Low back pain

Back pain is familiar to almost every modern person. Employment can be affected for a variety of reasons. These include back pain, sciatica, osteochondrosis and other pathological changes of the lumbosacral spine. You should not ignore this, because back pain can not only reach incredible strength, making a person's life unbearable, but also can be a sign of the most dangerous diseases.

Low back pain can be different: acute or dull, painful or burning, local (appearing in one place) or spreading to the entire back. Unpleasant feelings also manifest themselves in different ways: sometimes suddenly, suddenly, and sometimes gradually intensify every day.

The ability to react to and tolerate pain depends on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can not leave the disease to chance. Timely treatment will help prevent dangerous consequences.

To determine the cause of low back pain, you need a spinal examination and some additional procedures: X-ray examination, computed tomography or magnetic resonance imaging. Attacks of pain, lumbosacral, appear throughout life in about 80% of modern residents of European countries.

Acute or chronic low back pain in the lower back is the result of various neurological, degenerative-dystrophic diseases in women and men. In some cases, back pain is the result of diseases of the internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that there are dozens of causes of such pain, and a non-professional will never be able to determine the real source of the problem. In general, the medical classification distinguishes between primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of morphofunctional changes in locomotor activity. This is the cause of the vast majority of low back pain. The most important reasons are degenerative-dystrophic changes in different parts of the spine:

• Osteochondrosis, which is a damage to bone and cartilage tissue, is a dystrophic disease. It affects the intervertebral disc and adjacent vertebrae, and spondylosis begins to develop.
• Spondyloarthritis is a form of osteoarthritis in which the disease affects the intervertebral joints or synovial joints, which are responsible for spinal mobility.

There are many different causes of secondary pain syndrome:

• scoliosis with curvature of the spine, as well as some other growth disorders;
• various inflammations that are not contagious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• a tumor located in the vertebrae, in the spinal cord itself, or in the retroperitoneal space, whether primary or metastatic;
• fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases (tuberculosis, brucellosis, epidural abscess, etc. ) that cause damage to the vertebrae and intervertebral discs;
• stroke conditions with severe disruption of blood supply to the spinal cord. In this condition, there may also be a feeling of pain in the lower back;
• diseases of the gastrointestinal tract. For example, atypical acute appendicitis, intestinal obstruction;
• often has a nature that is reflected in back pain. A similar problem can occur with some diseases of the organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause back pain).

Acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced low back pain is also common: in this case, there is a translation of pain sensations from deeper internal organs and body structures; In other words, the patient feels pain in the lower back, but in fact a completely different part of the body is affected.

Most often, pain in the lower back is projected from the pelvic organs, kidneys, pancreas, colon, or tumors behind the peritoneum to this area. Many patients do not know what to do if they have back pain. But there is a clear recommendation, what not to do: to treat yourself. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.

Possible causes of acute back pain include:

• The pain is accompanied by a sharp stretching of the muscles. In this condition, pain signals are localized in the back, they are provided by spasmodic long muscles. The pain does not tend to spread to the groin or legs. Human mobility is limited.
• One of the most common and severe causes of severe back pain is a spinal fracture (a vertebral fracture, including a sprain). As a rule, this occurs with a failed fall, back bend and other injuries; but when a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, if there are cancerous tumors in the spinal region and their metastases or other lesions of the skeletal system, spinal fractures can occur "literally" from the sky. , and even without fixation with the patient's feelings during the fracture.
• An equally unpleasant condition in which there is severe back pain is the displacement of the intervertebral discs in the vertebral region. Regions differ according to the frequency of lesions: LV-SII - the most common; LIV-LV - second in frequency; LIII-LIV and above are more rare.

Symptoms include severe low back pain, forced posture, and limited mobility. Participation in the pathological process of nerve roots is indicated by:

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increase or decrease in sensitivity);
3. Decreased or absent Achilles reflex (in case of S or S2 root damage);
4. decreased intensity or absence of knee concussion (indicates damage to the L3-L4 area).

A common trend is that the protruding intervertebral disc affects the underlying root (e. g. , LIV-LV misalignment causes L5 root pathology). Defeat of the cauda equina (horse tail) impairs the function of the bladder and rectum. A similar situation can also occur with a strong protrusion of the spinal disc.

