September is Pain Awareness Month, a reminder that chronic back pain, neck pain, nerve pain, numbness, weakness, walking changes, and hand symptoms should not be dismissed as “just aging” or “something to live with.” Pain is not weakness. Pain is information, but it is incomplete until matched with a careful history, physical examination, imaging, function, and goals. At Vertrae® in Miamisburg, Dr. Kamal Woods and the Vertrae® team evaluate spine pain by looking at the person behind the MRI. Not every patient needs surgery, and not every MRI finding matters. The goal is a clearer answer: what may be causing the pain, what has already been tried, what warning signs should not wait, and what treatment options may realistically make sense.
Read the Full Video Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Hello, and welcome to this Vertrae® 360 explainer.
September is Pain Awareness Month, and today we are talking about something that affects millions of people every day: spine pain.
If you are living with back pain, neck pain, nerve pain, numbness, weakness, walking changes, or hand symptoms, you deserve more than a number on a pain scale. You deserve a clearer answer.
Today, we will walk through why pain is more than a simple score, how pain can act as important information, what different spine-related symptoms may feel like, why MRI findings do not always tell the whole story, which warning signs should not wait, and what a clearer spine evaluation can look like.
The goal is simple: clarity — not pressure.
Section 1: More Than a Pain Score
If you are living with spine pain, you already know that pain is not just a number.
It can change how you sleep.
How far you walk.
Whether you use the stairs.
Whether you cancel plans.
Whether you feel comfortable traveling, working, golfing, exercising, or keeping up with family.
That is why the 0-to-10 pain scale can be helpful, but incomplete.
A “six out of ten” does not tell us whether you are sleeping through the night. It does not tell us whether you can walk through the grocery store. It does not tell us whether you are avoiding certain movements, losing confidence, or quietly adjusting your life around pain.
In 2021, more than 51 million U.S. adults experienced chronic pain, and more than 17 million experienced high-impact chronic pain that limited daily life or work. These are not just statistics. These are people whose pain changed how they lived.
That brings us to an important point:
Pain is not weakness.
Pain is information.
But pain by itself does not tell the whole story.
Section 2: Pain Is Important Information
Pain is the body’s way of signaling that something may be irritated, inflamed, compressed, overloaded, or sensitized.
But to understand what that signal means, we have to look at the whole picture.
Modern pain science recognizes pain as both a sensory and emotional experience. That does not mean pain is imaginary. It means pain is processed by the nervous system and can be shaped by biology, inflammation, nerve irritation, sleep, stress, prior injury, and how long the pain signals have been active.
That is why a better question is not only, “How bad is your pain?”
A better question is:
What is pain changing about your life?
Two people can have similar imaging and very different symptoms. One person may have a large disc bulge and very little pain. Another person may have a smaller area of nerve irritation and significant pain that disrupts sleep, work, or walking.
That is why a good spine evaluation does not treat only a scan or a pain score. It treats the person.
Section 3: How Spine Problems Can Feel
Back pain and neck pain are not all the same.
Different symptom patterns can point to different possibilities. These patterns are not a diagnosis by themselves, but they give important clues.
A pinched nerve in the lower back may cause sciatica — pain, tingling, numbness, or weakness that travels from the back into the buttock, leg, or foot.
A pinched nerve in the neck may cause symptoms that travel into the shoulder, arm, hand, or fingers. This is often called cervical radiculopathy.
Lumbar spinal stenosis can feel different. Many patients describe leg heaviness, cramping, numbness, or weakness that gets worse with standing or walking and improves with sitting or leaning forward. That is why some people instinctively lean on a shopping cart when they walk through a store.
Cervical myelopathy is different again. This happens when the spinal cord in the neck is compressed. It may cause hand clumsiness, balance changes, gait changes, leg stiffness, or trouble with fine motor tasks like buttoning a shirt, writing, or holding objects. Importantly, cervical myelopathy may not always cause severe neck pain.
That is why the pattern matters.
Where do the symptoms travel?
What makes them worse?
What makes them better?
Is strength changing?
Is walking changing?
Is hand function changing?
Those clues help determine whether the issue may involve a muscle, joint, disc, nerve root, spinal canal, spinal cord, or a broader pain process.
Section 4: The Limits of an MRI
MRI scans are powerful tools, but they are not the whole diagnosis.
Many people have disc bulges, arthritis, narrowing, or age-related spine changes on imaging even when they do not have major symptoms. A scan can show many findings at once, but not every finding is the source of pain.
