Neck/Back/Flank Pain

Neck Pain.jpg

General Information

  • Patients may describe neck or flank pain as back pain

  • Back pain

    • Common: In any given 3 month period, affects 25% of American adults

    • Definitions

      • Acute: Duration < 4 weeks

      • Subacute: Duration 4-12 weeks

      • Chronic: Duration > 12 weeks

Neck Pain

  • Facet arthrosis: Neck pain predominant

  • Cervical radiculopathy: Arm pain predominant

    • Central stenosis

    • Foraminal stenosis

    • Disc herniation

  • Additional considerations

    • Atlantoaxial and/or atlanto-occipital joint pathologies

    • Shoulder pain radiating to neck

Back Pain

Adult

Common

  • Non-specific back pain

  • Radiculopathy/spinal stenosis

    • Spinal stenosis

    • Spondylolisthesis: Intervertebral disc degeneration → intersegmental instability and facet joint arthropathy

Red flags

  • Conditions

    • Cauda equina syndrome: Leg weakness, urinary retention, fecal incontinence, saddle anesthesia - MRI - steroids, surgical decompression within 24 hours

    • Trauma/Fracture

    • Infection: Osteomyelitis, epidural abscess

    • Lytic lesions/malignancy

      • Multiple myeloma

      • Metastatic breast cancer, lung cancer, and/or prostate cancer

  • ROS and Referral Pattern

    • Potential Neurosurgical Emergency

      • Trauma → ED

      • Urinary retention, fecal incontinence, weight loss, lower extremity weakness/sensory deficit → ED, orthopedics, or neurosurgery

    • Concern for Infection/Malignancy

      • Fever, chills, night sweats → ED or infectious disease

      • History of HIV, chronic corticosteroid use, IV drug use → Infectious disease

      • History of malignancy, unexplained weight loss → Orthopedics or oncology

    • Thoracic pain, night pain → Orthopedics

Additional Considerations: Compression fracture (osteoporosis), ankylosing spondylitis

Pediatric

Flank Pain

Resources