Back, back pain

Back pain is one of the most common causes of patients seeking help from medical institutions. Pain syndrome can be accompanied by diseases that affect the spine, kidneys and other organs and systems. Treatment and prevention of low back pain includes both medication and non-medication. Failure to provide timely medical care can lead to chronic disease with the development of complications.

Back pain is a separate symptom, not a nosological entity. For example, lumbosacral pain is a localized pain in the lower back. Concepts such as thoracic or cervical also differ. Accurate localization of the pathological symptom is necessary for the selection of the right treatment tactics and preventive measures.

Definition

Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of direct damage to a tissue or organ, or when exposed to unfavorable psychological factors (stress, anxiety, depression).

Back pain is a multifaceted application in medical practice. These include the musculoskeletal system, pelvic organs, retroperitoneal cavity (kidneys, pancreas, liver, etc. )

It should be noted that the pain syndrome may be accompanied by a deterioration of the patient's cognitive ability - memory disorders may appear, concentration decreases.

In most cases, the appearance of back pain is a protective reaction of the body under the influence of adverse factors. The most common cause of back pain is sciatica, herniated disc or spondylosis.

Epidemiology

According to statistics from the World Health Organization (WHO), back pain affects more than 40% of the population. In some countries, this figure can reach 80%.

This problem can lead to early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among working people. Therefore, pathology is a problem not only in medicine, but also in the field of economic activity.

People who work between the ages of 30 and 60 often go to the clinic for help. This is due to the development of degenerative pathological changes in the spine with age, resulting in acute and chronic pain.

In addition, men suffer more from the disease than women. This is due to job characteristics, physical labor and other risk factors. According to statistics, pain is more visible in the lumbosacral region.

Clinicians explain this fact by the fact that physical activity puts the most pressure on this part of the spine.

Risk factors

Stress and exercise alone cannot cause this pathology. Among the main risk factors are:

• Working age over 30 years;
• person;
• overweight and obesity (body mass index exceeds 30);
• presence of other pathologies (for example, frequent migraines or cardiovascular diseases);
• static physical activity that does not differ from each other in diversity;
• exposure to vibration.

In addition, some researchers point to smoking as a risk factor. In a smoker, a severe cough can indirectly cause pain.

Classification

A neurologist determines the nature of the pain after a thorough examination and examination. Back pain syndrome is divided according to the location, duration, causes and other characteristics of the pathology.

The following types of pain differ in terms of duration:

• iti,
• semi-acute,
• chronic

Patients with acute pain are most often treated in the clinic. Its duration does not exceed 6 weeks. Subacute pain can last 6-12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, this pain is called chronic.

Acute and subacute pain often lead to complete recovery with proper treatment. Chronic pain syndrome can lead to early disability of the patient. Therefore, you should consult a doctor at the first appearance of clinical signs of pathology. To do this, you should consult a neurologist.

The following types of pain differ in terms of severity:

• weak
• medium,
• strong

According to the nature of back pain, there are:

• explosion,
• aching
• fire,
• to draw
• stupid

The nature of the pain depends on the pathology that causes the syndrome. Thus, with osteochondrosis, the lower extremities suffer from pain distinctions characterized by radiation. With sciatica, stabbing pain often appears on one side.

According to the localization of back pain, there are:

• local (local),
• set out in,
• radiating.

Local pain occurs when the pathological focus is located directly behind. The pain is caused by irritation, stretching or other effects on the receptors under the skin.

Local pain has its own characteristics. For example, the pain syndrome is stable after an injury to the lumbosacral region of the spine. Due to the irritation of the receptors, the character may change with the change of body position.

Pain occurs with a pathology affecting the internal organs. It is related to the anatomical features of innovation. Thus, with the reflected type, pain occurs in the area of dermatomes. The most common cause of back pain may be pathology of the pancreas, uterus and its appendages.

Among the characteristics of the type of pain reflected is the lack of connection with physical activity. With a change in body position with a local type of pain, if the intensity of the symptom increases, there is no connection in this situation.

Radiation pain is associated with irritation of a nerve or root. In addition, in addition to the appearance of back pain, the patient may complain of decreased sensitivity, the appearance of gas lumps (paresthesia). Often during the examination, a neurologist can detect pathological reflexes, which are associated with impaired transmission of nerve impulses.

The cause of back pain

Pain syndrome can manifest itself for several reasons:

• pathology of the musculoskeletal system (trauma, sprains, hypothermia and other external causes);
• back diseases (osteochondrosis, hernia);
• diseases affecting the retroperitoneal organs (pathology of the gallbladder, pancreas and others);
• benign and malignant neoplasms;
• mental disorders (depression, anxiety, stress cause psychogenic pain).

In addition, daily problems can be the cause of a pathological symptom. Thus, after waking up, a patient with a restless posture during sleep may complain of pain in the neck or lower back.