The question is not simply:
“What does the MRI show?”
The better question is:
“Does the imaging fit with the symptoms, physical exam, and function?”
The opposite problem can happen too.
A patient may be told, “Everything looks normal,” even though they still cannot sleep, walk, work, drive, or use their hand normally. Sometimes the imaging truly does not explain the symptoms. Other times, the finding is subtle, the wrong region was imaged, or the symptoms need to be mapped more carefully.
Pain can also persist because the nervous system has become more sensitive over time. That does not mean the pain is imaginary. It means the evaluation may need to look beyond one scan and consider the whole clinical picture.
So if you can still tolerate the pain, do you need to get checked?
Sometimes symptoms can be watched, especially if they are improving.
But tolerance is not the same as safety.
If pain is waking you at night, traveling into an arm or leg, changing how you walk, affecting your hand function, or coming with numbness or weakness, it deserves a clearer explanation.
Section 5: Warning Signs That Should Not Wait
Most back and neck pain is not an emergency.
But some symptoms deserve urgent evaluation because they may reflect significant nerve or spinal cord involvement.
Please seek prompt medical care if you notice:
New bowel or bladder changes with back pain.
Numbness in the saddle area between the legs.
Rapidly worsening arm or leg weakness.
Foot drop or repeated tripping from weakness.
Hand clumsiness, balance problems, or gait changes with neck symptoms.
Pain with fever, recent serious trauma, cancer history, or unexplained weight loss.
These symptoms do not mean you should panic, but they do mean you should not wait for a routine appointment.
Changing neurologic function deserves respect. When symptoms are rapidly changing, waiting is not the safest plan.
Section 6: Getting a Clearer Answer
If an old explanation no longer matches what you are experiencing, it may be reasonable to ask for a fresh spine evaluation.
That does not mean you are asking for surgery.
It means you are asking for clarity.
A thoughtful spine evaluation is a pattern-matching process. It usually includes:
Your history: how symptoms started, what has changed, and what makes them better or worse.
A symptom map: where the pain travels, whether numbness or tingling is present, and whether the pattern fits a nerve, spinal cord, joint, muscle, or another source.
A physical exam: checking strength, sensation, reflexes, walking, balance, coordination, and hand function.
An imaging review: looking at whether the MRI or X-ray fits the symptoms and exam.
A function review: understanding what pain has taken away — sleep, work, walking, hobbies, independence, travel, or family life.
A treatment history: what has already been tried, what helped, what failed, and what has not yet been considered.
And finally, your goals: what you want to get back to.
For one patient, that may mean walking through the grocery store without stopping. For another, it may mean sleeping through the night, returning to work, getting back to golf, or feeling steady on their feet again.
At Vertrae®, our spine team and neurosurgical team focus on clarity, not pressure.
Sometimes the answer is conservative care. Sometimes it is physical therapy, a targeted injection, medication review, updated imaging, a longer recovery timeline, or reassurance. Sometimes a surgical discussion may be appropriate.
But the first step is understanding what fits your symptoms, your exam, your imaging, your function, and your goals.
You do not have to walk in asking for surgery.
You can walk in asking for clarity.
Closing
If your pain is changing how you walk, sleep, work, drive, move, or use your hands, and your old answer no longer fits, it may be time to ask for a clearer explanation.
Bring your story.
Bring your imaging.
Bring your questions.
Bring the list of what you have already tried.
Bring the goals you want to get back to.
At Vertrae®, the goal is not to pressure you into one path. The goal is to help you understand which path makes sense.
This presentation is for general education only. It is not medical advice and is not a substitute for evaluation by a qualified clinician. If you are experiencing urgent symptoms or rapidly changing neurologic function, please seek prompt medical care.
Thank you for joining this Vertrae® 360 explainer.
What would clarity look like for you?
Pain Awareness Month: Why Spine Pain Deserves a Clearer Answer
September is Pain Awareness Month (American Chronic Pain Association, n.d.). For a spine practice, that matters because back and neck pain are among the most common reasons people lose sleep, change how they walk, stop doing errands, give up exercise, avoid travel, or quietly shrink their lives.
Pain is often treated as a number. Zero to ten. Mild, moderate, severe. But patients know the truth: pain is not only a number. It is the school pickup that becomes hard. The grocery aisle you avoid. The golf round you cancel. The stairs you stop using. The hand numbness you pretend is “just sleeping wrong.”
