Back pain is one of the most common reasons patients seek help from medical institutions. Pain syndrome can be accompanied by diseases affecting the spine, kidneys, and other organs and systems. Treatment and prevention of back pain includes both pharmacological and non-pharmacological treatment. Untimely provision of medical care can cause chronic illness with the development of complications.
Back pain is a distinct symptom, not a pathological entity. For example, crippling pain is pain localized in the lumbar spine. In addition, concepts such as chest pain or cervical pain are also distinguished. Accurate identification of pathological symptoms is necessary for the selection of the correct treatment tactics and the selection of preventive measures.
Definition
Pain is a pathophysiological condition that occurs in response to stimulation of pain receptors. It can occur as a result of direct tissue or organ damage or from exposure to unfavorable psychological factors (stress, anxiety, depression).
Back pain is a multidisciplinary practice within medical practice. This is due to the fact that the pain syndrome can occur due to pathologies of the musculoskeletal system, pelvic organs, retroperitoneal cavity (kidney, pancreas, liver and others).
It should be borne in mind that the pain syndrome may be accompanied by a decline in the patient's cognitive abilities - memory disturbances may appear, a decrease in the ability to concentrate.
In most cases, back pain is a defense response of the body due to the influence of adverse factors. The most common cause of back pain is sciatica, herniated disc, or spondylolisthesis.
Epidemiology
According to statistics of the World Health Organization (WHO), back pain is a concern of more than 40% of the population. In some countries, this number can be as high as 80%.
This problem can cause early disability for the patient. In addition, pain syndrome is a common cause of temporary disability in working people. That is why pathology is such a problem not only in medicine, but also in the field of economic activity.
Usually, people of working age between 30 and 60 years old come to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, due to which acute and chronic pains appear.
In addition, men are affected more often than women. This is due to the nature of the job, physical labor, as well as other risk factors. Statistically, the pain appears much more often in the lumbosacral region.
Clinicians explain this fact by the fact that it is on this part of the spine where physical activity generates the most stress.
Risk factors
It is not only stress and exercise that can cause this pathology. Among the main risk factors are:
- working age from 30 years old and above;
- Male;
- overweight and obese (where body mass index is over 30);
- the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
- static physical activity, not differing in diversity;
- exposure to vibrations.
In addition, smoking has been noted by some researchers as a risk factor. It is possible that a violent cough in a smoker could be an indirect cause of the pain.
Classify
After a detailed examination and examination, the neurologist determines the nature of the pain. There are several classifications in which pain syndromes occurring in the back are subdivided according to the location of the pathology, duration, reason and other characteristics.
In terms of duration, the following types of pain are distinguished:
- sharp,
- subacute,
- chronic.
Patients with acute pain are usually treated in an outpatient clinic. Its duration is not more than 6 weeks. Subacute pain may last from 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 proper treatment, will lead to full recovery. Chronic pain syndrome can lead to early disability. That is why at the very first appearance of clinical signs of the pathology, you should seek the help of a doctor. To do this, you should undergo an initial consultation with a neurologist.
In terms of intensity, the following types of pain are distinguished:
- Weak
- Medium,
- strong.
Regarding the nature of back pain, there are:
- boom,
- hurting,
- take a shot,
- pulling,
- stupid.
The nature of the pain depends on the pathology causing the syndrome. So, with osteonecrosis, pain is accompanied by anxiety, which is different from irradiation to the lower extremities. With sciatica, stabbing pains occur, usually unilateral.
According to the localization of back pain, there are:
- local (local),
- reflect,
- irradiation.
Localized pain occurs when the pathological focus is located directly behind the back. Pain is caused by irritation, stretching, or other effects on receptors located under the skin.
Local pain has its own characteristics. For example, after an injury to the surrounding area of the spine, the pain syndrome is constant. Its properties may change with changes in body position due to stimulation of receptors.
Reflective pain occurs with a pathology affecting the internal organs. Relating to the anatomical features of the internal organs. So, with the type reflected, the pain occurs in the dermatological area. The most common cause of back pain can be pathology of the pancreas, uterus and its appendages.
Among the features of the type of pain reflected, a lack of connection with physical activity is distinguished. If, with a change in body position accompanied by a localized pain pattern, the intensity of the symptom increases, then in this case there is no association.
Irradiation pain is associated with nerve or root irritation. Furthermore, in addition to back pain, the patient may complain of decreased sensitivity, goosebumps (paresthesia). Often, on examination, a neurologist can reveal pathological reflexes, which are also associated with impaired nerve impulse conduction.
Causes of back pain
Pain syndrome can manifest itself for a number of reasons:
- pathologies of the musculoskeletal system (trauma, sprain, hypothermia and other external causes);
- diseases of the spine (osteonecrosis, hernia);
- diseases affecting the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others);
- benign and malignant tumors;
- mental disorders (depression, anxiety, stress-induced psychosomatic pain).
