Back pain: causes and treatment

In most cases, lower back pain is caused by hypothermia or muscle strain due to awkward movements or heavy lifting and may go away on its own. If pain interrupts the normal rhythm of life, improvement does not occur for too long, or other suspicious symptoms are present, the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.

Depending on how long the pain has bothered the patient, doctors distinguish:

1. acute pain - less than 4 weeks,
2. subacute pain - from 4 to 12 weeks,
3. chronic pain - more than 12 weeks.

At the appointment, the doctor clarifies to the patient exactly how the back hurts: it can be a sharp pain in the lower back during movement, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other unpleasant sensations of varying amounts of intensity. Based on the duration, location and nature of the pain, the doctor hypothesizes what its origin is.

Lumbar spine pain: causes

Pain in the lumbar region can be associated with both problems with the spine and other organs and systems of the body. To understand how to treat your lower back, you need to determine what causes the pain.

There are vertebrogenic pains caused by diseases of the spine:

• Osteochondrosis, manifested by problems with the intervertebral discs, facets or facet joints. Disorders occur with age in any person: intervertebral discs lose moisture and elasticity, facet joints become denser and become less mobile.
• Overload of the muscles and ligaments of the spine.
• Compression of spinal nerve roots - radiculopathies.
• Spinal injury.
• Instability of the spinal column due to weakness of the ligament-muscular system.

Nonvertebral causes include:

1. Neurological disorders

   • Lumbosacral plexopathies are damage to the nerve plexus that gives rise to the peripheral nerves of the lower limbs. It occurs with injuries and metabolic disorders.
   • Dystonia is a violation of the tone of the muscles that support the spine. In this case, the pain may be accompanied by poor posture. The disease can be congenital.

2. Systemic diseases

   • Infections affecting the vertebrae, discs, membranes of the spinal cord or the spinal cord itself, for example osteomyelitis, epidural abscess.
   • Malignant and benign tumors, metastases.
   • Osteoporosis is a decrease in the bone density of the skeleton, fraught with vertebral fractures.
   • Rheumatological diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.

3. Pain from internal organs.It is caused by causes external to the spine and radiates to the lower back, sometimes in the center, sometimes laterally, depending on the organ of origin. These include:

   • Diseases of the gastrointestinal tract - most often pancreatitis.
   • Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pain in the back and side accompanies renal colic as the stone moves along the ureter.
   • Aortic aneurysm is a rare and dangerous condition in which the wall of the body's largest artery forms a bulge. This can cause a throbbing sensation in the abdomen.
   • Hip joint diseases: injuries, inflammation, degeneration.

4. Psychogenic pain

   Lower back pain may be associated with an anxiety disorder or depression.

Injury to the spinal cord or lower spinal roots, called cauda equina, is a medical emergency. Compression of these structures can be caused by:

• slipped disc,
• injury,
• malignant or benign tumor,
• infection.

Spinal cord compression is accompanied by extremely severe bilateral back pain, leg muscle weakness, even paralysis, numbness in the lower extremities, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.

Symptoms

Low back pain is often nonspecific, that is, caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:

• Aching, pulling, or crushing pain.
• The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, for example, hanging curtains, changing light bulbs in a chandelier, bending over repeatedly and for a long time time: when washing floors, vacuuming, snow removal.
• No other symptoms.

The fact that pain can be a symptom of a dangerous condition is indicated by"red flags":

• Age over 50 years. This age group has a higher risk of osteoporosis and cancers.
• Pain at rest and at night, which interferes with sleep. Nonspecific pain usually appears with movement or prolonged static load, but disappears after resting in a comfortable position.
• General weakness is also not characteristic of nonspecific pain.
• Unexplained weight loss in recent months. It could be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
• Increased body temperature, chills. Indicates serious inflammation of various origins.
• Severely decreased or increasing sensation or weakness of the leg muscles.
• Impaired function of the bladder or intestines - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement combined with sharp pain is a sign of compression of a nerve and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord may be lost forever.
• Lack of effect from treatment and transition of acute to chronic pain.
• Features of medical history. For example, if lower back pain appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn't matter how long ago the diagnosis was made. Or the pain has appeared in a person who has recently undergone a serious infection, surgery, or who has a severely reduced immune system for any reason, for example, has taken a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, back pain can indicate various complications.