Pain Awareness Month is a useful moment to say something clearly: pain is not weakness. Pain is information. But pain by itself does not tell the whole story. A clearer answer comes from matching the pain pattern to the physical exam, imaging, function, medical history, and the patient’s goals.
That is the Vertrae® approach. Not every patient needs surgery. Not every MRI finding explains the pain. Not every symptom should wait. The goal is not to make pain sound simple. The goal is to understand what it may be trying to tell us.
Key Takeaway
Pain deserves to be understood, not dismissed. Chronic back pain, neck pain, nerve pain, numbness, weakness, walking difficulty, and hand symptoms can come from different causes. Some are temporary and improve with time. Some reflect nerve compression or spinal cord involvement. Some involve chronic pain pathways that require a broader plan. A good spine evaluation does not treat a pain score or an MRI report alone. It connects the patient’s story, exam, imaging, function, and goals so the next step is based on clarity — not fear.
Pain Is Not Just a Number
Modern pain science defines pain as both a sensory and emotional experience, which is why two people with similar imaging can describe very different lives (Raja et al., 2020). One person may have a large disc bulge and few symptoms. Another may have a smaller nerve compression finding and severe leg pain that disrupts sleep, work, and walking.
That does not mean pain is “in your head.” It means pain is processed by the nervous system, shaped by biology, inflammation, nerve irritation, sleep, stress, prior injury, and how long the signals have been active. Chronic pain can become a condition of the nervous system itself, especially when pain pathways stay turned up over time (Fitzcharles et al., 2021; Finnerup et al., 2021).
The CDC has estimated that more than 51 million U.S. adults experienced chronic pain in 2021, and more than 17 million experienced high-impact chronic pain that limited daily life or work activities (Rikard et al., 2023). Those numbers are not abstract. They are people who stop walking the dog, stop sleeping well, stop golfing, stop traveling, or stop trusting their own bodies.
That is why the better question isn’t just, “How bad is your pain?” The better question is: what is pain changing about your life?
When Spine Pain May Be Pointing to Nerve Compression
Back pain and neck pain are not all the same. Low back pain alone can involve overlapping biological, mechanical, and psychosocial contributors (Knezevic et al., 2021). A sore muscle, an arthritic joint, a herniated disc, spinal stenosis, and spinal cord compression (myelopathy) can feel very different — and they need different conversations.
Spine-related nerve symptoms often travel. In the lower back, a pinched nerve may cause sciatica, leg pain, numbness, tingling, weakness, or walking limitation, especially when a herniated lumbar disc is involved (Deyo & Mirza, 2016). In the neck, a pinched nerve may cause pain, tingling, numbness, or weakness that travels into the shoulder, arm, hand, or fingers (Iyer & Kim, 2016).
Spinal stenosis can produce a different pattern. In the lumbar spine, patients often describe leg heaviness, cramping, numbness, or weakness that worsens with standing or walking and improves with sitting or leaning forward (Katz et al., 2022). In the cervical spine, spinal cord compression can show up as hand clumsiness, balance changes, gait changes, or trouble with fine motor tasks — symptoms that deserve prompt attention (Fehlings et al., 2017).
Pain Pattern Clues — What the Pattern May Suggest
| What the patient notices | Why it matters | What to clarify |
|---|---|---|
| Pain traveling from the back into one leg | May suggest lumbar nerve root irritation, such as sciatica from a herniated disc or stenosis. | Which nerve path? Does the MRI match the leg symptoms? |
| Leg heaviness or cramping with walking | Can be a classic lumbar stenosis pattern, especially if sitting or leaning forward helps. | How far can the patient walk now compared with before? |
| Neck pain with pain, numbness, or tingling into the arm or hand | May suggest cervical radiculopathy, especially when symptoms follow a nerve distribution. | Which fingers? Any weakness, reflex changes, or neck-position triggers? |
| Hand clumsiness, balance changes, or frequent dropping objects | Can be a warning pattern for cervical myelopathy or spinal cord involvement. | Is there gait change, loss of dexterity, or worsening balance? |
| Localized back or neck ache without nerve symptoms | May be muscular, joint-related, disc-related, or inflammatory; not every ache is nerve compression. | What movements worsen it? Any red flags? What has already been tried? |
| Numbness or weakness that is worsening | Progressive neurologic change deserves more urgency than stable pain alone. | How quickly is it changing? Is there foot drop, hand weakness, or new functional loss? |
What Pain Can Tell Us, and What It Cannot
Pain can tell us something is irritated, inflamed, compressed, overloaded, or sensitized. It can tell us a patient is losing sleep, avoiding movement, or changing how they live.
