Alternative Names: Pain - neck; Neck stiffness

Neck pain may begin in any of the structures in the neck. These include muscles and nerves as well as spinal vertebrae and the cushioning disks in between. Neck pain may also come from regions near the neck, like the shoulder, jaw, head, and upper arms.

Causes  A common cause of neck pain is muscle strain or tension. Usually, everyday activities are to blame. Such activities include bending over a desk for hours, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising.

Traumatic accidents or falls can cause severe neck injuries like vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include herniated disk, fibromyalgia (pain syndrome throughout the body), and arthritis. Meningitis, although much less common, can cause significant neck stiffness.

After examination there may be a need to perform additional tests. The following diagnostic tests may be performed: X-rays of the neck, CT scan of the neck or head, Blood tests such as a complete blood count or a thyroid test, MRI of the neck, EMG testing.

Treatment will depend on the source and severity of the pain and may include pain medications, physical therapy, exercise program, nerve blocks or surgery. Your doctor will work with you on these problems.

Alternative Names: Backache; Low back pain; Lumbar pain; Pain - back

Definition Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.

You may feel a variety of symptoms if you’ve hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet.

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body’s weight.

Low back pain is the #2 reason that Americans see their doctor — second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Whether identified or not, there are several possible sources of low back pain:

• Small fractures to the spine from osteoporosis
• Muscle spasm (very tense muscles that remain contracted)
• Ruptured or herniated disk
• Degeneration of the disks
• Poor alignment of the vertebrae
• Spinal stenosis (narrowing of the spinal canal)
• Strain or tears to the muscles or ligaments supporting the back
• Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens
• Other medical conditions like fibromyalgia

After examination there may be a need to perform additional tests. Tests that might be ordered include an X-ray, a CT of the lower spine or MRI of the lower spine, EMG testing.

Treatment will depend on the source and severity of the pain and may include pain medications, physical therapy, exercise program, nerve blocks or surgery.

Tremor is involuntary trembling in part of the body. The most common type is essential tremor. It is associated with purposeful movement (e.g., holding a glass to drink, shaving, writing, buttoning a shirt). It occurs most often in the hands and head and also may affect the arms, voice box (larynx), trunk, and legs.Essential tremor is caused by abnormalities in areas of the brain that control movement and does not occur as the result of disease (e.g., Parkinson’s disease). It usually does not result in serious complications.

The cause of essential tremor in people without the genetic mutation is unknown.

Essential tremor usually develops gradually during middle age or later in life. Symptoms may remain mild or increase in severity over time. Stress, fatigue, anxiety, and hot or cold weather can worsen the disorder. Severe tremor may cause difficulty performing activities of daily living, such as:

• Brushing hair and teeth
• Holding a glass without spilling
• Performing self-care (e.g., getting dressed, shaving, putting on makeup)
• Using eating utensils
• Writing and drawing

Tremor is usually more severe during fine motor activities such as writing or threading a needle and does not occur during rest or sleep. If it occurs in the voice box, speech will be affected.

Diagnosis of essential tremor is based on the observation of symptoms, a thorough medical history, physical examination, and neurological examination. Results from blood and urine tests can help the physician rule out other causes such as the following:

• Heavy metal poisoning (usually caused by exposure to lead or mercury)
• Parkinson’s disease
• Side effect of medication (e.g., asthma drugs, antidepressants)
• Thyroid disease

Essential tremor is not related to Parkinson’s disease. Tremor caused by Parkinson’s is more pronounced during rest and usually does not affect the head or voice.

Essential tremor often does not require treatment. Lifestyle changes, Physical therapy may improve symptoms. Severe tremor that affects the patient’s ability to perform daily tasks and interferes with their quality of life can be treated with medication. Surgery may be recommended when essential tremor is so severe that it causes disability.

Carpal tunnel syndrome is a common condition caused by compression, or entrapment, of the motor and sensory nerve in the wrist (median nerve), resulting in pain, muscle weakness, impaired reflexes, numbness, and tingling in the hand. Nerve compression is often associated with repetitive activities (e.g., typing, painting, hammering) that cause stress injury, swelling, and inflammation.Carpal tunnel syndrome is caused by compression of the median nerve. The primary risk factor is a history of another musculoskeletal disorder. The condition develops most often in people who regularly use vibrating machinery and tools and those who use their wrists repetitively, such as:

• Accountants
• Artists-musicians, painters, writers
• Assembly line workers
• Bus, taxi, and truck drivers
• Carpenters
• Check-out clerks
• Computer operators and programmers

Hobbies such as rowing, knitting, needlepoint, and gardening may also increase the risk for carpal tunnel syndrome. There are other risk factors including underlying medical conditions.