With facet syndrome, the spine aches sharply in the lumbar region: in this case, the disc remains ineffective, and the pain appears as a result of compression of the root itself at the exit of the spinal canal. The most common unilateral facet syndrome in the L5 root region; It is caused by an increase in the facets of the intervertebral joint (upper and lower) and, as a result, a narrowing of the intervertebral foramen.

Also, severe back pain is accompanied by an epidural abscess, a serious illness that requires urgent diagnosis and urgent treatment. Often the inflammatory process develops in the thoracic region of the spine; The pain is especially strong with mechanical impact (pressure, beating) on the area of pathology.

If there are signs of spinal cord compression, any highly effective medical measures, including surgery, are recommended. Another cause of low back pain may be diseases of the hip joint - primarily coxarthrosis. This condition is characterized by pain that spreads to the lower back, hips, as well as the legs and knees.

Diseases characterized by chronic low back pain:

• Deformative spondylosis is a disease characterized by dystrophic changes in the vertebrae of the spine, calcification of their ligamentous apparatus, and further growth of bones; narrows the spinal canal by pressing the bone protrusions to the roots. When low back pain is accompanied by weakness, numbness, and other neurological symptoms in the legs, the possibility of interstitial claudication syndrome, which may result from narrowing of the spinal canal, should be considered. An examination is needed to determine the final diagnosis.
• Ankylosing spondylitis (or Bechterew's disease). In the early stages, especially in the morning, it is characterized by limited mobility with a decrease in chest movements during breathing. There are pains in the lower back; further, and the curvature of the spine in the thoracic region progresses. X-ray examination corrects anomalies of the sacroiliac joints: destruction, structural changes, "bamboo" spine. A thorough examination and finding the cause of back pain is necessary, because similar symptoms and limited mobility of the lower spine can lead to other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic disorders (including NBO). The following causes of low back pain should be ruled out: metastatic carcinoma of the lungs, chest, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). Exceptions are made by X-ray examination and myelography.
• Osteomyelitis also causes long-lasting pain in the lower back. If you suspect this disease, an x-ray of the bone tissue is performed, a skin test with tuberculin and an ESR test to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria, usually staphylococci, in the body. the causative agent of osteomyelitis.
• Different types of spinal cord tumors (intradural tumors). Diseases such as lipoma, neurofibroma, meningioma can cause persistent back pain without any accompanying neurological symptoms at first.

Causes of intermediate back pain. Many diseases of the internal organs cause periodic, sharp or cramping pain in the lower back. At the same time, patients do not feel stiffness in the back, there is no clear localization of pain, and the pain does not increase with the maximum range of motion possible. The answer to the question of what to do if the lower back hurts not always, but from time to time is simple: do not wait until the pain "as needed", but consult a doctor.

The pathology of this or that organ has a clear effect on a certain part of the spine. Thus, pain from the pelvic organs spreads to the sacrum, in diseases of the organs located in the lower abdomen to the lower back (segments L3-L5), and in the upper part to the segments. the upper part of the lumbar region or the lower part of the chest.

Diseases - causes of back pain and area of pain:

• If the pelvic organs are affected, lower back pain with endometriosis, ovarian or uterine cancer. In men, such intermittent pain can be caused by the development of chronic prostatitis or prostate cancer.
• Various kidney diseases cause pain in the joints of the ribs and spine.
• stomach, duodenum, gastric ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - the pain spreads to the T10-L2 spinal segments;
• Low back pain with ulcerative colitis, diverticulitis or colon tumors;
• If there is pain in the chest / lumbar region, aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis of low back pain

For back pain and low back pain, it is recommended to undergo computed tomography (showing the condition of the bone tissue of the spine) and magnetic resonance imaging (allowing to assess the condition of soft tissues) and ultrasound examination of internal organs. .

One method of diagnosis is radiography, which is relatively inexpensive and can be helpful in detecting a range of disorders, from bone fractures to kidney stones. Most of the changes found only suggest a correct diagnosis and additional research may be required to confirm it. In addition, some radiological changes may be associated findings that do not cause pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological condition is assessed, as well as possible violations of the biomechanics of the spine are identified by mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine, back and low back pain can be diagnosed and treated.