Pain of vertebral origin

With this type of pain, degenerative pathological changes are observed in the spine. Thus, vertebral bodies, intervertebral discs can be damaged. Often, pain of vertebral origin can be associated with a disease that affects the joints.

According to statistics, patients seeking medical attention complain of the appearance of severe pain due to spinal cord injury. The cause may be a disc herniation, spondylosis or lumbago.

Spinal neoplasms are found in less than 1% of visits to the doctor. Metastases of malignant tumors are rare, but they can also cause back pain of varying intensity.

Illness	ICD-10 code	Features
Osteochondrosis	M42	A disease in which the intervertebral discs and spine are destroyed. It is characterized by appearancepulling with radiation and short-term pain.Exposure to external factors in the form of exercise or coughing increases the pain.
Intervertebral hernia	M51	A disease caused by a bulge in the spinal canal. It seemsacute pain syndrome that occurs when coughing, sneezing and physical exertion.
Radiculitis	M54. 1	A disease in which degenerative changes are observed in the roots. It is characterized by appearancea change in body position or excruciating pain associated with physical exertion. . . In addition to pain syndrome, sensitivity disorders are also added.
Discogenic lumbodynia	M54. 4	A pathology characterized by severe pain that begins suddenly in the lumbar region of the spine.The pain is shooting and is very clear.
Spondylosis	M47	A disease characterized by degenerative changes in the vertebrae. There is a chronic course, pain in the lower extremities, neck during radiation.

It should be noted that each disease has its own characteristics. Therefore, when making a diagnosis, it is necessary to pay attention not only to the anamnestic data, but also to the results of examinations. To do this, modern diagnostic instrumental methods are used, which allow not only to determine the pathological focus, but also to determine the boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.

These are the vertebrogenic causes that cause the appearance of back pain. In addition to the diseases listed above, pain may occur during trauma and stretching of the musculoskeletal system. Thus, with excessive physical exertion or weight lifting, a sudden sharp aching pain may appear.

Pain of non-vertebral origin

According to statistics, patients complain of pain of non-vertebral origin in more than 2% of cases. This category includes diseases and somatic conditions with low back pain.

The most common diseases that cause the appearance of pain syndrome are pathologies of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. The following differ from the first group:

• blockage of blood vessels,
• severe angina,
• aortic aneurysm (in the abdominal or thoracic region).

Among the second group:

• gastric ulcer,
• duodenal ulcer,
• cholelithiasis,
• dyskinesia of the bile ducts,
• inflammatory changes in the pancreas.

Cardiovascular diseases often cause the appearance of back pain. Thus, a patient with angina pectoris is concerned about pain in the heart area that spreads to the shoulder, arm, or back. Therefore, patients may complain of back pain during an attack.

Pain syndrome with angina pectoris has its own characteristics. First, the pain has a crushing nature. The second appears behind the sternum, extending to the back, arms, or shoulders. Third, the pain syndrome disappears immediately after application of the drug. It should be noted that physical activity and stress cause the appearance of an attack.

An aortic aneurysm is a rupture of a blood vessel that weakens and then swells. In this case, the patient complains of the appearance of dull pain with radiation to the back and lower extremities in the heart area while seeking medical attention. Symptoms such as dizziness, weakness, and a sharp drop in blood pressure will also be a concern. Low back pain with an aortic aneurysm can occur with both thoracic localization of the pathological focus and abdominal pain.

It should be noted that aneurysm pain is not related to physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment is started immediately, including the use of medications and surgery.

Back pain can not be caused only by cardiovascular disease. In diseases affecting the organs of the retroperitoneal cavity, patients may also complain of pain syndrome. This is due to the nature of the innervation - inflammatory and degenerative changes in this area cause the appearance of back pain.

Back pain during pregnancy

Pregnancy is a physiological condition, but the course may be accompanied by the appearance of pain and other unpleasant symptoms. This is due to changes in the location of the organs, hormonal changes, weight gain in the early and late stages.

Back pain during pregnancy can be caused by physiological and pathological changes.

Among the first group are:

• natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• enlargement of the uterus with the formation of a "baby" place where the internal organs are displaced;
• In late pregnancy, a change in the center of gravity as the fundus of the uterus descends.

The immediate cause of back pain during pregnancy may be the initial period. It is characterized by the appearance of irregular contractions. In this case, pain may appear in the lower back and lumbar region due to the active work of the pelvic floor muscles. However, due to the production of female sex hormones and oxytocin, a pregnant woman cannot feel these pains.

However, the appearance of severe back pain during pregnancy may be an objective reason to seek advice from a gynecologist. If there is a pathological suspicion, a pregnant woman may be asked to stay in the hospital for further observation.

The appearance of severe back pain during pregnancy can lead to a serious illness. This is due to the fact that extragenital diseases can worsen in a woman during this period. The most commonly diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile duct can cause pain.

Exacerbation of pyelonephritis or cystitis is not only associated with the entry of microbial flora into sterile organs. Extragenital diseases are often caused by irritation of the walls of the organs, hormonal changes during pregnancy. Aggravates the stress symptoms that often accompany pregnancy.