The primary symptoms of carpal tunnel syndrome are pain and numbness in the thumb, index, and middle fingers that often worsen at night and may radiate to the upper arm. Symptoms usually occur near the palm of the hand. Other symptoms include muscle weakness in the hand and wrist, tingling, and impaired reflexes.In advanced cases of carpal tunnel syndrome, shrinkage (atrophy) of the fleshy area at the base of the thumb may occur.

Diagnosis of carpal tunnel syndrome is based on the history of symptoms, presence of risk factors, physical and neurological examination, and diagnostic tests. Nerve conduction velocity (NCV) and electromyography (EMG) are used to evaluate nerve and muscle function. NCV involves placing electrodes on the skin above the median nerve to monitor the speed at which an impulse travels along the nerve. EMG involves placing small electrodes into the abductor pollicis brevis muscle to detect abnormalities that may indicate that the median nerve supplying the muscle is damaged. These tests, which are often referred to as EMG/NCV studies, may reveal delayed nerve conduction in the median nerve.

Treatment for carpal tunnel syndrome involves activity modification and rest, splinting, medication (including injection therapy), and surgery.

Maintaining proper posture, body position, and technique when performing repetitive wrist movements may help to prevent carpal tunnel syndrome. It is important to relax, move around, and change positions frequently when performing any one task for an extended period of time. See a health care provider as soon as possible after symptoms develop. Essential tremor is rarely debilitating. Severe cases can usually be treated with medication.

Restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) are common sleep disorders, especially in the elderly. RLS is a genetic disorder resulting in prickly or tingling sensations in the leg that cause patients to want to move their legs. It often results in insomnia. PLMD causes jerking in the legs or arms that occurs frequently during resting or sleeping. Jerking may occur as many as 3 times in a minute and each jerk can wake the patient.

As with other neurological disorders, an accurate medical history is an essential component of a sleep disorder diagnosis. People with sleep disorders should keep a daily diary of activities and sleep-both when they try to go to sleep and when they actually do sleep. Behavior during sleep (e.g., snoring), and alcohol, tobacco, and other drug use should be reported to the physician.

A polysomnogram is a sleep study that involves using electroencephalography (EEG) to monitor the brain and muscle activity, heart rhythm, and breathing during sleep. Patients are usually tested in a sleep lab, or they are given portable equipment to take home. The EEG monitors the various stages of sleep, which is interpreted by the clinician. For example, the EEG shows the degree of muscle activity during the various NREM and REM sleep stages. This information may provide clues about the type and cause of the sleep disorder.

These disorders may be treated using medication.

There are more than 70 different sleep disorders that are generally classified into one of three categories:

• lack of sleep (e.g., insomnia),
• disturbed sleep (e.g., sleep apnea, REM sleep behavior disorder, restless leg syndrome and periodic limb movement disorder), and
• excessive sleep (e.g., narcolepsy).

In most cases, sleep disorders can be easily managed once they are properly diagnosed. Insomnia is the most common sleep disorder. It occurs more often in women and in the elderly.

Falling asleep and waking up are controlled by various chemical changes in the brain and in the blood. Foods and medicines that alter the balance of these chemicals also affect how well we sleep. Caffeine, for example, can cause insomnia (lack of sleep). Antidepressants can cause a loss of REM (rapid eye movement) sleep, as can smoking and alcohol. Smoking and alcohol also can result in a loss of deep sleep. Both REM and deep sleep are essential parts of the normal sleep cycle.

As with other neurological disorders, an accurate medical history is an essential component of a sleep disorder diagnosis. People with sleep disorders should keep a daily diary of activities and sleep-both when they try to go to sleep and when they actually do sleep. Behavior during sleep (e.g., snoring), and alcohol, tobacco, and other drug use should be reported to the physician.

A polysomnogram is a sleep study that involves using electroencephalography (EEG) to monitor the brain and muscle activity, heart rhythm, and breathing during sleep. Patients are usually tested in a sleep lab, or they are given portable equipment to take home. The EEG monitors the various stages of sleep, which is interpreted by the clinician. For example, the EEG shows the degree of muscle activity during the various NREM and REM sleep stages. This information may provide clues about the type and cause of the sleep disorder.

In people with suspected obstructive sleep apnea (OSA), overnight oximetry (measuring the oxygen saturation in the blood) may be performed to determine the oxygen level duriIn people with suspected narcolepsy, there are various tests that can be performed. The multiple sleep latency test (MSLT), for example, measures the time it takes for REM sleep to occur in patients who fall asleep suddenly and repeatedly. In people with narcolepsy, REM occurs immediately.

Treatment

Treatment for sleep disorders depends on the cause and may include non-medication therapies (behavioral therapy, use of breathing machines and others) as well as various medications (prescriptions medications and/or natural supplements). All treatment options will be determined by your doctor and discussed with you in detail.

