Back pain is one of the most common reasons for patients to seek help from medical organizations. Pain syndrome can accompany diseases affecting the spine, kidneys and other organs and systems. The treatment and prevention of back pain includes both medical and non-medical treatment. Untimely provision of medical care can cause chronic disease with the development of complications.
Back pain is a separate symptom, not a nosological unit. For example, lumbodinia is pain that is localized in the lumbar spine. There are also concepts such as thoracalgia or cervicalgia. The exact location of the pathological symptom is necessary for the choice of the correct tactics of treatment and the choice of 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 adverse psychological factors (stress, anxiety, depression).
Back pain is a multidisciplinary practice in medical practice. This is due to the fact that the pain syndrome can occur due to the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver and others).
It should be noted that the pain syndrome may be accompanied by deterioration of the patient's cognitive abilities - memory impairment may occur, concentration decreases.
In most cases, the appearance of back pain is a protective reaction of the body due to the influence of adverse factors. The most common cause of back pain is sciatica, disc herniation or spondylosis.
Epidemiology
According to statistics from the World Health Organization (WHO), back pain is a problem for more than 40% of the population. In some countries, this figure can reach 80%.
This problem can cause early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among working people. That is why pathology is a problem not only in the medical, but also in the economic sphere of activity.
Most often people of working age from 30 to 60 years turn to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, resulting in acute and chronic pain.
In addition, men suffer from the disease more often than women. This is due to the peculiarities of work, physical labor, and other risk factors. According to statistics, pain occurs much more often in the lumbosacral region.
Clinicians explain this fact by the fact that it is on this part of the spine that physical activity exerts the greatest pressure.
Risk factors
Not only stress and exercise can cause this pathology. Among the main risk factors are the following:
- working age of 30 years and older;
- male;
- overweight and obesity (in which the body mass index exceeds 30);
- the presence of other pathologies (eg frequent migraines or diseases of the heart and blood vessels);
- static physical activity, which does not differ from each other in diversity;
- vibration exposure.
In addition, smoking has been reported as a risk factor by some researchers. Intense cough in a smoker may be an indirect cause of pain.
Classification
A neurologist, after a detailed examination and examination, determines the nature of the pain. There are several classifications, among which the pain syndrome that occurs in the back is divided according to the place of origin of the pathology, duration, causes and other characteristics.
The following types of pain are distinguished by duration:
- sharp,
- subacute,
- chronic.
Patients with acute pain are most often treated in an outpatient setting. Its duration does not exceed 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, this pain is called chronic.
Acute and subacute pain most often, with appropriate treatment, lead to complete recovery. Chronic pain syndrome can cause early disability of the patient. Therefore, at the first appearance of clinical signs of pathology you should seek medical help from a doctor. To do this, you must undergo an initial consultation with a neurologist.
The following types of pain are distinguished by intensity:
- weak
- average,
- strong.
By the nature of back pain there are:
- bursting,
- pain,
- shooting,
- pulling,
- stupid.
The nature of the pain depends on the pathology that caused the syndrome. So, in osteochondrosis, the pulling of the pain is disturbing, which differs in radiation to the lower extremities. Sciatica causes stabbing pain that is often unilateral.
According to the location of the back pain there are:
- local (local),
- reflected,
- irradiating.
Local pain occurs when the pathological focus is directly in the back. Pain is caused by irritation, stretching or other effects on the receptors located under the skin.
Local pain has its own characteristics. For example, after an injury to the lumbosacral region of the spine, the pain syndrome is permanent. Its nature may change with a change in body position due to irritation of the receptors.
Reflected pain occurs with pathology that affects the internal organs. Related to the anatomical features of innervation. So in the affected type there is pain 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 reflected type of pain is the lack of connection with physical activity. If the intensity of the symptom increases with a change in the position of the body with a local type of pain, then in this case there is no connection.
Irradiating 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 goosebumps (paresthesia). Frequently a neurologist may reveal pathological reflexes, which are also associated with impaired nerve impulse transmission.
Cause of back pain
The pain syndrome can occur for several reasons:
- musculoskeletal pathology (trauma, sprains, hypothermia and other external causes);
- diseases of the spine (osteochondrosis, hernia);
- diseases affecting the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others);
- benign and malignant neoplasms;
- mental disorders (depression, anxiety, stress cause psychogenic type of pain).
