Every honest effort is made in informing and explaining about diagnosis to the patient and treatment options are discussed. In most of common acute back or neck pain, a short period of pain medications and good reassurance is enough without even need of any imaging test. While in case of chronic pain, I believe in establishing a diagnosis first before proceeding to management.

Treatment is tailored for each patient and the initial approach is directed at pain control and the restoration of movement. Pain is usually the first complaint; patients will frequently limit their activities or even immobilize themselves in order to prevent pain exacerbation. Immobility can quickly lead to deconditioning, leading to further decreases inactivity, further deconditioning, and chronic pain.

Pain medications

• Medications are prescribed depending upon the symptoms and level of pain to lessen the swelling and reduce pain in the back and neck. Paracetamol, NSAIDs(Naproxen, Etoricoxib etc) are commonly prescribed medications to ease pain.

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Adjuvant pain medications

• Anticonvulsant’s medications such as Pregabalin, Gabapentin are used to alleviate the neuropathic or radicular pain. Antidepressants like Nortriptyline have multifactorial benefits in that it is able to treat depression, sleeplessness, and pain, all of which can be associated with chronic neck pain.

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Oral Steroids

• Judicious use of oral steroids can be helpful in relieving the symptoms. They have strong anti-inflammatory action which reduces any swelling surrounding impinged nerve roots, and may diminish radicular pain. It is thought they are more effective at treating radicular arm pain than axial pain

Immobilization

• A short course of cervical spine immobilization can be used initially to decrease local inflammation of painful joints and soft tissues around nerve roots and muscle spasm. However, Prolonged immobilization should be avoided to prevent deconditioning and atrophy of the spine muscles otherwise will cause delay in return to work.

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Temperature Therapy

• In acute pain, cold fomentation will help in reducing swelling, inflammation while in chronic pain hot fomentation will be beneficial by providing soothing effect and increase the local blood flow to heal the site of injury or inflammation.

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Passive Modalities

• Massage, ultrasound, and iontophoresis have little role in recovery while TENS therapy can be helpful in radicular arm or leg pain.

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Traction

• Cervical or lumbar traction has no role, infact can aggravate radicular symptoms, hence should be avoided.

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Dry Needling

• Small tender knots in the fascia of muscles known as trigger points can be a source of chronic pain. With dry needling (without injected any medication) can be very useful to break these trigger points and relax the muscle spasm.

After the acute phase is over, a graduated program of physical therapy is commonly prescribed in order to regain strength and flexibility lost during any immobilization, which will prevent future back strain and injury. Supervised program of isometric exercises is started allowing strengthening without potentially painful spine motion followed by home based exercise regimen.

Psychological evaluation for stress and depression is often required for patients with chronic back pain if all radiological evaluations are negative, as it has been shown to manifest as back pain or at least modulate the chronicity of pain.