Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndrome can be associated with diseases that affect the spine, kidneys, and other organs and systems. Treatment and prevention of back pain includes both medication and non-medication. Premature provision of medical care can cause chronic illness with the development of complications.
Back pain is a distinct symptom, not a nosological entity. For example, lumbodynia is pain that is localized in the lumbar spine. Concepts such as thoracalgia or cervicalgia are also distinguished. Accurate localization of the pathological symptom is necessary for the selection of the correct treatment tactics and the choice of preventive measures.
The definition
Pain is a pathophysiological condition that appears 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 unfavorable 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 and others).
It should be noted that pain syndrome may be associated with a deterioration of the patient's cognitive abilities - memory disorders may appear, concentration decreases.
In most cases, the onset 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 provided by the World Health Organization (WHO), back pain is a concern for more than 40% of the population. In some countries, this figure can be as high as 80%.
This problem can cause early disability of the patient. Moreover, pain syndrome is a common cause of temporary disability among working people. This is why pathology is a problem not only in the field of medical activity, but also in the economic one.
Most often, working people between the ages of 30 and 60 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, as a result of which acute and chronic pain appear.
In addition, men suffer from the disease more often than women. This is due to the peculiarities of work, physical work, as well as other risk factors. According to statistics, pain occurs much more often in the lumbosacral region.
Doctors explain this fact with the fact that it is in this part of the spine that physical activity exerts the most pressure.
Risk factors
Not only stress and exercise can cause the appearance of this pathology. Among the main risk factors are the following:
- working age from 30 years and above;
- man;
- overweight and obesity (in which body mass index exceeds 30);
- the presence of other pathologies (for example, frequent migraines or cardiovascular disease);
- static physical activity, which does not differ from each other in diversity;
- exposure to vibration.
In addition, smoking has been observed as a risk factor by some researchers. It is possible that a strong cough in a smoker may be an indirect cause of pain.
Distribution
A neurologist, after a thorough examination and examination, determines the nature of the pain. There are several classifications, among which the pain syndrome that appears in the back is divided according to the place of occurrence of the pathology, duration, reasons and other features.
In terms of duration, the following types of pain are distinguished:
- sharp,
- subakut,
- chronic.
Patients with acute pain are most often treated in the outpatient clinic. 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 proper treatment, lead to complete recovery. Chronic pain syndrome can cause early disability of the patient. This is why at the first appearance of clinical signs of pathology, you should seek medical help from 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
- average,
- strong.
By the nature of back pain, there are:
- exploding,
- it hurts
- shooting,
- pulling,
- FOOL
The nature of the pain depends on the pathology that caused the syndrome. So with osteochondrosis, attracting pain concerns, which varies in radiation to the lower extremities. With sciatic nerve pain, stabbing pain appears, which is often unilateral.
According to the localization of back pain, the following are distinguished:
- local (local),
- reflected,
- radiant
Local pain occurs when the pathological focus is located directly on 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 lumbosacral region of the spine, the pain syndrome is constant. Its character may change with a change in body position due to receptor irritation.
Reflected pain occurs with a pathology that affects the internal organs. Associated with anatomical features of innervation. So with the reflected type, the pain appears in the area of the dermatomes. The most common cause of back pain may be pathology of the pancreas, uterus and its appendages.
Among the features of the reflected type of pain, the lack of connection with physical activity is distinguished. If, with a change in body position with some kind of local pain, the intensity of the symptom increased, then in this case it does not matter.
Radiation pain is accompanied by irritation of the nerve or root. Moreover, in addition to the appearance of back pain, the patient may complain of a decrease in sensitivity, the appearance of goose bumps (paresthesia). Often, after examination, a neurologist can detect pathological reflexes, which are also associated with impaired transmission of a nerve impulse.
The cause of back pain
Pain syndrome can occur for several reasons:
- pathology of the musculoskeletal system (trauma, spasm, hypothermia and other external causes);
- spinal diseases (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 become the cause of the appearance of a pathological symptoms. So, with an uncomfortable stay in sleep after waking up, the patient may complain of pain in the neck or lumbar spine.
Pain of vertebral origin
With this type of pain, pathological changes of the degenerative type are observed in the spine. So vertebral bodies, intervertebral discs can be damaged. Most often, pain of vertebral origin can be associated with a disease that affects the joints.
According to statistics, patients seeking medical help complain of the appearance of acute pain associated with spinal cord injury. The cause may be a disc herniation, spondylosis or lumbago.
In less than 1% of all doctor visits, spinal neoplasms are detected. Malignant tumor metastases are rare, but they can also cause back pain of varying intensity.
disease |
ICD-10 code |
Features |
|---|---|---|
Osteochondrosis |
M42 |
A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by appearancetraction and short-term pain with radiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain. |
Intervertebral hernia |
M51 |
A disease in which a bulge forms in the spinal canal. She looka sharp pain syndrome that appears when you cough, sneeze, and exercise. |
Radiculitis |
M54. 1 |
A disease in which degenerative changes are observed in the root. Characterized by appearancepainful pain accompanied by a change in body position or physical exercise. . . In addition to pain syndrome, sensitivity disorders are added. |
Discogenic lumbodynia |
M54. 4 |
A pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is strong and very pronounced. |
spondilosis |
M47 |
A disease manifested by degenerative changes in the vertebrae. There is of course a kind of chronic, pain during radiation pain in the lower extremities, neck. |
It should be noted that each disease has its own characteristic features. This is why, when diagnosing, attention should be focused not only on the anamnestic data, but also on the test results. For this, modern instrumental diagnostic methods are used, which allow not only the identification of the pathological focus, but also the determination of its boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.