But pain cannot identify the exact structure by itself. Sharp pain does not always mean disc herniation. Severe pain does not always mean severe damage. Mild pain does not always mean a mild problem. Some patients with spinal cord compression have surprisingly little pain, but significant changes in balance, hand function, or walking.
That is why Vertrae® looks beyond the pain score. Symptom location, symptom patterns, what makes them worse, what improves them, whether strength has changed, and how function is changing often matter more than the number alone.
Patient Question |
“If I can still tolerate the pain, do I really need to get checked?” Tolerance is not the same as safety. Many spine symptoms can be watched, especially if they are improving. But pain that is limiting your life, changing your walking, waking you at night, traveling into an arm or leg, or coming with numbness or weakness deserves a clearer explanation. Getting evaluated is not the same as agreeing to surgery. It is a way to understand what is happening. |
Why “Your MRI Looks Bad” Is Not Enough
MRI scans are powerful, but they are not the whole diagnosis. Many people have disc bulges, arthritis, narrowing, or age-related spine changes on imaging even when they do not have major symptoms. A systematic review of imaging findings in people without back pain found that degenerative changes become increasingly common with age (Brinjikji et al., 2015).
That matters because a scan can show many findings at once: a disc bulge, arthritis, stenosis, facet changes, or disc degeneration. The question is not simply, “What does the MRI show?” The question is, “Which finding explains this patient’s symptoms, exam, and function?”
At Vertrae®, that distinction is central. We do not treat the MRI report alone. We ask whether the imaging matches the person in front of us.
Why “Everything Looks Normal” May Also Not Be Enough
The opposite problem also happens. A patient may be told the MRI does not look “bad enough,” but they still cannot sleep, walk, work, drive, or use their hand normally. Sometimes the imaging truly does not explain the symptoms. Other times, the right finding is subtle, the wrong region was imaged, or the symptoms need more careful mapping.
Pain can also persist because the nervous system has become sensitized after a long period of pain. Nociplastic pain and central sensitization are real biological concepts, not labels that mean pain is imaginary (Fitzcharles et al., 2021). This is one reason chronic pain care often needs a broader plan: movement, sleep, mental health support, medication review, interventional options, and sometimes surgical evaluation when anatomy and symptoms match.
A clearer answer does not always mean a surgical answer. It may mean a better non-surgical plan, reassurance, a targeted injection, updated imaging, closer monitoring, or recognizing that a symptom pattern deserves more urgency.
When Pain Should Not Wait
Most back and neck pain is not an emergency. But some symptoms deserve urgent evaluation because they may reflect significant nerve or spinal cord involvement.
| If you notice this | Why it matters | What to do |
|---|---|---|
| New bowel or bladder changes with back pain | Can be a warning sign of severe nerve compression. | Seek urgent medical evaluation or emergency care. |
| Numbness in the saddle area between the legs | Can be associated with cauda equina-type nerve involvement. | Seek urgent medical evaluation or emergency care. |
| Rapidly worsening leg or arm weakness | Progressive neurologic change should not be watched casually. | Call the medical team promptly or seek urgent evaluation. |
| Foot drop or repeated tripping from weakness | May reflect motor nerve involvement. | Prompt spine evaluation is appropriate. |
| Hand clumsiness, balance problems, or gait change with neck symptoms | Can suggest possible spinal cord compression. | Prompt evaluation is important. |
| Pain with fever, recent serious trauma, cancer history, or unexplained weight loss | May point to causes beyond routine mechanical spine pain. | Contact a medical professional urgently for guidance. |
This list is not a substitute for discharge instructions or medical advice. It is a reminder that changing neurologic function deserves respect. When symptoms are rapidly changing, waiting is not the safest plan.
When a Fresh Spine Evaluation May Help
Pain Awareness Month is not about telling everyone with pain to see a surgeon. It is about giving patients permission to ask for clarity when the old explanation no longer matches their life.
A fresh spine evaluation may be reasonable when:
- Back pain or neck pain has persisted despite appropriate conservative care.
- Pain travels into the leg, arm, hand, or foot.
- Numbness, tingling, or weakness is present or worsening.
- Walking tolerance is shrinking over time.
- Hand function, balance, or coordination is changing.
- Sleep, work, driving, errands, or family life have been significantly affected.
- You were told years ago that nothing could be done, but symptoms are now different or worse.
