Back pain

Low back pain is familiar to almost every modern person. Employment can be affected for many reasons. These include back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be careless about it, because back pain can not only reach incredible power, making human life unbearable, but also turn out to be a symptom of the most dangerous diseases.

Low back pain can be varied: severe or dull, painful or burning, local (appears in one place) or spreads all over the back. Unpleasant sensations also manifest themselves in different ways: sometimes suddenly, suddenly and sometimes gradually, every day.

The response to pain and its ability to tolerate depend on many factors: age, mental characteristics, accompanying symptoms, and other factors. But in any case, you can not leave the disease by accident. Timely treatment will help to avoid dangerous consequences.

To determine the cause of back pain requires an examination of the spine and several additional procedures: X-ray examination, computed tomography or magnetic resonance imaging. Pain attacks, lumbosacral, occur in a lifetime, in about 80% of modern residents of European countries.

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

Pain syndrome - primary and secondary

To understand why lower back pain hurts, we must not forget that the causes of such pain are dozens and the unprofessional 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 may affect the lumbar region.

Primary lumbar pain syndrome arises as a result of muscular changes of a morphofunctional nature. It is the cause of the vast majority of cases of back pain in the lumbar region. The most important cause is the degenerative-dystrophic changes that occur in different parts of the spine:

• Osteochondrosis, which is damage to bone and cartilage tissues, this disease has a dystrophic character. With it, the intervertebral disc and surrounding vertebrae are damaged, spondylosis begins to develop.
• Spondyloarthritis is a form of osteoarthritis in which the disease affects the intervertebral joints that are responsible for the movement of the spine, or the synovial joints.

Secondary pain syndrome has a wide variety of causes of pain:

• Scoliosis, which is a curvature of the spine, like some other growth disease;
• Various inflammations of non-infectious nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• A tumor located on the vertebrae themselves, in the spinal cord or in the retroperitoneal space, whether primary or metastatic;
• Fracture of one or more dorsal vertebrae. This is one of the most serious causes of back pain;
• Various infectious diseases that cause damage to the spine and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• Stroke conditions in which a severe disruption of the blood supply to the spinal cord is manifested. In this case there may also be a feeling that the lower back hurts;
• Diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
• Often back pain is of a reflected nature. A similar problem can occur with some diseases of the pelvic organs. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, urethroplasmosis, annexitis - all of 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. So-called displaced lumbar pain is also often observed: in this case pain sensations are transmitted from the deeper internal organs and structures of the body; In other words, the patient appears to have a sore lower back, but in reality a completely different part of the body is injured.

Most often, the back hurts in the lumbar region when the pain in this area arises from tumors of the pelvic organs, kidneys, pancreas, large intestine or behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation of what not to do exactly: self-medication. The causes of pain are so varied that only a qualified specialist can make a correct diagnosis.

Possible causes of severe lumbar pain include:

• The pain is accompanied by sharp stretching of the muscles. In this case the pain signals are localized in the back, they are delivered to the spasmodic long muscles. The pain does not spread to the groin or leg area. Human mobility is limited.
• One of the most common and severe causes of severe back pain is spinal fractures (spinal fractures, including compression fractures). Typically, this occurs with unsuccessful falls, spinal flexion, and other injuries; But if a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, malignant tumors and their metastases to the spine or other damage to the bone system, spinal fractures can occur literally "naturally". And even without fixation of sensations by the patient during a fracture.
• An equally unpleasant situation in which the lower back hurts sharply is the movement of the intervertebral discs that has occurred in the spine. Areas are divided according to the frequency of injuries: LV-SII - most often; LIV-LV - frequency second; LIII-LIV and above are more rare cases.

Symptoms include severe lumbar pain, forced posture, limited mobility. Indicates involvement in the pathological process of nerve roots:

1. Radicular pain, usually unilateral;
2. Sensitivity disorders (numbness, increase or decrease in sensitivity level);
3. Reduction or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. Decreased intensity or lack of knee acceleration (indicates damage to the L3-L4 area).

There is a general tendency for the protruding intervertebral disc to affect the root canal (e. g. , incorrect placement of LIV-LV causes L5 root pathology). Defeat of the cauda equina disrupts bladder and rectal function. Also, a similar condition can occur during a severe rash on the spinal disc.

