Pain Generators in the back and neck pain – what actually causes pain?

In this episode of PodMD, experienced Brain and Spinal Surgeon Dr Ameya Kamat will be discussing the topic of pain generators in the back and neck pain – what actually causes pain? Including what are the major pain generators in these areas, the major risks, the surgical and non-surgical treatment options, the indicators of a more serious underlying condition, some common misconceptions about back and neck pain, when to refer and more.


  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Dr Ameya Kamat

    Dr Ameya Kamat is an experienced Brain and Spinal Surgeon, specialising in the surgical treatment of conditions involving the brain, spine, and peripheral nerves. Dr Kamat consults at various locations across Victoria, including Mulgrave and Moorabbin.

    Dr Kamat embarked on his medical career by receiving his Fellowship in Neurosurgery in 2019. He furthered his studies by earning a Masters in Medicine (Neurosurgery) degree in Cape Town, South Africa in 2020. Following this, Dr Kamat then pursued a Complex Spine Fellowship at Macquarie University Hospital in Sydney, where he honed his skills. In recognition of his accomplishments, Dr Kamat was awarded a Fellowship of the Royal Australasian College of Surgeons in 2023.

    Today, we’ll be discussing the topic of Pain Generators in Back and Neck pain: What actually causes pain?

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Ameya, thanks for talking with us on PodMD today.

    Ameya : Thank you for having me, good to be here!

    Question 1
    The topic of today’s discussion is Pain Generators in the Back and Neck pain: What actually causes pain? Ameya, can you first give us a brief overview about pain generators?

    Ameya: Yeah. So we actually have two main pain generators. You have the intervertebral discs, which essentially work as like shock absorbers between the bones of the spine, and you have the small joints of the spine. And as we age you get a bit of wear and tear of the discs and of the joints themselves, and then once these things get literally worn out and inflamed, these cause pain

    Question 2
    How would a patient with this type of pain in the back or neck typically present?

    Ameya: So typically presents as a sharp or like a grinding sort of pain. It’s worse with movement. Lots of patients have pain when they extend their backs like backwards. Certainly things like cold climates, early morning, late in the evening. These can be like the biggest problems and the and the issue is the pain also wakes up at night and that’s you know like not really helpful because there’s one thing we need is a good night’s sleep and having neck and back pain really doesn’t help.

    Question 3
    What are the major risks from these pain generators?

    Ameya: So severe pain effects our lifestyle. It affects our participation in activities, affects our sleep, affects our enjoyment so it can affect your mental health. It can really get you down being in pain for long periods of time. It can affect your mental health, affect your sleep. It can require taking medications that can make you feel like a zombie, and on the whole it can really bring you down.

    Question 4
    What are the surgical and non-surgical treatment options?

    Ameya: So that’s a non surgical, it’s always nice to start with the least invasive things like activity modification. You know how you bend to reach objects from the ground like lifting, you know things that aren’t too heavy. It’s always good to start with that. Things like weight loss, smoking cessation because like smoking is something that really accelerates the degenerative processes in your spine. Things like Pilates and acupuncture also take the pain away because this thing called the gated theory. Where the pain pathways are alternated by using things like dry needling and platies, and you also have cortisone injections which are very, very useful in terms of reducing swelling around. The nerve itself

    There becomes a point in time the where the non surgical modalities are exhausted and then you need to go into surgical modalities, and I like to like divide these between like non invasive and invasive, essentially noninvasive or things like coral epidural injections where you inject a high volume of other steroid and local anesthetic into to the spinal canal that that basically coats, then the nerves and joints and helps with the pain and things like radio frequency ablation are quite useful as well. What they do is essentially they cause a thermal injury to some of the very small nerves that transmit pain from the small joints of the spine. And then when you go into more invasive procedures, there are things like spinal decompressions and spinal fusions. But these should only be really performed in people who absolutely need them, and you have to 1st exhaust all the non-operative modalities before you try and do surgery in the majority of cases.