- You have imaging, but no one has clearly explained whether it matches your symptoms.
- You are not sure whether continued PT, injections, medication, or a procedural option makes sense next.
What a Clearer Spine Evaluation Looks Like
A good spine evaluation is not a quick glance at an MRI. It is a pattern-matching process. The goal is to connect what the patient feels with what the body shows.
What We Try to Clarify
| Part of the evaluation | What it helps answer |
|---|---|
| History | How did symptoms start? What makes them worse or better? What has changed over time? |
| Pain and symptom map | Does the pattern fit a nerve root, spinal cord issue, joint problem, muscle problem, or something else? |
| Physical exam | Are reflexes, strength, sensation, walking, balance, or hand function affected? |
| Imaging review | Does the MRI or X-ray match the symptoms and exam, or is it an unrelated finding? |
| Function review | What has pain taken away — walking, sleep, work, hobbies, independence, caregiving, travel? |
| Treatment history | What has already been tried? What helped briefly? What failed? What has not been considered? |
| Goals | What does the patient need to get back to: walking, working, golf, family life, travel, sleep, or daily independence? |
This is why two patients with similar MRI findings may receive different recommendations. One may need more time, physical therapy, or a targeted injection. Another may need a surgical discussion. Another may need reassurance that the MRI finding is not the true pain generator. The right answer depends on the whole picture.
What Pain Awareness Month Means at Vertrae®
At Vertrae®, Pain Awareness Month is not about dramatizing pain, promising a quick fix, or telling every patient they need surgery. It is about taking pain seriously enough to understand it.
Dr. Kamal Woods is a dual fellowship-trained neurosurgeon and spine surgeon specializing in minimally invasive spine surgery. Vertrae® is a comprehensive spine center serving Miamisburg, Dayton, Centerville, Kettering, Beavercreek, Springboro, West Chester, Cincinnati, and Southwest Ohio.
Our work is to help patients understand what is actually happening in the spine and nervous system. The right path may be conservative care, physical therapy, injections, medication review, a longer recovery timeline, a minimally invasive decompression, a cervical procedure, a neuromodulation discussion, or a fresh surgical opinion. The point is not to force one path. The point is to understand which path fits the patient.
The recurring Vertrae® message is simple: you deserve clarity, not pressure.
A Letter to the Patient Still Living With Pain
If you are still living with pain because someone told you it was just aging, just arthritis, just posture, or just something you would have to live with, this is your reminder: an old answer may not be the final answer.
Pain does not always mean something dangerous is happening. But pain that changes how you walk, sleep, work, move, or use your hands deserves to be understood. You do not have to arrive asking for surgery. You can arrive asking for clarity.
Bring the MRI. Bring the story. Bring the list of what has already been tried. Bring the person who has watched these changes happen. A fresh evaluation is not a promise of a procedure. It is a chance to find out whether your current answer still fits.
FAQ: Pain Awareness Month and Spine Pain
What is Pain Awareness Month?
Pain Awareness Month is observed each September to raise awareness about pain, its impact on daily life, and the need for appropriate evaluation and care. For spine patients, it is a reminder that back pain, neck pain, nerve pain, numbness, weakness, and function loss deserve clear answers — not dismissal.
When should spine pain be evaluated?
Spine pain should be evaluated when it persists despite appropriate conservative care, travels into an arm or leg, causes numbness or weakness, limits walking, disrupts sleep or work, or begins to limit daily life. A spine evaluation does not mean surgery. It means clarifying what is causing the symptoms.
Does a bad MRI always explain pain?
No. Many people have disc changes, arthritis, or narrowing on imaging without severe symptoms. The MRI should match the patient’s history, physical exam, symptom pattern, and function. At Vertrae®, the goal is not to treat an MRI report alone. The goal is to understand the person attached to it.
Can pain be real even if imaging does not clearly explain it?
Yes. Pain is a real nervous-system experience. Sometimes imaging does not fully explain symptoms, and sometimes chronic pain pathways become more sensitive over time. That does not mean the pain is imaginary. It means the evaluation may need to look beyond one scan and consider the whole clinical picture.
What symptoms should not wait?
New bowel or bladder changes, saddle-area numbness, rapidly worsening weakness, foot drop, hand clumsiness with balance changes, or symptoms that are rapidly changing should be evaluated promptly. These may reflect nerve or spinal cord involvement and should not be watched casually at home.
What does a fresh spine evaluation include?