If you have identified at least one of the listed points, immediately consult a doctor for further examination.

Diagnostics

Pain is a subjective symptom, so a survey and examination by a doctor plays a huge role in the diagnosis. The doctor prescribes further tests depending on the diagnosis he suggests. For an accurate diagnosis carry out:

• Lab test— complete blood count, biochemical blood test, general urinalysis, tests to detect infections, autoimmune diseases.
• Electroneuromyography- study of the conduction of impulses along nerve fibers, which allows you to accurately determine the location of the lesion in neurological disorders.
• Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spine, the presence of hernias, compression of the roots of the spinal nerves.
• Ultrasoundkidneys and abdominal cavity - carried out if a pathology of the internal organs is suspected.
• Evaluation of bone conditions: densitometry - for suspected osteoporosis, bone scan - for malignant lesions.

If the doctor is absolutely sure that the low back pain is non-specific, he can prescribe treatment based on the exam alone, without further testing.

Often, with low back pain, a person does not see a doctor, but only comes for an MRI of the spine on his own. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic disc herniation. The patient attributes the pain to this MRI finding and does not seek further medical treatment. As a result, a person suffers discomfort for a long time, takes painkillers uncontrollably, and develops complications and side effects.

Which doctor should I contact?

First of all, if you suffer from back pain, you can also consult a primary care doctor. He will suggest the cause of the pain and, depending on this, refer you to another specialist. You can skip this step and make an appointment with a neurologist immediately.

If a neurologist, after a specialist visit, suspects a pathology external to the spine, he can refer to:

• rheumatologist,
• surgeon,
• urologist,
• gastroenterologist,
• endocrinologist,
• oncologist.

Doctors of all these specialties periodically encounter the symptom of low back pain, because it has a large number of possible causes.

If a diagnosis of mechanical pain has been established, the patient will be treated by physiotherapy specialists, reflexologist, physiotherapist and masseurs.

How to cure back pain

• SurgeryThey are mainly used for signs of compression of the spinal cord or spinal nerve roots, when the patient has paresis of a limb or urinary disorders. These symptoms can be caused by an intervertebral hernia, a tumor or an injury. Furthermore, consultation with a neurosurgeon may be recommended to the patient in case of chronic pain when conservative treatment is ineffective within 12 weeks. The decision on surgical intervention is made only after visualization of the spine.

  Studies have shown that uncomplicated disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.

• Conservative treatmentincludes medicinal and non-medicinal methods.

  Drug treatment is carried out using non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.

  Non-drug treatment includes:

  • Physiotherapy— is aimed at quickly eliminating pain and inflammation, as well as accelerating tissue restoration and muscle relaxation. The most effective methods: magnetotherapy, laser therapy and shock wave therapy.
  • Acupuncture- insertion of special sterile needles in biologically active points to reduce pain and relax muscles.
  • Massage— improves the mobility of the spine and joints, promotes the correct distribution of the load on the back muscles.
  • Physiotherapy- allows you to relax and strengthen the back muscles. The exercises are effective for both acute and chronic back pain.

  If the patient feels pain for more than 12 weeks, it is called chronic pain. In its treatment, antidepressants with analgesic effect and cognitive behavioral psychotherapy are added to all the above methods.

Bed rest does not provide benefits in the treatment of mechanical low back pain and is not an alternative to the above methods. Furthermore, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly slows recovery.

Consequences

Acute nonspecific low back pain has a favorable prognosis. Of those who seek treatment immediately, 70-90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with analgesic effect. If the pain is caused by compression of the spinal nerve roots by a hernia, it may be accompanied by numbness in the limbs, as well as problems with urination and defecation.

Prevention

Helps prevent back pain:

• Moderate exercise for 150 minutes per week: walking, swimming, core muscle exercises: abdomen, lower back, pelvic floor, thighs and buttocks.
• Maintain a healthy weight.
• Warm up every 40-60 minutes with a long static position.
• Thigh muscle stretching exercises.
• Correct body position when lifting weights: you need to squat, do not lean forward.
• Prevention of decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis by densitometry. This is especially important for older people and postmenopausal women.
• Maintenance of general, somatic and psychological health.