Pain in the back

Back pain is one of the most common causes for patients seeking medical help. Pain syndrome can be accompanied by diseases that affect the spine, kidneys and other organs and systems. Treatment and prevention of back pain includes both medications and non-medications. Timely delivery of medical care can lead to chronicity of the disease with the development of complications.

Back pain is a separate symptom and not a nosological unit. For example, lumbodinia is a pain that is localized in the lumbar spine. Also, concepts such as thoracalgia or cervicalgia are distinguished. Accurate localization of the pathological symptom is essential for choosing the right treatment tactics and prophylactic measures.

Definition

Pain is a pathophysiological condition that arises in response to stimulation of pain receptors. This can occur as a result of direct damage to tissue or organ or under the influence of undesirable psychological factors (stress, anxiety, depression).

Back pain is a multidisciplinary practice in medical practice. This is due to the fact that pain syndrome can occur due to pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver, etc. ).

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

In most cases, the appearance of back pain is a defensive reaction of the body due to the influence of unfavorable factors. The most common cause of back pain is sciatica, disc herniation or spondylosis.

Epidemiology

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

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

Most often, people between the ages of 30 and 60 turn to the clinic for help. This is due to the fact that with age there are pathological changes of a degenerative nature of the spine, resulting in acute and chronic pain.

In addition, men suffer from this disease more often than women. This is due to the characteristics of the job, physical labor, as well as other risk factors. According to statistics, pain is much more common in the lumbosacral region.

Clinicians explain this fact by saying that it is this part of the spine that exerts the most pressure.

Რisk factors

Not only stress and exercise can cause this pathology. The main risk factors include the following:

• Working age 30 years and above;
• Male;
• Overweight and obesity (in which the body mass index exceeds 30);
• The presence of other pathologies (e. g. , frequent migraine or cardiovascular disease);
• Static physical activity that does not differ from one another in diversity;
• Impact of vibration.

In addition, smoking has been cited as a risk factor by some researchers. Intense cough in a smoker may be an indirect cause of pain.

Classification

The 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.

Depending on the duration, the following types of pain are distinguished:

• Sharp,
• Subacute,
• Chronic.

Patients with severe pain are most often treated in an outpatient clinic. Its duration does not exceed 6 weeks. Subacute pain can last from 6 to 12 weeks. If a pathological syndrome bothers a patient for 12 weeks or more, this pain is called chronic.

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

In terms of intensity, the following types of pain are distinguished:

• Weak
• Medium,
• Strong

Due to the nature of back pain, there are:

• Burst,
• it hurts,
• Shooting,
• Withdrawal,
• Fool

The nature of the pain depends on the pathology that caused the syndrome. So with osteochondrosis, a pain concern that is different from radiation to the lower extremities. Acute pain occurs during sciatica, often unilateral.

According to the localization of back pain, there are:

• Local (local),
• Reflected in
• Irradiation

Local pain occurs when the abnormal focus is located directly on the back. Pain is caused by irritation, stretching, or other effects on receptors under the skin.

Local pain has its own characteristics. For example, pain syndrome after injury to the lumbosacral region of the spine is permanent. Its character can be changed by changing the position of the body due to irritation of the receptors.

The reflected pain occurs with pathology affecting the internal organs. Associated with the anatomical features of innervation. So, in the type shown, the pain occurs in the area of the dermatome. The most common cause of back pain may be pathology of the pancreas, uterus and its appendages.

Among the peculiarities of pain is the lack of connection with physical activity. If by changing the position of the body with local pain, the intensity of symptoms has increased, then in this case there is no connection.

Radiation pain is associated with nerve or root irritation. Moreover, in addition to the appearance of pain in the back, the patient may complain of decreased sensitivity, the appearance of goose bumps (paresthesia). Often, on examination, a neurologist can detect abnormal reflexes that are also associated with a disturbance in nerve impulse transmission.

Cause of back pain

Pain syndrome can be manifested 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, etc. );
• Benign and malignant neoplasms;
• Mental disorders (depression, anxiety, stress cause psychogenic pain).

