NECK & SPINE
by Dr NACHIKET KULKARNI

The current issue of MAI Annual Magazine has a very interesting theme 'Neck and Spine'. This theme has a great importance from medical, social and philosophical perspective. Philosophically back(including neck and spine) is considered the basis of a strong body  the literary use of the phrase 'backbone' is not anatomical but for support and strength. This metaphor is true even in medical sense. A healthy social life is dependent on how 'straight back' a person can face a problem again signifying importace of a healthy back. Coming back to science back is made of two major components a Bone and soft tissues(muscles, tendons, ligaments, bursa). Nerves and blood vessels are also an important part. Among all of them diseases of soft tissue are most common hence merit detailed discussion. Humanity prides itself on two major virtues as compared to our primitive primates a Intelligence and erect posture. The erect posture has come more based on change in bony and soft tissue architecture. The bones are relatively weaker and soft tissues are relatively more strained for this achievement. Soft tissues hence need to be looked after for better ambulation.

Soft tissue rheumatism (STR) pains of back can be generalised or regional. Generalised are those that come with Fibromyalgia or Polymyalgia Rheumatica. Fibromyalgia is associated with decreased pain handling capacity. The person has pain in back and throughout body. It can be associated with headaches, joint pains, sleeping problems, anxiety,etc. This topic has been covered in earlier MAI Magazines. Summarizing points are that there is a psycho-physical component to this problem. Treatment in form of medications and exercise is available and disease is controllable assuring the person a functional life. Polymyalgia Rheumatica is an autoimmune condition requiring specific medications. Patients suffer with pain around sholders, upper back with extreme stiffness. It might appear as weakness too. It requires a thorough Rheumatological assessment. Regional soft tissue problems of back can present as Neck pain, Back pain, coccydynia. It's commented that every individual on this planet suffers from back pain atleast once in life. Neck forms the cradle for the head. It also is the most mobile component of the spine. The STR of neck can present as one sided or diffuse pain. Sometimes can be associated with tingling of upper limbs or headache.

Back Pain is a terminology that can cover problems from neck to low back. Pains in this region are most common. They can be localised or sometimes diffuse. Rarely there could be shooting pains originating from back and traversing down the back or legs.

Coccydynia is a very irritating pain. It is perceived and the tail bone (makadhad) region a in between buttocks. Even sitting or sleeping becomes painful and patients feel helpless.

The STR of neck and spine can have many causes. Arthritis(Seronegative Spondyloarthritis ets), injury, wrong postures, infections, spinal cord disorders, etc. All these causes have some specific treatment and need to be handled by specialist. In this article i would like to highlight the effect of Fibromyalgia spectrum disorders(FSD). The STR associated with FSD tend to be very resistant to treatment. It is sometimes coupled with anxiety, stress or occasionally depression. It's also important to know that these causes can occur in isolation or a combination of different causes mentioned above. Need to highlight another fact a 'THESE PAINS ARE NOT A SELF INFLICTED DISEASE'. Some of our habits do increase susceptibility to STR with FSD but they cannot qualify as 'self inflicted'. Understanding about this basic fact helps in tackling this menace. The core pathology of such STR is increased pain sensitivity. Lack of exercise, stress, incorrect postures repetitive strenuous work are risk factors. Nutritional deficiencies increase this risk.

At outset of discussion the treatment i want to state that good, effective and safe treatment practices can be offered by your Rheumatologist. Hence RELAX! The first step is to diagnose the bad or serious causes of back pain as they need urgent treatment. The RED FLAGS are (source a JAPI Feb 2015) :

1.Leg weakness, uncontrolled bladder and bowel function, erectile dysfunction, loss of limb sensation and imbalance of limb or ataxia

2.Sudden new back pain, old age with back pain, history of malignancy or repeated urinary retention

3.Fever, malaise, loss of weight ,immunocompromised patient, long standing steroid use

Please see your doctor urgently if any of these above problems are noted in your case. Your Rheumatologist would do a through clinical examination(most important test) and might ask for blood tests &Xrays of back. Occasionally advanced scans like CT scans or MRI might be asked. Once a diagnosis of STR with FSD is made a combination of mild medication schedule, exercise and life style modification is designed. Please not hear that the responsibility of treatment is a shared onus of your efforts and doctors efforts(medicine + guidance). It is not a one way traffic! It is always better to learn exercises from Physiotherapist and stick to one so that the plan is custom made and more inclusive of your inputs. The medications are required in initial phases but gradually as the strength picks up and habits reform; their requirement comes down. In hands of your Rheumatologist a functional life is assured.

Alternative therapies have been available in increasing numbers. As a practioner of allopathy, i am not the best judge for the same. I would like to brush off some myths of allopathy though. This science is a holistic branch taking cognisance of not only the main disease but also the background ones. Lifestyle and habits are followed keenly. Diet and exercises guidance forms the corner stone of treatment not medicines. The side effects of medicines are known to your Rheumatologist and hence within a measure of control. It would be helpful if you bring to notice of your doctor what other treatment you are taking.

I would like to end with expressing confidence that thought the burden of neck and spine STR is high the modern science has an effective and safe relieving strategies in store. Meet your Rheumatologist and strengthen the back.