Today, back pain is the second most common reason for patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (back pain) is considered an interdisciplinary pathology, because in the clinic there is a symptom of both neurological and somatic diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs with diseases of the spine (spinal pain). In other cases, the cause may be pathologies of internal organs, spinal cord, etc. (non-vertebral pain).
Thus, the vertebrogenic group includes:
- intervertebral hernia;
- sacral or lumbarization;
- spondylosis; osteoporosis;
- tumor processes of the vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
Non-vertebral group includes:
- psychogenic pain; fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formations (neurinomas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its strength and duration vary depending on the underlying condition.
- Intervertebral hernia.A hernial protrusion appears between the vertebrae with the development of osteochondrosis. In this case, the pain can be acute or acute and local in nature (depending on the level of the affected disc). The pain usually extends to the limbs, accompanied by numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), disorders of the sensory and motor spheres of the arms or legs may appear. Rarely, violations of urination, defecation and sexual function (with damage to the pelvic spine) occur.
- Sacral or lumbarization.Sacralization is a congenital anomaly associated with the fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first sacrum vertebra is separated and becomes an additional lumbar vertebra. Pathologies are usually asymptomatic, but the clinic is caused by excessive physical activity or weight lifting. In such cases, there is a low back pain in the sacrum region, which increases with movement, spreading to the lower extremities. The pathology is also characterized by the fact that it occurs at a young age (usually between 20 and 25 years).
- Spondylosis.Spondylosis (unlike the previous disease) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear and tear". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous with lesions of neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens at the end of the day. Sometimes, the pain syndrome manifests itself not only in movement, but also at rest, leading to insomnia. In uncontrolled disease, cases of immobilization of the vertebral joints are frequent, as well as pinching of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis. Osteoporosis is a metabolic disease, during which bone destruction processes prevail over bone formation. The clinical picture of the disease is scarce: the pathological process is usually asymptomatic and is detected at random (with X-ray). However, in the more advanced stages of the disease, dull pains appear, as well as curvature of the posture.
- Tumor processes of the vertebrae.Vertebral tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic back pain (usually in the lower spine) occurs, which can spread to the thighs and lower legs. Sooner or later, the growth of the tumor leads to compression of the nerve roots, which is manifested by neurological disorders: loss of sensation and movement of the limbs.
- Injuries.A common cause of acute pain, limited mobility and neurological symptoms are spinal injuries: fractures, bruises, dislocations / subluxations, as well as "slipping" of the vertebrae due to damage to the ligamentous apparatus - spondylolisthesis. Typically, patients notice acute diffuse pain in the back, the presence of bleeding ("bruising"), local edema and restricted movement.
- Psychogenic pain.A similar view occurs in the context of full health after an emotional outburst or stressful situation. Patients describe pain in different ways, which is limited only by the patient's imagination. Sometimes there is a call. “Painful behavior” when people, maintaining mobility, tend to use auxiliary supports: crutches, poles and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is extremely similar to that of psychogenic pain. At the same time, the pain is also caused by stress, weather and emotional overload. However, an important difference is that the pain must be observed for more than three months, accompanied by local sensitivity at characteristic points (place of attachment of the occipital muscles, middle of the trapezius muscles, etc. ). In addition, the diagnosis requires the complete exclusion of all types of somatic diseases.
- Pathologies of internal organs.Back pain can often appear with diseases in various organs of the body. Thus, in infarction, the pain syndrome is located behind the sternum, spreading under the scapula and the left arm, as well as in the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, radiating to the spine. A complex of symptoms appears in the context of difficulty breathing and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, it appears in the upper part of the abdomen in the form of a "belt", covering the sides and the back. Back pain appears along with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Usually, the pain is so severe that it makes patients bend for relief. In the context of an attack, the urine turns dirty red due to impurities in the blood.
- Tumor processes.A neurinoma is a tumor of the nerve sheath. When spinal cord roots are affected, back pain usually occurs, as well as loss of sensation and motor activity below the level of the injury. It is also important to note that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases from breast, prostate, lung, kidney, etc.