The back aches sharply in the lumbar region with phase syndrome: in this case the disc remains intact and the pain occurs at the exit of the spinal canal as a result of the root itself being compressed. The most common unilateral phase syndrome is in the L5 root area; Arises on the basis of increasing aspects of the intervertebral joint (upper and lower) and, consequently, narrowing of the intervertebral foramen.

Also, severe low back pain is accompanied by an epidural abscess, a serious disease that requires urgent diagnosis and urgent treatment. Most often the inflammatory process develops in the thoracic region of the spine; The pain becomes particularly strong with mechanical impact on the area of pathology (pressure, grip).

If there are signs of spinal cord compression, any highly effective medical measures including surgical intervention are recommended. Another reason why the lower back hurts may be diseases of the femoral joint - primarily coxarthrosis. This case is characterized by pain that radiates to the lower back, buttocks and also the legs up to the knees.

Diseases characterized by chronic low back pain:

• Deformed spondylosis is a disease in which dystrophic changes of the lumbar spine occur, calcification of their ligament apparatus, and subsequent growth of bone; Bone growths press on the roots and narrow the spinal canal. In cases where excruciating pain is accompanied by leg weakness, numbness, and other neurological symptoms, the possibility of intermittent claudication syndrome, which may be caused by narrowing of the spinal canal, should be considered. An examination is necessary, the results of which determine the final diagnosis.
• Ankylosing spondylitis (or Bekhterev disease). The early stages are characterized by limited mobility, especially in the morning, with a decrease in chest movement during breathing. There is pain in the lower back; Further curvature of the spine arises and progresses in the chest area. X-ray examination fixes anomalies of the sacral joint: destruction, change in structure, "bamboo" spine. It is necessary to thoroughly examine and determine the cause of lower back pain, as 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). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid, kidneys, gastrointestinal tract; Lymphoma; Multiple myeloma (multiple myeloma). Exceptions are made by the method of radiological examination and myelography.
• Osteomyelitis also causes prolonged, excruciating pain in the lumbar region. If you suspect this disease, a bone x-ray is done, a skin test is done with tuberculin, and an ESR is done to determine the presence / absence of tuberculosis bacteria or pyogenic bacteria in the body, usually staphylococci - the cause of osteomyelitis.
• Spinal cord tumors (intrauterine tumors) are of different types. Diseases such as lipoma, neurofibroma, meningioma can cause persistent back pain, initially without any accompanying neurological symptoms.

Causes of back pain of an intermittent nature. Many diseases of the internal organs cause periodic, sharp or excruciating pain in the lumbar region. At the same time, patients do not experience a feeling of tightness in the spine, there is no clear localization of pain, and the pain does not increase with the maximum range of motion. To the question of what to do if the lower back hurts not constantly, but from time to time, the answer is simple: do not wait until it hurts "properly", but consult a doctor.

The influence of pathology of this or that organ on a certain part of the spine is obvious. Thus, pain radiates from the pelvic organs to the sacrum, in diseases of the organs located in the lower abdomen, it radiates to the lower part of the spine (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 zone.

Diseases - Causes of low back pain and area of pain spread:

• If the pelvic organs are damaged, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, such intermittent pain can be caused by chronic prostatitis or the development of prostate cancer.
• Various diseases of the kidneys cause pain when connecting the ribs and spine.
• Tumors of the stomach, duodenum, peptic ulcer, pancreas (especially if the disease extends beyond the peritoneum) - pain extends to the T10-L2 region of the spinal segments;
• In ulcerative colitis, diverticulitis, or tumors of the large intestine, the lower back hurts;
• If the back hurts in the chest / lumbar region, aortic dissection (excision aneurysm) should be ruled out.

Diagnosis of low back pain

For low back pain and lumbago, computed tomography (MRI of the vertebral bone tissue) and magnetic resonance imaging (soft tissue assessment) and ultrasound scans of internal organs are recommended. .

One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a range of disorders, from bone fractures to kidney stones. Many of the identified changes suggest only a correct diagnosis and additional studies may be needed to confirm it. In addition, some X-ray changes may be accompanied by findings that are not a cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. This examination assesses the patient's neurological condition, as well as the detection of possible disorders of spinal biomechanics with a mandatory assessment of the condition of the muscles of the spine and gluteal region. At this stage of the study it is already possible to diagnose and treat a patient with spinal osteochondrosis.