In addition, everyday problems can become the cause of the appearance of a pathological symptom. Therefore, with an uncomfortable position in sleep after waking up, the patient may complain of neck or lumbar spine pain.
Pain of vertebral origin
With this type of pain, pathological changes of the degenerative type are observed in the spine. Therefore, the vertebral bodies and discs can be damaged. Often, pain that originates in the vertebrae may be related to a disease affecting the joints.
Statistically, patients who seek medical help complain of the occurrence of acute pain associated with spinal cord injuries. The cause may be herniated disc, spondylolisthesis or low back pain.
In less than 1% of all medical examinations, a tumor in the spine is detected. Metastasis of malignancies is rare, but they can also cause back pain of varying intensity.
Sick |
Code ICD-10 |
Specifics |
|---|---|---|
Bone tumor |
M42 |
A disease in which the discs and vertebrae are destroyed. Characterized by lookstraction and short-term pain during irradiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain. |
Disc herniation |
M51 |
A disease in which a bulge forms in the spinal canal. It appeara painful syndrome that occurs with coughing, sneezing, and physical exertion. |
Tooth decay |
M54. first |
A disease in which degenerative changes are observed in the roots. Characterized by appearanceaches and pains related to a change in body position or exertion. . . In addition to the pain syndrome, sensitivity disorders are added. |
Vaginal paralysis |
M54. 4 |
A pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is shooting out and very pronounced. |
Spondylolisthesis |
M47 |
A disease manifested by degenerative changes in the vertebrae. Of course there is a chronic type, pain when irradiated to the lower extremities, neck. |
It should be noted that each disease has its own characteristic features. That is why, when making a diagnosis, focus not only on the pathological data but also on the examination results. For this, modern diagnostic instrumental methods are used, which allow not only to determine the focus of the pathology, but also to determine its boundaries and the degree of inflammation or destruction of the anatomical structure of the spine. .
It is the vertebrae that cause the appearance of pain in the back. In addition to the diseases mentioned above, pain can occur during trauma and stretching of the musculoskeletal system. So, when overexerting or lifting weights, acute pain can come on suddenly.
Pain not originating in the vertebrae
According to statistics, no more than 2% of patients complain of pain of extravertebral origin. This category includes somatic diseases and conditions, including back pain.
The most common diseases that cause the appearance of pain syndrome are pathologies of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. Among the first group, the following are distinguished:
- artery occlusion,
- exertional angina,
- aortic aneurysm (in the abdomen or chest area).
In the second group:
- stomach ulcers,
- duodenal ulcer,
- gallstones,
- dyskinesia of the biliary tract,
- inflammatory changes in the pancreas.
Cardiovascular diseases often cause back pain. Therefore, with angina attacks, the patient is worried because the pain in the heart area spreads to the shoulder, arm or back. That is why when having an attack, the patient may complain of back pain.
With angina, the pain syndrome has its own characteristics. First, pain is devastating. Second, it appears behind the sternum radiating to the back, arms, or shoulders. Third, the pain syndrome disappeared after taking the drug immediately. It should be borne in mind that physical activity and stress provoke the occurrence of an attack.
An aortic aneurysm is a rupture of a blood vessel that weakens and then bulges. In this case, when going to the doctor, the patient complained of a dull pain in the heart area accompanied by irradiation of the back and lower extremities. Symptoms such as dizziness, weakness, and a sharp drop in blood pressure will also cause confusion. Back pain with an aortic aneurysm may be present both when localized to the thoracic region of the focus of the disease and to the abdomen.
It should be noted that the pain in 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 drugs and surgical methods.
Back pain is not only caused by cardiovascular diseases. In diseases affecting the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarities of the interior - inflammatory and degenerative changes in this area lead to the appearance of back pain.
Back pain during pregnancy
Pregnancy is a physiological condition, however, this process can be accompanied by the appearance of pain and other unpleasant symptoms. It is due to changes in the position of organs, hormonal changes, weight gain in the early and late stages.
During pregnancy, back pain can be caused by physiological and pathological changes.
In the first group, there are:
- natural weight gain during pregnancy, which increases the load on the skeletal system;
- enlargement of the uterus with the formation of a "children's" place, in which internal organs are displaced;
- The center of gravity shifts towards the end of pregnancy, when the bottom of the uterus descends.
The immediate cause of back pain during pregnancy can be infancy. It is characterized by the appearance of irregular contractions. In this case, due to the active work of the pelvic floor muscles, pain in the back and lower back may appear. However, due to the production of female sex hormones, as well as oxytocin, pregnant women may not feel these pains.
However, the occurrence of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If a medical condition is suspected, the pregnant woman may be asked to stay in the hospital for further monitoring.
The occurrence of severe back pain during pregnancy can be the cause of serious illness in pregnant women. This is due to the fact that during this period, ectogenital diseases in women can become aggravated. Usually diagnosed as pyelonephritis and cystitis. In addition, stone formation in the gallbladder or biliary tract can cause pain.