This pain, also known as tic douloureux, involves the nerves of the face and usually occurs on one side of the face only. Its pain is intermittent and severe, often describes as electric shock-like or stabbing. Talking, eating, or even by something as seemingly innocuous as wind blowing against the cheeks may trigger pain. Where many attacks occur in a short period, the face may be sore constantly. People often lose weight and sleep from frequent attacks.

Trigeminal neuralgia is most common in people over 40. The disorder may have many causes. Multiple sclerosis, tumors and blood vessel abnormalities may be responsible for a few cases, but in most instances the cause remains obscure.

One of the more commonly prescribed drugs used to treat trigeminal neuralgia is carbamazepine (Tegretol, Carbatrol). Three-quarters of all patients respond favorably to its use. Other medications that may be beneficial include gabapentin (Neurontin), tramadol (Ultram) and phenytoin (Dilantin). Pain medications also may be necessary during prolonged attacks.

Headache is a term used to describe aching or pain that occurs in one or more areas of the head, face, mouth, or neck. Headache can be chronic, recurrent, or occasional. The pain can be mild or severe enough to disrupt daily activities. Headache involves the network of nerve fibers in the tissues, muscles, and blood vessels located in the head and at the base of the skull.Types.

Primary headache accounts for about 90% of all headaches. There are three types of primary headache: tension headache, cluster headache, and migraine.

Tension headache is the most common type of primary headache. Episodes usually begin in middle age and are often associated with the stresses, anxiety, and depression that can develop during these years.

Cluster headaches occur daily over a period of weeks, sometimes months. They may disappear and then recur during the same season in the following year.

Migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.

Secondary headache is associated with an underlying condition such as cerebrovascular disease, head trauma, infection, tumor, and metabolic disorder (e.g., diabetes, thyroid disease). Head pain also can result from syndromes involving the eyes, ears, neck, teeth, or sinuses. In these cases, the underlying condition must be diagnosed and treated. Also, certain types of medication produce headache as a side effect.

Severe, sudden, and debilitating secondary headache that develops after a blow to the head, that interferes with normal activity, or that accompanies other symptoms (e.g., convulsions, disorientation, dizziness, loss of consciousness, pain in the eye or ear, fever) should be evaluated by a physician as soon as possible.

Treatment depends on the type and severity of a headache. Therefore accurate diagnosis is the first step that will determine further treatment. There may be a need for brain imaging (CAT scans or MRI), blood tests or other procedures. Treatment for secondary headaches depends on the underlying cause. Treatment for primary headaches may include medications for acute attacks and prophylactic treatment to prevents acute attacks and/or decrease their severity. There are non-medication therapies available as well (natural therapies, acupuncture, physical therapy etc).

Bell’s palsy is a neurological disorder caused by damage to the seventh cranial nerve, also known as the facial nerve, which results in weakness or paralysis on one side of the face. The paralysis causes distortion of facial features and interferes with normal functions, such as closing the eye and eating.The onset of Bell’s palsy is usually sudden. Many people wake up in the morning and find that one side of their face is paralyzed. Patients often fear that they have suffered a stroke, but Bell’s palsy is not related to stroke. Milder symptoms include tingling around the lips or a dry eye, and usually progress quickly, reaching maximum severity in 48 hours or less.

The most common symptoms are facial weakness or paralysis, a dry eye or mouth, and problems tasting. The severity of symptoms depends on the extent of facial nerve damage and varies from mild weakness to complete paralysis. Bell’s palsy usually affects both the upper and lower parts on one side of the face. Both sides of the face are affected in less than 1% of cases.

In addition to paralysis, other symptoms include:

• Dizziness
• Drooling
• Dry mouth
• Facial twitching
• Hypersensitivity to sound
• Inability to blink or close the eye, tearing, and dry eyes
• Impaired sense of taste

A diagnosis of Bell’s palsy is often based on symptoms and by ruling out other disorders. Other conditions that may cause facial paralysis include facial tumors, certain cancers, and autoimmune diseases. The physician can usually exclude other disorders by taking the patient’s history of symptoms, and by examining the head, neck, ears, and eyes. Imaging tests such as computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) are used to detect infection, tumor, bone fracture, or other abnormality in and around the facial nerve. Hearing and balance tests are used to determine if the nerve responsible for hearing is also damaged and assess injury to the inner ear. The sense of taste also can be evaluated to determine the location and severity of a facial nerve lesion. Electromyography (EMG) assesses injury by electrically stimulating the facial nerve. Electrical current is applied to the skin over the nerve and nerve function is determined by the amount of current needed to cause contraction of the facial muscles. The test is often repeated to assess disease progression and the extent of injury. Laboratory tests can help the physician determine the underlying cause. For example, a blood test for Lyme disease may be ordered if there is a chance that the patient was bitten by a deer tick.

Treatment

Medications and non-medication treatment are used to improve recovery.