In addition, everyday problems can cause a pathological symptom. So, with an uncomfortable sleeping position after waking up, the patient may complain of pain in the neck or in the lumbar spine.
Pain of spinal origin
In this type of pain, pathological changes of the degenerative type are observed in the spine. So, the vertebral bodies, the intervertebral discs can be damaged. Most often, pain of spinal origin can be associated with a disease affecting the joints.
According to statistics, patients seeking medical help complain of acute pain associated with spinal cord injury. The cause may be a herniated disc, spondylosis or lumbago.
In less than 1% of all cases of a visit to the doctor, neoplasms are found in the spine. 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 vertebrae are destroyed. It is characterized by appearancepulling and short-term pain with radiation.Exposure to external factors in the form of exercise or cough contributes to increased pain. |
Intervertebral hernia |
M51 |
A disease in which a bulge forms in the spinal canal. It seemsacute pain syndrome, which occurs when coughing, sneezing and exercise. |
Sciatica |
M54. 1 |
A disease in which degenerative changes in the roots are observed. It is characterized by appearancepainful pain associated with a change in body position or exercise. . . In addition to the pain syndrome, sensitivity disorders are added. |
Discogenic lumbodinia |
M54. 4 |
Pathology characterized by the sudden onset of severe pain in the lumbar spine.The pain is shooting and very pronounced. |
Spondylosis |
M47 |
Disease manifested by degenerative changes in the vertebrae. Of course, there is a chronic type,pain in pain with radiation to the lower extremities, neck. |
It should be noted that each disease has its own characteristics. Therefore, when diagnosing, attention should be paid not only to the anamnestic data, but also to the test results. For this, modern diagnostic instrumental methods are used, which allow not only to identify the pathological focus, but also to determine its limits and the degree of inflammation or destruction of the anatomical structures of the spine.
Vertebrogenic causes provoke the appearance of back pain. In addition to the diseases listed above, pain can occur during trauma and stretching of the musculoskeletal system. So, with excessive exercise or lifting weights, sharp pain can suddenly appear.
Pain of non-vertebral origin
According to statistics, patients complain of pain of non-vertebral origin in no more than 2% of cases. This category includes diseases and somatic conditions in which there is back pain.
The most common diseases that provoke the appearance of pain syndrome are the pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. Among the first group the following are distinguished:
- clogged arteries,
- angina on exercise,
- aortic aneurysm (in the abdomen or chest).
Among the second group:
- stomach ulcer,
- duodenal ulcer,
- cholelithiasis,
- biliary dyskinesia,
- inflammatory changes in the pancreas.
Cardiovascular diseases often provoke back pain. So, with angina pectoris, the patient worries about pain in the heart area that radiates to the shoulder, arm or back. Therefore, during an attack, patients may complain of back pain.
In angina pectoris, the pain syndrome has its own characteristics. First, the pain is overwhelming. Second, it appears behind the sternum, radiating to the back, arms or shoulder. Third, the pain syndrome disappears after immediate administration of the drug. It should be noted that physical activity and stress provoke an attack.
An aortic aneurysm is a rupture of a blood vessel that weakens and then protrudes outward. In this case, the patient, when seeking medical help, complains of dull pain in the heart with irradiation to the back and lower limbs. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also disturb. Back pain with an aortic aneurysm can occur with both the thoracic location of the pathological focus and the abdominal.
It should be noted that aneurysm pain is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are started immediately, including the use of medications and surgical methods.
Back pain can be caused not only by cardiovascular disease. In diseases affecting the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarities of innervation - inflammatory and degenerative changes in this area provoke 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 organs, hormonal changes, weight gain in the early and late stages.
During pregnancy, back pain can be caused by physiological and pathological changes.
Among the first group there are:
- natural weight gain during pregnancy, which increases the load on the bone and joint system;
- enlargement of the uterus with the formation of a "childish" place in which the internal organs are displaced;
- a change in the center of gravity at the end of pregnancy when the uterine fundus descends.
The immediate cause of back pain during pregnancy may be the preliminary period. It is characterized by the appearance of contractions that are irregular. In this case, due to the active work of the pelvic floor muscles, back and lower back pain may occur. However, due to the production of female sex hormones as well as oxytocin, a pregnant woman may not feel these pains.
Nevertheless, the appearance of severe back pain during pregnancy may be an objective reason to seek the advice of a gynecologist. If pathology is suspected, a pregnant woman may be asked to remain in the hospital for further monitoring.