    Question 5
    Have there been any developments in treatment in the last few years?

    Ameya: Absolutely. So historically, you know, 30-40 years ago people used to mainly decompressions and then trying to avoid fusions, but then fusions became the in fashion thing over the last 20 years and lots of people have been doing these massive spinal fusions. But there’s one thing we’ve learned now over the past few years is that we’ve reverted back towards doing minimally invasive procedures because patients actually. Do better. They protect the bio-mechanics of the spine. They spare muscles, they avoid unnecessary instrumentation, and we’re now doing procedures that can add blade nerves. We’re using endoscopic procedures where we don’t need to do these complex fusions, and it’s very minimalist surgery. Patients go home literally a day or two after surgery as opposed to being in hospital for a couple of weeks and then rehabilitation for a couple of weeks.

    Question 6
    What are some key signs or symptoms that GPs should look for that might indicate a more serious underlying condition in a patient?

    Ameya: Certainly pain. That’s worse first thing in the morning or the evening’s pain that wakes them up at night, pain that’s worse. And movement, especially things like extension of the spine. But night pain is a big factor. If someone’s got severe night pain, you really need to act because as I mentioned earlier, you know, a poor night’s sleep has so many other negative impact on complications on your lifestyle, on your well-being increases obesity, diabetes, mental health issues. Yeah. So I think those you like the main things that GP should.

    Question 7
    What are some common misconceptions about back and neck pain that you encounter in your practice?

    Ameya: I think one major misconception that people think if you have severe crippling back pain that they need surgery and that’s not the case. In fact, it’s far from the truth. The majority of patients don’t need surgery. From all the patients I see less than 10% require any form of actual intervention. And in terms of actual surgery leaving with two or three percent of patients with severe pain who actually need that so. We have so many techniques we can perform these days that, you know, do not require you to go under the knife.

    Question 8
    How do GPs determine when to refer a patient with back or neck pain to a specialist?

    Ameya: Yes, I would always start with all the conservative measures like, you know, analgesia, weight loss, smoking cessation, activity modification, physiotherapy, Pilates, acupuncture. Once a patient has exhausted all those that that’s a good time now to recommend seeing a specialist. The problem is, you know giving patients like chronic analgesics is not really the solution. They have lots of negative impacts. These are opioid addiction, non-steroidal drugs can cause ulcers in your stomach. And your small intestines. So once you’ve exhausted all conservative measures, that’s obviously certainly something you wanted and that’s are referring. And one more thing, it would be if a patient has like neurological deficit or bladder or bowel issues. That becomes more of an emergency. That’s something you want to go on the phone and either refer them to Ed or just call us directly.

    Question 9
    What role does the GP play in the ongoing treatment of the back and neck pain?

    Ameya: GP is a very important role. They like the gatekeepers, essentially the majority of patients if they have an issue, will go and see their GP’s first, so encouraging things like activity modification, you know we spoke earlier about like lifting. Actions bending your knees to bigger objects from the ground, avoiding repetitive twisting and bending and jumping and climbing. Things like weight loss, smoking cessation, promoting active lifestyle. These are certainly the two strategies a GP should be promoting, but once those have been exhausted, give us a call.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on Pain Generators in the Back and Neck pain: What actually causes pain?

    Ameya: Sure. Yeah. So I think #1, nobody should live with back or neck pain, especially for a long period. You know, having a pain for having pain for like a day or two, that’s OK. But having chronic pain or pain lasting weeks, that’s really not appropriate.

    #2 refer patients early, I mean like many patients I see in my practice by the time they come to me, the pain is actually gone away. But at least we we’ve seen them. We’ve had done a baseline examination. We’ve done some imaging. So we know there’s nothing sinister going on.

    And also I think that the third thing would be that most patients can be treated with minimally invasive treatments. The minority of patients actually need to go under the knife.

    Thanks for your time and the insights you’ve provided.

    Ameya: Thank you

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.