A fresh spine evaluation reviews the patient’s story, symptom pattern, physical exam, imaging, prior treatments, function, and goals. The purpose is to determine whether symptoms are coming from nerve compression, stenosis, disc disease, spinal cord involvement, another spine source, or a broader pain process.
Listen to this topic: Pain Awareness Month — Why Spine Pain Deserves a Clearer Answer
Prefer to listen? In this Vertrae® 360 episode, we discuss why pain deserves to be understood, how spine pain can reflect different underlying causes, why imaging alone is not enough, and when back pain, neck pain, numbness, weakness, walking changes, or hand symptoms deserve a fresh evaluation.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1:
Imagine this: someone has life-disrupting back pain — the kind that affects sleep, work, errands, and daily life. They finally get an MRI, expecting the scan to explain everything. But the report comes back without a clear answer.
Speaker 2:
And then you see the opposite situation: someone has an MRI showing disc bulges, arthritis, or narrowing, but they are active, functional, and not experiencing major pain.
Speaker 1:
Exactly. It can feel confusing, even frustrating, especially when you are the person sitting in the exam room trying to understand what your pain actually means.
Speaker 2:
That is why today’s conversation matters. September is Pain Awareness Month, and for spine patients, this is not just about naming pain. It is about understanding it.
Speaker 1:
Today, we are talking about why back pain, neck pain, nerve symptoms, walking changes, numbness, weakness, and hand symptoms deserve a clearer answer than “it is just aging” or “you will have to live with it.”
Speaker 2:
And we are also talking about why a clearer answer does not automatically mean surgery. It means understanding the full picture.
Speaker 1:
That is the key theme for this episode: pain deserves to be understood, not dismissed.
Section 1: Pain Is More Than a Number
Speaker 1:
When you walk into many medical offices, one of the first questions you may be asked is, “How bad is your pain on a scale from zero to ten?”
Speaker 2:
That number can be useful as a quick snapshot, but it does not tell the whole story.
Speaker 1:
Right. A pain score does not explain that you have stopped walking the dog. It does not explain that you avoid the grocery store, cancel golf, skip the stairs, or wake up every few hours because you cannot get comfortable.
Speaker 2:
It also does not explain the quiet adjustments people make around pain. Maybe someone stops traveling. Maybe they avoid picking up a grandchild. Maybe they stop trusting their balance. Maybe they keep telling themselves the hand numbness is just from sleeping wrong, even though it keeps happening.
Speaker 1:
That is why the better question is not only, “How bad is your pain?”
Speaker 2:
The better question is: “What is pain changing about your life?”
Speaker 1:
That question matters because chronic pain is common, and high-impact chronic pain can change a person’s ability to work, sleep, move, and function.
Speaker 2:
And that brings us to one of the most important messages of this episode: pain is not weakness.
Speaker 1:
Pain is information.
Speaker 2:
But pain by itself is incomplete information. It needs to be matched with the patient’s story, physical exam, imaging, function, treatment history, and goals.
Section 2: Pain Is Real, Even When It Is Complex
Speaker 1:
Let’s talk about something that can be misunderstood: pain is both a sensory and emotional experience.
Speaker 2:
And that phrase can make patients feel dismissed if it is not explained carefully.
Speaker 1:
Exactly. When we say pain has an emotional component, we are not saying it is imaginary. We are not saying it is “just stress.” We are not saying it is all in someone’s head.
Speaker 2:
Pain is processed by the nervous system. It can be shaped by biology, inflammation, nerve irritation, sleep, stress, prior injury, and how long the pain signals have been active.
Speaker 1:
When pain continues over time, the nervous system can become more sensitive. The alarm system can get turned up.
Speaker 2:
A simple way to think about it is this: a normal alarm goes off when something important happens. But if the system becomes too sensitive, the alarm may go off more easily, more often, or more intensely.
Speaker 1:
The alarm is still real. The pain is still real. But the threshold has changed.
Speaker 2:
That is why two people can have similar imaging and very different symptoms. One person may have a significant-looking MRI finding and little pain. Another may have a smaller finding and major pain that affects sleep, work, and walking.
Speaker 1:
That is why a good spine evaluation does not treat only the picture on the screen.
Speaker 2:
It treats the person.
Section 3: Spine Pain Patterns Matter
Speaker 1:
Back pain and neck pain are not all the same.
Speaker 2:
Different patterns can point to different possibilities. They are clues, not conclusions.
