially for “weekend warriors” aiming to make up for sedentary lifestyles.

When is it time to seek medical attention?
If you have mild to moderate back pain that is not preventing you from doing daily activities and is not associated with other conditions such as herniated discs or spinal stenosis, it’s not necessary to seek medical attention right away. When moderate to severe pain has lasted several weeks or if it is radiating to the extremities, it’s time to see a physician. I recommend going to a multidisciplinary spine center like NewYork-Presbyterian Och Spine Hospital (where there are different types of physicians such as physiatrists and surgeons, and other professionals such as physical therapists) when seeking treatment. Why? Because spine problems are not one size fits all. If you’re connected with a good team, you’re more likely to get the help you need.

When are neck and back pain considered chronic?
Pain that lasts three to six months is considered chronic, which is frustrating with back and neck pain because often these conditions take that long to resolve. It’s common to end up in the chronic back and neck pain category.

What are the best ways to manage and treat this type of pain?
The best way to manage neck and back pain is through modifying factors in your life that cause pain. Limit screen time, get regular exercise, maintain strength, and manage other parts of your well-being, including stress. Change what you can on your own, and if that doesn’t work, see a doctor who can evaluate your condition. Doctors who treat spine disorders can be physiatrists (experts in rehabilitation, interventional procedures and other non-operative treatments) or surgeons (orthopedists or neurosurgeons) who can fix the problem surgically. For spine disorders that don’t involve the loss of strength or sensation, there are usually many nonsurgical treatment options, such as physical therapy, non-narcotic medications, injections or alternative treatments (for example, acupuncture).

Dr. Clark Smith

Are there any innovative new treatments that have been effective?
A positive trend I’ve seen is the movement away from medication and major surgery to more minimally invasive treatments. There is a procedure I use, radiofrequency ablation, where I essentially zap an offending nerve and stop pain signals for up to two years. If something is inflamed, steroids can be inserted directly using a special machine that allows image guidance.

My colleagues in surgery are also developing better imaging techniques, and minimally invasive options are available in many cases when surgery is needed.

Could you offer some tips for a healthier work setup?
For someone who sits at a desk all day, I say you’re not a baseball player. You don’t have to train to play baseball, but you do have to condition your body to do the type of work that you’re asking it to do, which is sit in a chair for long periods. That means core strengthening, maintaining flexibility, and doing other exercises to keep your weight down.

Optimize your workstation. If you’re lucky enough to have an ergonomic specialist in your office to set up your workstation, take advantage of that resource. Generally, your monitor should be at eye level, your chair should be adjustable, and the keyboard should be low enough that your elbows are at 90 degrees. A physical therapist or rehabilitation medicine physician can give you additional tips.

For someone who does heavy lifting at work, investigate your workplace standards on how to lift properly, and be sure to follow those guidelines.

Does how you sleep affect neck and back pain? What about your diet?
Getting good, restorative sleep is most important. The actual mechanics of your bed matter less than some companies would make you believe. I haven’t seen a good study that examines different sleep positions over time and their impact on spine pain.

There aren’t many tricks with diet, but you do want to avoid foods that cause inflammation and will make you gain weight, such as processed food and foods with excessive calories and simple sugar.

Any promising new research or treatments?
There is real untapped potential in the role of regenerative treatments. Are there going to be ways to regenerate disks? Platelet rich plasma (a procedure in which growth factors in your blood are obtained and injected back into the injured site) has been used in musculoskeletal medicine for muscle and joint disorders, but is still an unproven treatment for the back. There is more research to be done, but there is hope for that in the future. Spine surgeons are also coming up with shorter, more specific and minimally invasive surgeries, which is certainly more appealing to patients.

To learn more about spine care at NewYork-Presbyterian Och Spine Hospital, visit nyp.org/spinehospital.

Clark Smith, M.D., MPH, is an attending physiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center and the John A. Downey Associate Professor of Rehabilitation and Regenerative Medicine at Columbia University Vagelos College of Physicians and Surgeons. A fellowship trained physiatrist, Dr. Smith specializes in treating patients with acute and chronic sports and spine injuries. Dr. Smith is board certified in both physical medicine & rehabilitation and pain medicine.