Occasionally, the following additional diagnostic procedures may be prescribed based on the results of an orthopedic examination of a patient with a symptom of spinal osteochondrosis:

• X-ray of the lumbosacral spine with functional tests;
• Lumbar-sacral CT scan of the spine;
• MRI of the lumbosacral spine.

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

The thickness of the discs decreases, the vertebral bodies get closer to each other, the intervertebral foramina shrinks and endangers the nerves and vessels located in them (osteochondrosis).

Disc protrusion (intervertebral disc protrusion) with their subsequent prolapse into the lumen of the spinal canal (hernia) most often causes compression of the nerve roots, causing pain along the compressed nerve (pain radiating to the leg, arm, back of the head, neck, ribs)By weakening muscle strength at their innervation sites and by impairing sensitivity.

Often, a protrusion or hernia of the intervertebral disc is 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 may also be impaired. When the spine is unstable, the vertebrae move forward (anterolysis) or backward (retrolysis). X-ray of the lumbosacral spine with functional tests may be needed to make a diagnosis.

Most often, the nerve bundle that forms the sciatic nerve due to their anatomical location experiences compression of the hernia or protrusion of the intervertebral disc. The sciatic nerve is made up of L5, S1, S2, S3 fibers - the spinal nerves.

Focusing on chronic inflammation in the lumen of the spinal canal can lead to its narrowing (spinal canal stenosis) and compression of the outgoing nerves and spinal cord. Therefore in case of spinal canal stenosis it is always necessary to conduct a full course of treatment using a whole arsenal of different methods of treatment, and in case of ineffectiveness surgical treatment.

Which doctor should I go to?

In case of back pain, you should first consult a neurologist at the district clinic if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Low back pain is combined with various infections, with injuries to the limbs. Pain in the lumbar region with heart and lung disease is not excluded. This is determined by in-depth examination. Once a patient has been diagnosed, he or she is usually prescribed medications that reduce back pain, normalize blood circulation, and restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasm.

Surgical intervention is usually required in the diagnosis of disc herniation, which is a complication of osteochondrosis. The hernia, which compresses the nerve root, is removed, restored, and the pain passes over time.

It is best to relax your spine and paravertebral muscles if you are sleeping on a firm mattress with a small pillow under your knees. At the same time, bed rest should not be continued for too long as it is fraught with weakening of the paravertebral muscles, which only exacerbates the problem. Even in the case of severe pain you should try to maintain at least weak physical activity.

How to relieve low back pain

Symptoms of pain often occur due to muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used to treat diseases of the spine.

So, in case of strong, sudden pain in the lower part of the spine, it is recommended to take a muscle relaxant tablet, spraying the spine with a warming anesthetic gel. You must strictly follow its instructions when using funds.

In cases where the unpleasant symptom is caused by inflammatory diseases of the internal organs, it is recommended not to delay contacting a doctor, if at a particular moment it is impossible to go to a specialist and the pain is very strong, you can take Pentalgin or No-shpu. The painful area should not be covered with a warming pad, as the heat helps to spread the inflammatory process and, consequently, intensify the accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used to treat diseases of the lower back. These drugs include drugs that have pronounced anti-inflammatory, mild analgesic and antipyretic effects.

The course of treatment is prescribed taking into account the severity of the pain symptom. Back pain ointment is used as a basic or auxiliary remedy. With pronounced symptoms of osteochondrosis, it has been shown to lubricate the lower back with ketoprofen-based ointments, a substance with a strong analgesic effect.

The main plus of topical drugs is due to their action not on the whole body, but on a specific area that needs treatment. Analgesics and anti-inflammatory ointments have fewer contraindications and side effects in the form of tablets compared to similar drugs.

Exercises for back pain

Exercise is considered as an additional method for the treatment of diseases of the lower spine. The exercises shown for patients are quite simple and do not involve a special load on the body. For example, the usual hanging of a horizontal bar cross-section has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate the lumbago - pain caused by pressing on its nerve roots. Therapeutic exercises for spinal diseases, accompanied by pain in the lower back, include the following exercises:

• Raising the legs (so that the knee touches the chin);
• "Bicycle", performed lying on his back;
• Walk on your knees.

It is recommended to do exercises for no more than 10-15 minutes every day, with pronounced pain - refuse to perform them.