Low back pain with coronavirus

Coronavirus infection can also cause severe back pain. COVID-19 causes specific symptoms, including a sudden rise in temperature, unproductive cough, chest pain, weakness, and fatigue. However, some patients also complain of back pain that occurs with the onset of a coronavirus infection.

Among the main reasons:

• exposure to toxins in the body;
• exacerbation of chronic diseases of the musculoskeletal system;
• emergence of new, previously undiagnosed spinal pathologies;
• viral radiculopathy.

Poisoning syndrome is often accompanied by diseases affecting the upper and lower respiratory tract. The main clinical manifestations are weakness, fever, aches and pains. As with other respiratory illnesses, non-specific low back pain may appear in the coronavirus. This is one of the manifestations of intoxication syndrome. With effective drug treatment, the intensity of pain decreases after a few days.

The body's active fight against infection can lead to exacerbation of chronic diseases. In addition, previously hidden pathologies may appear in the background of respiratory disease. For this reason, patients may be concerned about back pain.

Among the main causes, the appearance of viral radiculopathy also differs. It cannot be associated with the formation of an intervertebral hernia alone. Radiculopathy is a concern when a viral agent causes inflammation or irritation in the roots of the spinal cord.

Diagnostic measures

If you have back pain, you should seek help from a medical institution immediately. You should consult a neurologist to diagnose a disease in this area.

The specialist at the reception should conduct a neurological examination of the patient after collecting detailed anamnestic data. At the stage of data collection, attention is paid to the following points:

• the first appearance of back pain;
• the relationship of pain to physical activity;
• presence of concomitant diseases;
• localization of pain syndrome;
• duration of pain;
• appearance of other symptoms.

After collecting the anamnesis, the neurologist continues the examination. At this stage, the specialist pays attention to the patient's pathology, the position of the spine, checks for reflexes.

To learn the patient's gait, the neurologist asks the patient to walk a few meters in the office and perform some tests. If the patient is unable to support his legs while walking, if he makes unnecessary movements - this is one of the obvious signs of neurological disease.

In addition, the position of the spine should be assessed. A neurologist will look at the presence or absence of kyphosis, lordosis, and scoliosis. The specialist assesses the patient's reaction to the irritation of the reflexes with the help of tests.

When low back pain occurs, the disease may be accompanied by a change in sensitivity. Therefore, a neurologist assesses the condition of touch, temperature and other sensitivities. The specialist also pays attention to the appearance of pathological sensations, such as a feeling of crawling or tingling in the back.

After the examination, the neurologist may order a number of additional tests. Instrumental examination is required when it is necessary to determine the exact location of the pathological focus. Modern methods allow a safe and painless examination of the patient's results after a few days.

To determine the causes of low back pain, a neurologist may perform the following diagnostic measures:

• magnetic resonance imaging (MRI);
• computed tomography (CT);
• Radiography of the abdominal organs.

In some cases, additional tests may not be needed to make a diagnosis. After receiving the results of instrumental diagnostics, the neurologist selects the optimal treatment tactics.

Treatment of low back pain

Treatment of acute or chronic low back pain should be mandatory under the supervision of a physician. Independent use of drugs can lead not only to ineffective treatment, but also to complications of the disease. Therefore, in case of back pain, it is recommended to seek medical help from a specialist. After passing the diagnostic tests, the patient will be prescribed treatment based on the characteristics of the clinic, pathogenetic mechanisms and the course of the disease.

A few years ago, in medicine, it was recommended to follow a strict bed rest when back pain appeared. There is no need to restrict the patient's movement now. In addition, it is recommended to wear a special bandage and use an ax or support while walking.

Modern treatments for low back pain are based on evidence-based medicine. They use not only drugs, but also non-drug therapies.

The following groups of drugs are used as medical drugs for back pain in medical practice:

• non-steroidal anti-inflammatory drugs;
• muscle relaxants to reduce muscle tone;
• analgesics.

The groups of drugs listed can be used both monotherapy and together to achieve the effect of the drug. In addition to medications for back pain, manual treatment is also recommended.

If the patient's pain syndrome is very obvious, it will be necessary to limit daily activities, follow the recommendations of other doctors, but in general, the level of previous physical activity should be maintained.

In addition to the listed treatments for chronic low back pain, physiotherapy exercises (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Special attention is paid to cognitive-behavioral therapy in combination with antidepressants.

The duration of treatment is determined by a neurologist. If the treatment is ineffective, you should change the group of drugs and conduct additional research.

Forecast

With timely diagnosis and properly selected treatment tactics, back pain can be reversed after a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.

Prophylaxis

To prevent the appearance of back pain, you need to follow a healthy lifestyle and distribute physical activity properly so as not to create an excessive load on different parts of the back. In addition, concomitant diseases should be diagnosed and treated in a timely manner.