In addition, everyday problems can cause abnormal symptoms. So, after waking up in an uncomfortable posture during sleep, the patient may complain of pain in the neck or lumbar spine.

Pain in the spine

With this type of pain, degenerative-type pathological changes are observed in the spine. So the bodies of the spine, the intervertebral discs can be damaged. Most often, pain originating in the spine can be associated with a disease that affects the joints.

According to statistics, patients who seek medical help complain of the appearance of severe pain associated with spinal cord injury. The cause may be a herniated disc, spondylosis or lumbago.

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

ᲓSickness	ICD-10 code	Features
Osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by appearancePulling and short-term pain with radiation.Exposure to external factors in the form of exercise or coughing can increase pain.
Intervertebral hernia	M51	A disease in which a bulge forms in the spinal canal. ᲠAs it seemsAcute pain syndrome that occurs with coughing, wheezing, and physical exertion.
Sciatica	M54. 1	A disease in which degenerative changes are observed in the roots. Characterized by appearancePainful pain associated with a change in body position or physical exertion. . . In addition to 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	A disease manifested by degenerative changes in the spine. Has of course the chronic type!Pain with irradiation of the lower extremities, pain in the neck.

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

These are the causes of the spine that cause pain in the back. In addition to the diseases listed above, pain may appear during trauma and stretching of the musculoskeletal system. So with excessive physical exertion or weight gain, severe pain may appear suddenly.

Pain of non-vertebral origin

According to statistics, patients complain of pain in no more than 2% of cases of non-spinal origin. This category includes diseases and somatic conditions in which there is pain in the back.

The most common diseases that cause pain syndrome are pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. The following is distinguished among the first group:

• Occlusion of arteries,
• Tense angina,
• Aortic aneurysm (in the abdomen or chest).

Among the second group:

• Stomach ulcer,
• Peptic ulcer disease of the duodenum,
• Cholelithiasis,
• Biliary tract dyskinesia,
• Inflammatory changes in the pancreas.

Cardiovascular diseases often provoke the appearance of pain in the back. So with angina, the patient suffers from pain in the heart area that radiates to the shoulder, arm or back. This is why patients may complain of back pain during an attack.

With angina pectoris, pain syndrome has its own characteristic signs. First of all, pain has a crushing character. Second, it appears beyond the abdomen, radiating to the back, arms, or shoulders. Third, the pain syndrome disappears immediately after taking the medication. It should be noted that physical activity and stress provoke the appearance of an attack.

Aortic aneurysm is a division of a blood vessel that weakens and then collapses. In this case, the patient, upon seeking medical help, complains of dull pain in the heart area with irradiation of the hind and lower limbs. Also bothered by symptoms such as dizziness, weakness, a sharp drop in blood pressure. With aortic aneurysm, back pain can appear both in the abnormal focus of the chest and in the abdomen.

It should be noted that pain during an aneurysm is not related to 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 that affect 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 side provoke the appearance of back pain.

Back pain during pregnancy

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

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

The first group includes:

• Natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• Enlargement of the uterus by the formation of a "baby" place in which the internal organs are displaced;
• Change in the center of gravity at the end of pregnancy when the cervix collapses.

The immediate cause of back pain during pregnancy can be the premenstrual period. It is characterized by the appearance of compressions that are irregular. In this case, due to the active work of the pelvic floor muscles, pain may appear in the back and lower back. However, due to the production of female sex hormones as well as oxytocin, the pregnant woman may not feel these pains.

Nevertheless, the appearance of severe back pain during pregnancy can be an objective reason to seek the advice of a gynecologist. If pathology is suspected, a pregnant woman may be asked to stay in the hospital for further observation.

The appearance of severe back pain during pregnancy can be the cause of a serious illness. This is due to the fact that extragenital diseases in women during this period may 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 entry of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. Stress, which often accompanies pregnancy, exacerbates 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 that appears with the onset of corovirus infection.

The main reasons are:

• Effects of toxins on the body;
• Exacerbation of chronic diseases of the musculoskeletal system;
• The emergence of new, previously diagnosed pathologies of the spine;
• Viral radiculopathy.