- Epidural abscess.An epidural abscess is an accumulation of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, which is complemented by neurological disorders: paresis (decreased muscle strength), loss of sensation, pelvic disorders, etc. frequently appear. A purulent process occurs in the context of infections, wounds, immunodeficiency or as a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, brain compression, etc. cause the disease. In the early stages, there is a slight pain in the spine, which does not bring discomfort. Then there is weight loss, muscle weakness, loss of sensitivity to pain, there is no sweat and bones become fragile. There are often injuries in the joints, bone skeleton (burns, fractures, cuts), however, due to the lack of sensitivity to pain, they pass imperceptibly.
Diagnosis
As a diagnosis, a qualitative research and a physical examination of the patient are necessary through palpation (touch), percussion (percussion) and auscultation (listening). For some pathologies, it is necessary to carry out laboratory blood tests (infarction, pancreatitis, tumor processes).
To view soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or MRI. X-rays and computed tomography are used for direct examination of the skeleton.
In some cases, less common techniques may be necessary: bone scintigraphy, electromyography, etc.
Treatment for back pain
To relieve acute low back pain, apply ice (for 20 minutes every 4 hours), exclude physical activity, immobilizing the spine if possible. If the pain is unbearable, pain relievers can be taken. However, it is worth remembering that anesthetics "lubricate" the disease outpatient clinic. This can subsequently complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
Herniated disk
The main drug treatment is based on the use of anti-inflammatories (Diclofenac, Ibuprofen) and analgesics (Ketorolac). In some cases, surgical removal of the intervertebral hernia, as well as an intervertebral disc endoprosthesis, may be necessary.
Sacral or lumbarization
When pain occurs, blockages with anesthetics and also physiotherapy (paraffin applications, electrophoresis, etc. ) are prescribed. With the ineffectiveness of conservative treatment, reconstructive operations are indicated.
Spondylosis
Anti-inflammatories (Meloxicam, Indomethacin), as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and painful syndrome.
Osteoporosis
The treatment of osteoporosis begins with a diet rich in calcium and vitamin D.
Perhaps the naming of these substances in the form of drugs. In some cases, hormone therapy with estrogens, calcitonin and parathyroid hormones is used.
Tumor processes
Treatment for tumor diseases consists of chemotherapy and surgery. In this case, the cost of care depends on the specific clinical case.
Injury
In case of minor injuries, a gentle regimen and warm-up are prescribed. In some situations, skeletal traction or reduction is required. When neurological symptoms appear, operations are performed with fixation of bone fragments.
Psychogenic pain
The help in the treatment of psychogenic pain consists of complex psychotherapy, in addition to the administration of antidepressants (fluoxetine, sertraline).
Fibromyalgia
Since the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), hypnotics (Zopiclone) or tranquilizers (Diazepam). Self-tuning for positive thinking, avoiding stressful situations and being in a hot, dry climate are also important.
Pathologies of internal organs
Each of the possible internal pathologies requires individual treatment tactics. Emergency care for a heart attack is taking nitroglycerin (one pill every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in the case of an open lung wound; with renal colic - antispasmodics (Drotaverin, Metamizole sodium) and heating.
Epidural abscess
Treatment consists of urgent surgery to normalize pressure in the spinal canal and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgical intervention.
Syringomyelia
Normally, patients are advised to protect their skin from cuts and burns (the latter often occur because patients lose sensation and do not experience trauma). Painkillers, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgical intervention is possible to review the formed cavities of the spinal cord.
Back prevention
For the prevention of back pain, it is necessary to prevent the occurrence of each of the pathologies mentioned above. To do this, you need to:
- Normalize your lifestyle: reduce your body weight to normal; make a correct diet rich in trace elements and vitamins; ensure adequate physical activity without excessive effort.
- Give up bad habits: smoking and alcohol consumption.
- Correct posture curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, clubfoot, etc. ).
- Diagnose and treat concomitant diseases of the musculoskeletal system or internal organs in a timely manner.
- Prevent or properly treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The main illness can be extremely serious and, if left untreated, can lead to disability and even death of the patient!