The appearance of severe back pain during pregnancy can be a cause of serious illness. This is due to the fact that during this period, extragenital diseases in women can worsen. The most commonly diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile ducts can cause pain.
Exacerbation of pyelonephritis or cystitis is associated not only with the penetration of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy aggravates the symptoms.
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 and weakness and fatigue. However, some patients also complain of back pain, which occurs with the onset of coronavirus infection.
Among the main reasons are:
- exposure to toxins on the body;
- exacerbation of chronic diseases of the musculoskeletal system;
- the appearance of new, undiagnosed pathologies of the spine;
- viral radiculopathy.
The intoxication syndrome often accompanies diseases affecting the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains. In coronavirus, as in other respiratory diseases, nonspecific back pain may occur. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the intensity of pain decreases after a few days.
The body's active fight against infection can cause exacerbation of chronic diseases. In addition, previously hidden pathologies may appear against the background of respiratory disease. This is why patients may be worried about back pain.
Among the main causes is the appearance of viral radiculopathy. It can be associated not only with the formation of an intervertebral hernia. Radiculopathy is a concern when a viral agent causes inflammation or irritation of the spinal cord roots.
Diagnostic measures
If you have back pain, you should seek medical help immediately. To diagnose a disease in this area, you need to visit a neurologist.
The receptionist, after a detailed collection of anamnestic data, should perform a neurological examination of the patient. At the information collection stage, attention is paid to the following aspects:
- the first appearance of back pain;
- the relationship of pain to physical activity;
- the presence of concomitant diseases;
- localization of pain syndrome;
- the duration of the pain;
- the appearance of other symptoms.
After collecting the anamnesis, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the walking of the patient with pathology, the position of the spine, checks the presence or absence of reflexes.
To examine the patient's gait, the neurologist asks the patient to walk a few meters in the office, as well as to perform some tests. If during walking the patient can not transfer support to his leg, performs unnecessary movements - this is one of the clear signs of neurological disease.
In addition, the position of the spine should be assessed. A neurologist pays attention to the presence or absence of kyphosis, lordosis and scoliosis. The specialist uses tests to assess the patient's response to stimulus reflexes.
When back pain occurs, the disease may be accompanied by a change in sensitivity. That is why the neurologist assesses the state of tactile, temperature and other types of sensitivity. 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 prescribe a number of additional tests. Instrumental examination is necessary when it is necessary to establish the exact location of the pathological focus. Modern methods allow safe and painless examination, the results of which the patient receives after a few days.
To diagnose the causes of back pain, a neurologist may send a patient to undergo 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 diagnosis, the neurologist chooses the optimal treatment tactics.
Treatment of back pain
Treatment of acute or chronic 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 the emergence of complications of the disease. Therefore, it is recommended to seek medical help from a specialist for back pain. After passing the diagnostic tests, the patient will be prescribed treatment based on the characteristics of the clinic, the pathogenetic mechanisms and the course of the disease.
A few years ago in medicine, when back pain appeared, it was recommended to follow a strict bed rest. Now there is no need to restrict the patient's movement. In addition, it is recommended to wear special bandages and use crutches or stilts when walking.
Modern treatments for back pain are based on proven medicine. They use not only drugs but also non-drug treatments.
The following groups of drugs are used as drug therapy in medical practice for back pain:
- non-steroidal anti-inflammatory drugs;
- muscle relaxants to reduce muscle tone;
- analgesics.
The listed groups of drugs can be used both in monotherapy and in combination to achieve a therapeutic effect. Along with medications for back pain, manual therapy is recommended.
In case the patient's sick syndrome is very pronounced, it will be necessary to limit the daily activity, as well as to adhere to other recommendations of the doctor, but in general the level of previous physical activity must be maintained.
In chronic back pain, in addition to the listed methods of treatment, methods of physiotherapy exercises (TP) can be used. In addition, a neurologist may recommend massage sessions. Particular attention is paid to cognitive-behavioral therapy along with the intake of antidepressants.
The duration of treatment is determined by a neurologist. In case the treatment is ineffective, you need to change the group of drugs, as well as conduct additional tests.
Forecast
With timely diagnosis and properly chosen treatment tactics, back pain can subside after a few weeks. In the case of a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.
Prevention
To prevent back pain, you need to adhere to a healthy lifestyle and properly distribute physical activity so as not to create congestion on different parts of the spine. In addition, comorbidities must be diagnosed and treated promptly.