Intoxication syndrome is often accompanied by diseases that affect the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains. With coronavirus, as with other respiratory diseases, nonspecific back pain can occur. This is one of the manifestations of intoxication syndrome. With effective medication therapy, the intensity of the pain decreases after a few days.

The body’s active fight against infection can lead to exacerbation of chronic diseases. In addition, in the background of respiratory disease, latent pathologies may appear earlier. Therefore patients may suffer from back pain.

Among the main causes, the appearance of viral radiculopathy also stands out. It may be associated not only with the formation of the intervertebral hernia. Radiculopathy is concerned 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 should visit a neurologist.

The receiving specialist, after detailed collection of anamnestic data, should conduct a neurological examination of the patient. At the information gathering stage, the following aspects are considered:

• The first appearance of back pain;
• The connection between pain and physical activity;
• The presence of concomitant diseases;
• Localization of pain syndrome;
• Duration of pain;
• The appearance of other symptoms.

After collecting the anamnesis, the neurologist continues the examination. At this stage the specialist pays attention to the patient walking with pathology, the position of the spinal column, checks the presence or absence of reflexes.

To examine a patient’s gait, a neurologist asks the patient to walk a few feet into the office, as well as perform several tests. If, while walking, the patient is unable to move the support on the leg, performing unnecessary movements - this is one of the clear signs of neurological disease.

In addition, the position of the spine should be assessed. The neurologist pays attention to the presence or absence of kyphosis, lordosis, and scoliosis. The specialist assesses the patient's response to irritation reflexes with the help of tests.

When back pain occurs, the disease may be accompanied by a change in sensitivity. This is why a neurologist assesses the state of tactile, temperature and other types of sensitivity. Also, the specialist pays attention to the formation of abnormal sensations, for example, a crawling or tingling sensation in the back.

After the examination, the neurologist may order a number of additional tests. Instrumental examination is necessary when it is necessary to determine the exact localization of the abnormal focus. Modern methods provide a safe and painless examination, the results of which the patient receives after a few days.

To determine the cause of back pain, a neurologist can refer the patient for the following diagnostic measures:

• Magnetic resonance imaging (MRI);
• Computed tomography (CT);
• X-ray of the abdominal organs.

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

Treatment of back pain

Treatment of acute or chronic pain should be mandatory under the supervision of a physician. Independent use of the drug can lead not only to ineffective treatment, but also to the emergence of 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, when pain appeared in the back, it was recommended to follow a strict bed rest. There is now no need to restrict patient movement. In addition, it is also recommended to wear special bandages and use crutches or sticks when walking.

Modern treatment of back pain is based on evidence-based medicine. They use not only drugs but also non-medicinal methods of treatment.

The following groups of medications are used as drug therapy in the treatment of back pain:

• Nonsteroidal anti-inflammatory drugs;
• Muscle relaxants to reduce muscle tone;
• Painkillers.

The listed groups of drugs can be used both in monotherapy and in combination to achieve a therapeutic effect. Manual therapy is recommended in combination with spinal analgesics.

In cases where the patient's pain syndrome is very pronounced, it will be necessary to limit daily activity as well as follow the recommendations of another physician, but in general, previous levels of physical activity should be maintained.

In case of chronic back pain, in addition to the listed methods of treatment, methods of physiotherapy exercises (exercise therapy) can also be used. Alternatively, your neurologist may recommend massage sessions. Along with taking antidepressants, special attention is paid to cognitive-behavioral therapy.

The duration of treatment is determined by a neurologist. In case the treatment was ineffective, you should change the group of medications as well as conduct additional studies.

Forecast

With timely diagnosis and properly selected treatment tactics, back pain can be reduced after a few weeks. During the chronic course, long-term remission can be achieved by following the recommendations of the attending physician.

Prevention

To prevent the appearance of back pain, you need to follow a healthy lifestyle and properly distribute physical activity so as not to create overload on different parts of the spine. In addition, comorbidities must be diagnosed and treated in a timely manner.