Exacerbation of pyelonephritis or cystitis is not only associated with the invasion of microflora into sterile organs. Most often, ectogenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy will worsen symptoms.
Back pain due to coronavirus
Coronavirus infections can also cause severe back pain. COVID-19 causes specific symptoms, including a sudden increase in temperature, unprovoked cough, chest pain, weakness, and fatigue. However, some patients also complain of back pain, which accompanies the onset of the coronavirus infection.
Among the main reasons are:
- exposure to toxins on the body;
- exacerbation of chronic diseases of the musculoskeletal system;
- the emergence of new, previously undiagnosed pathologies of the spine;
- disease caused by viruses.
Toxic syndrome is often accompanied by diseases affecting the upper and lower respiratory tract. The main clinical manifestations of the disease are weakness, fever, and pain. With coronavirus, as with other respiratory diseases, nonspecific back pain may appear. This is one of the symptoms of drunken syndrome. With effective drug therapy, pain intensity subsides after a few days.
The body's active fight against infections can trigger exacerbations of chronic diseases. In addition, against the background of a respiratory illness, previously hidden pathologies may appear. That is why patients may worry about back pain.
Among the main reasons, the occurrence of viral etiology is also distinguished. It can be associated not only with the formation of herniated discs. Spinal cord disease is of concern when a viral agent causes inflammation or irritation of the roots of the spinal cord.
Diagnostic measures
If you have back pain, you should immediately seek medical help. To diagnose a disease in this area, you should visit a neurologist.
The specialist at the front desk, after collecting detailed pathological data, should conduct a neurological examination of the patient. At the information collection stage, the following aspects should be paid attention to:
- the first appearance of back pain;
- the connection of pain with physical activity;
- the presence of concomitant diseases;
- localization of pain syndrome;
- duration of pain;
- presence of other symptoms.
After taking the history, the neurologist conducts an examination. At this stage, the specialist pays attention to the patient's walking pathology, the position of the spine, checking the presence or absence of reflexes.
To study the patient's gait, the neurologist asks the patient to walk a few meters in the office, as well as perform a number of tests. If, while walking, the patient is unable to transfer support to his legs, makes unnecessary movements - this is one of the obvious signs of a neurological disease.
In addition, the position of the spine must be evaluated. A neurologist notices the presence or absence of kyphosis, scoliosis, and scoliosis. The specialist assesses with the help of tests the patient's response to stimulated reflexes.
When back pain is present, it may be accompanied by a change in sensitivity. That is why a neuroscientist assesses the state of touch, temperature and other types of sensitivities. In addition, the specialist also notes the appearance of pathological sensations, such as a crawling sensation or tingling in the back.
After the examination, the neurologist may order some additional studies. Instrumental examination is necessary when necessary to determine the exact location of the pathological focus. Modern methods allow safe and painless examination, patients receive results in a few days.
To diagnose the cause of back pain, a neurologist may have a patient perform the following diagnostic measures:
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- X-ray of organs in the abdomen.
In some cases, additional tests may not be required to make a diagnosis. After receiving instrumental diagnostic results, the neurologist selects the optimal treatment strategy.
Back pain treatment
Treatment of acute or chronic back pain should be mandatory under the supervision of a physician. The independent use of drugs can not only lead to ineffective treatment, but also to the appearance of complications of the disease. That is why you should seek medical help from a specialist in case of back pain. After passing the diagnostic tests, the patient will be assigned treatment based on the characteristics of the clinic, the pathogenesis and the course of the disease.
A few years ago, in medicine, when back pain appeared, it was recommended to strictly adhere to the regime of bed rest. Now there is no need to restrict the patient's movement. In addition, wearing special bandages and using crutches or stilts when walking are also recommended.
Modern back pain treatments are based on evidence-based medicine. They not only use drugs, but also use non-drug treatments.
The following classes of drugs are used as drug therapy in medical practice for back pain:
- non-steroidal anti-inflammatory drugs;
- muscle relaxants to reduce muscle tone;
- analgesic.
The drug classes listed can be used both as monotherapy and in combination to achieve a curative effect. Along with medication for back pain, manual therapy is recommended.
In cases when the patient's pain syndrome is very pronounced, it is necessary to limit daily activities, as well as follow other recommendations of the physician, but in general, the previous level of physical activity should be maintained. .
For chronic back pain, in addition to the listed treatments, physical therapy (exercise therapy) methods can also be applied. Alternatively, a neurologist may recommend massage sessions. Particular attention is paid to cognitive-behavioral therapy along with taking antidepressants.
The duration of treatment is determined by a neurologist. In the event that the treatment is not effective, you should change the class of drugs, as well as conduct additional research.
Forecast
With timely diagnosis and correctly selected treatment strategies, back pain can be relieved after a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.
Preventive
To prevent the occurrence of back pain, you should adhere to a healthy lifestyle and properly allocate physical activity so as not to create an overload for different parts of the spine. In addition, concomitant diseases need to be diagnosed and treated promptly.