Occasionally, based on the results of an orthopedic examination of a patient with symptoms of pain in the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:

• radiography of the lumbosacral spine with functional tests;
• CT examination of the lumbosacral spine;
• MRI of the lumbar-sacral spine.

The center of the intervertebral disc is occupied by the gelatinous pulposus nucleus. It is surrounded and supported by annulus fibrosus, which consists of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.

The thickness of the discs decreases, the vertebral bodies come closer together, the intervertebral spaces narrow, and the nerves and blood vessels in them become endangered (osteochondrosis).

Dislocation of the discs (prolapse of the intervertebral disc) with subsequent prolapse into the lumen of the spinal canal (herniated disc) causes compression of most nerve roots, pain along the compressed nerve (pain in the legs, arms, back of the head, neck, intercostal spaces, depending on the degree of nerve compression)) with weakening of muscle strength and impaired sensitivity in their innervation areas.

An intervertebral disc protrusion or hernia is often accompanied by muscle pain along the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal segment can also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). X-rays of the lumbosacral spine with functional tests may be required to clarify the diagnosis.

The nerve ligaments that make up the sciatic nerve, due to its anatomical location, often suffer from hernia compression or protrusion of the intervertebral disc. The sciatic nerve consists of L5, S1, S2, S3 fibers - spinal nerves.

Focusing on chronic inflammation in the lumen of the spinal canal can lead to its narrowing (stenosis of the spinal canal) and constriction of the nerves passing through it and the spinal cord. That is why stenosis of the spinal canal should always be treated with a full course of treatment, using a whole arsenal of different treatments, and if ineffective, surgery.

Which doctor should I see?

If the patient's condition is stable, primarily with back pain, you should contact a neurologist at the district clinic or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Low back pain is associated with various infections, limb damage. Pain in the lower back with heart and lung disease is not excluded. This is determined by an in-depth examination. Once diagnosed, the patient is usually prescribed medications that reduce back pain, normalize blood circulation, and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.

Surgery is usually required to diagnose a herniated disc with complications of osteochondrosis. The nerve root is removed, repaired, and the pain goes away over time.

If you are lying on a hard mattress with a small pillow under your knees, it is best to relax your spine and paravertebral muscles. At the same time, bed rest should not last too long, as it is fraught with weakening of the paravertebral muscles, which will exacerbate the problem. Even with severe pain, you should at least try to maintain poor physical activity.

How to relieve back pain

The onset of pain symptoms is often associated with muscle spasms, which can be relieved with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

Thus, with a strong, unexpected pain in the lower back, it is recommended to take a muscle relaxant tablet and rub the back with a warming anesthetic gel. You must strictly follow his instructions when using the tools.

In cases where an unpleasant symptom is associated with the presence of inflammatory diseases of the internal organs, it is recommended not to delay seeing a doctor, if it is not possible to consult a specialist at a certain time and the pain is very strong, you can take Pentalgin or No-shpu. The painful area should not be heated with a heating pad, as heat helps to spread the inflammatory process and, consequently, to intensify the accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have a pronounced anti-inflammatory, mild analgesic and antipyretic effect.

The course of treatment is determined by the severity of the pain symptoms. Ointment for low back pain is used as a primary or adjunctive treatment. With obvious signs of osteochondrosis, it is indicated to rub the lower back with ointments based on Ketoprofen, a substance with a strong analgesic effect.

The main advantage of topical drugs is their effect not on the whole body, but on a specific area that needs treatment. Analgesics and anti-inflammatory ointments have fewer contraindications and side effects than similar drugs in tablet form.

Exercises for back pain

Gymnastics is an additional method in the treatment of diseases of the lower spine. The exercises shown to patients are very simple and are not accompanied by a special load on the body. For example, the usual hanging on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and relieve pain caused by compression of the lumbago - its nerve roots. Therapeutic exercises for lower back pain include:

• lift the legs (so that the knee touches the chin);
• "bicycle, " played lying on the back;
• walk on your knees.

It is recommended to exercise no more than 10-15 minutes every day, with an obvious pain - refrain from doing them.