Speaker 1:
Let’s start with the lower back. If pain starts in the back and travels down one leg, that may suggest lumbar nerve irritation, often called sciatica.
Speaker 2:
That can happen when a nerve root in the lower back becomes irritated or compressed. The problem may begin in the spine, but the symptoms may travel into the buttock, leg, or foot.
Speaker 1:
What about leg heaviness or cramping that gets worse with standing or walking?
Speaker 2:
That pattern may suggest lumbar spinal stenosis. Stenosis means narrowing. In the lower back, narrowing around the nerves can cause leg heaviness, cramping, numbness, or weakness that often improves with sitting or leaning forward.
Speaker 1:
That is why some patients feel better leaning on a shopping cart.
Speaker 2:
Exactly. That pattern is an important clue.
Speaker 1:
Now let’s move to the neck. If neck symptoms travel into the shoulder, arm, hand, or fingers, that may suggest cervical radiculopathy.
Speaker 2:
That is similar to sciatica, but in the neck. A nerve root may be irritated or compressed, and symptoms can travel along the pathway of that nerve.
Speaker 1:
And then there is a different pattern: hand clumsiness, balance changes, gait changes, or trouble with fine motor tasks.
Speaker 2:
That can be more concerning because it may suggest cervical myelopathy, which means the spinal cord in the neck may be involved.
Speaker 1:
And this is important: cervical myelopathy does not always cause severe neck pain.
Speaker 2:
Someone may notice they are dropping objects, struggling with buttons, having trouble writing, feeling unsteady, or walking differently. Those changes deserve attention.
Speaker 1:
We should pause here and say clearly: this episode is not meant to diagnose anyone.
Speaker 2:
Exactly. These patterns are clues, not conclusions. A careful evaluation is what helps determine what is actually happening.
Section 4: Why the MRI Is Not the Whole Answer
Speaker 1:
MRI scans are powerful tools. They can show discs, nerves, narrowing, arthritis, and other structural changes.
Speaker 2:
But the MRI is not the entire diagnosis.
Speaker 1:
Many people have age-related changes on imaging — disc bulges, arthritis, narrowing, or degeneration — even when they are not having major symptoms.
Speaker 2:
So if an MRI shows several findings, the question is not simply, “What looks abnormal?”
Speaker 1:
The better question is: “Which finding matches this patient’s symptoms, physical exam, and function?”
Speaker 2:
The opposite problem can happen too. A patient may have real, significant pain, but the MRI does not fully explain it.
Speaker 1:
Sometimes the finding is subtle. Sometimes the wrong area was imaged. Sometimes the symptoms need to be mapped more carefully. And sometimes chronic pain pathways have become more sensitive over time.
Speaker 2:
That is why Vertrae® focuses on connecting the whole picture.
Speaker 1:
The symptoms. The exam. The imaging. The function. The treatment history. The patient’s goals.
Speaker 2:
Because the goal is not to treat an MRI report alone.
Speaker 1:
The goal is to understand the person attached to it.
Section 5: Warning Signs That Should Not Wait
Speaker 1:
Most back and neck pain is not an emergency.
Speaker 2:
But some symptoms deserve prompt medical attention because they may reflect significant nerve or spinal cord involvement.
Speaker 1:
Let’s walk through those calmly.
Speaker 2:
New bowel or bladder changes with back pain should be evaluated urgently.
Speaker 1:
Numbness in the saddle area — the area between the legs that would touch a saddle — should also be treated as urgent.
Speaker 2:
Rapidly worsening arm or leg weakness deserves prompt evaluation.
Speaker 1:
Foot drop, or repeated tripping because you cannot lift the front of the foot normally, is another important warning sign.
Speaker 2:
Hand clumsiness, balance problems, or gait changes with neck symptoms should also be taken seriously.
Speaker 1:
And pain with fever, recent serious trauma, cancer history, or unexplained weight loss should be discussed with a medical professional promptly.
Speaker 2:
Again, this does not mean every episode of back or neck pain is dangerous.
Speaker 1:
But changing neurologic function deserves respect.
Speaker 2:
If symptoms are rapidly changing, waiting is not the safest plan.
Section 6: What a Clearer Evaluation Looks Like
Speaker 1:
So for people who do not have emergency symptoms, but do feel stuck — maybe pain is limiting sleep, walking, work, hobbies, or independence — what does a high-quality spine evaluation actually include?
Speaker 2:
A thoughtful evaluation is a pattern-matching process. It is not just a quick glance at an MRI.
Speaker 1:
It starts with the history: how symptoms began, what has changed, what makes symptoms better or worse, and what has already been tried.
Speaker 2:
Then there is the symptom map: where the pain travels, whether numbness or tingling is present, whether weakness is developing, and whether the pattern fits a nerve root, spinal cord issue, joint problem, muscle problem, or another source.
Speaker 1:
The physical exam matters too. Strength, reflexes, sensation, walking, balance, and hand function can all provide important clues.
Speaker 2:
Then imaging is reviewed to see whether the MRI or X-ray fits the symptoms and exam.
Speaker 1:
A function review is also essential. What has pain taken away? Sleep? Work? Walking? Golf? Travel? Family life? Independence?
Speaker 2:
And the treatment history matters. What has helped? What has not helped? What options have not yet been considered?
Speaker 1:
Finally, there are the patient’s goals.
Speaker 2:
Because success looks different for every patient.
Speaker 1:
For one person, success may mean walking through the grocery store without stopping. For another, it may mean sleeping through the night, getting back to work, playing golf, or feeling steady on their feet again.
Speaker 2:
That is why getting evaluated is not the same as agreeing to surgery.
Speaker 1:
Sometimes the answer is conservative care.
Speaker 2:
Sometimes it is reassurance.
Speaker 1:
Sometimes it is physical therapy, a targeted injection, updated imaging, medication review, or a longer recovery timeline.
Speaker 2:
And sometimes, when the symptoms, exam, imaging, function, and goals all fit, a surgical discussion may be appropriate.
Speaker 1:
But the first step is clarity.
Closing
Speaker 2:
At Vertrae®, Dr. Kamal Woods and the Vertrae® spine team help patients understand whether their symptoms, exam, imaging, function, and goals fit together.
Speaker 1:
The focus is clarity, not pressure.
Speaker 2:
If pain is changing how you walk, sleep, work, move, drive, use your hands, or live your daily life, you do not have to keep tolerating it without answers.
Speaker 1:
Bring your story. Bring your imaging. Bring your questions. Bring the list of what you have already tried. Bring the goals you want to get back to.
Speaker 2:
You do not have to arrive asking for surgery.
Speaker 1:
You can arrive asking for clarity.
Speaker 2:
This episode is for general education only. It is not medical advice and is not a substitute for evaluation by a qualified clinician. If you are experiencing urgent symptoms or rapidly changing neurologic function, please seek prompt medical care.
Speaker 1:
Thank you for listening to Vertrae® 360.
A Clearer Answer Starts With a Fresh Look
If pain has been changing how you walk, sleep, work, drive, move, or use your hands, you deserve more than a vague answer. You deserve to know what is actually happening and what options may realistically help.
Vertrae®, a comprehensive spine center led by Dr. Kamal Woods, helps patients understand their spine symptoms by connecting the story, exam, imaging, function, and goals. Whether the next step is conservative, procedural, or surgical, the first step is clarity.
Request a consultation with Dr. Kamal Woods and the Vertrae® team at vertrae.com.
References
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Fehlings, M. G., Tetreault, L. A., Riew, K. D., Middleton, J. W., Wang, J. C., & AOSpine North America and the Cervical Spine Research Society. (2017). A clinical practice guideline for the management of patients with degenerative cervical myelopathy. Global Spine Journal, 7(3_suppl), 70S–83S. https://doi.org/10.1177/2192568217701914
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Fitzcharles, M.-A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: Towards an understanding of prevalent pain conditions. The Lancet, 397(10289), 2098–2110. https://doi.org/10.1016/S0140-6736(21)00392-5
Iyer, S., & Kim, H. J. (2016). Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine, 9(3), 272–280. https://doi.org/10.1007/s12178-016-9349-4
Katz, J. N., Zimmerman, Z. E., Mass, H., & Makhni, M. C. (2022). Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 327(17), 1688–1699. https://doi.org/10.1001/jama.2022.5921
Knezevic, N. N., Candido, K. D., Vlaeyen, J. W. S., Van Zundert, J., & Cohen, S. P. (2021). Low back pain. The Lancet, 398(10294), 78–92. https://doi.org/10.1016/S0140-6736(21)00733-9
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
Rikard, S. M., Strahan, A. E., Schmit, K. M., & Guy, G. P., Jr. (2023). Chronic pain among adults — United States, 2019–2021. Morbidity and Mortality Weekly Report, 72(15), 379–385. https://doi.org/10.15585/mmwr.mm7215a1