There are vertebrogenic causes that 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 physical exercise or weight lifting, an acute aching 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 somatic diseases and conditions in which there is back pain.
The most common diseases that provoke the onset of pain syndrome are pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. Among the first group, the following are distinguished:
- closure of arteries,
- exercise angina,
- aortic aneurysm (in the region of the abdomen or chest).
Among the second group:
- stomach ulcer,
- duodenal ulcer,
- kolelithiasis,
- biliary tract dyskinesia,
- inflammatory changes in the pancreas.
Cardiovascular diseases often provoke the onset of back pain. So with angina pectoris, the patient is concerned about pain in the region of the heart, which radiates to the shoulder, arm or spine. This is why, during an attack, patients may complain of back pain.
With angina pectoris, pain syndrome has its own characteristic features. First, the pain has an overwhelming character. Second, it appears behind the chest 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 the onset of an attack.
Aortic aneurysm is a rupture of a blood vessel that weakens and then comes out. In this case, the patient, when seeking medical help, complains of the appearance of dull pain in the region of the heart with radiation to the back and lower limbs. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also bother. Back pain with aortic aneurysm can appear with both thoracic localization of the pathological focus and abdominal one.
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 begin immediately, including the use of medication 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, however, the course may be associated with the onset 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 groups, there are:
- natural weight gain during pregnancy, which increases the load on the osteoarticular system;
- enlargement of the uterus with the formation of a "baby" site, in which the internal organs are displaced;
- a change in the center of gravity in late pregnancy, when the end of the uterus descends.
The immediate cause of back pain during pregnancy may be the premenstrual period. It is characterized by the appearance of contractions that are irregular. In this case, due to the active work of the pelvic muscles, pain may appear in the back and lower back. However, due to the production of female sex hormones as well as oxytocin, a pregnant woman may not feel these pains.
However, the appearance of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If a 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 during this period, extragenital diseases in a woman can worsen. The most diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile duct can cause pain.
A worsening 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 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, a nonproductive cough, chest pain, and weakness and fatigue. However, some patients also complain of back pain, which appeared along with the onset of coronavirus infection.
Among the main reasons are:
- exposure to toxins in the body;
- exacerbation of chronic diseases of the musculoskeletal system;
- the emergence of new, previously undiagnosed pathologies of the spine;
- viral radiculopathy.
Intoxication syndrome often accompanies diseases affecting 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 may occur. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the intensity of the pain decreases after a few days.
The body's active fight against infection can cause a worsening of chronic diseases. In addition, in the background of a respiratory disease, previously hidden pathologies may appear. This is why patients may worry about back pain.
Among the main reasons, the occurrence of viral radiculopathy is distinguished. It can be associated not only with the formation of an intervertebral hernia. Radiculopathy is troubling when a viral agent causes inflammation or irritation of the spinal cord roots.
Diagnostic measures
If you have back pain, you should immediately seek help from a medical organization. To diagnose a disease in this area, you should visit a neurologist.
The pending specialist, after a detailed collection of anamnestic data, should perform a neurological examination of the patient. In the information gathering phase, attention is paid to the following aspects:
- first appearance of back pain;
- the association of pain with 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 passes the examination. At this stage, the specialist pays attention to the gait of the patient with pathology, the position of the spine, checks the presence or absence of reflexes.
To study the patient's gait, the neurologist asks the patient to walk a few feet in the office, as well as perform some tests. If, while walking, the patient can not transfer support to his leg, performs unnecessary movements - this is one of the clear signs of a 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 evaluates with the help of tests the patient's response to the irritation of the reflexes.
When back pain occurs, the disease may be accompanied by a change in sensitivity. This is why a neurologist assesses the state of touch, temperature, and other types of sensitivity. The specialist also pays attention to the appearance of pathological sensations, for example, a feeling of crawling or needle piercing in the spine.
After the examination, the neurologist may prescribe a number of additional studies. Instrumental examination is necessary when it is necessary to determine the exact localization of the pathological focus. Modern methods allow a 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 refer a patient to undergo 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 required 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 back pain should be mandatory under the supervision of a physician. Independent use of medication can lead not only to ineffective treatment, but also to the appearance of complications of the disease. This is why it is recommended to seek medical help from a specialist in case of 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 observe 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 styles when walking.
Modern treatments for back pain are based on evidence-based medicine. They use not only medicines but also non-drug treatment methods.
The following groups of drugs are used as medical 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 medical effect. Along with medications for back pain, manual therapy is recommended.
In case the patient's pain syndrome is very severe, it will be necessary to limit daily activity as well as adhere to the recommendations of other doctors, but in general, the level of previous physical activity should be maintained.
For chronic back pain, in addition to the listed treatment methods, methods of physiotherapy exercises (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Special attention is paid to cognitive-behavioral therapy along with taking antidepressants.
The duration of treatment is determined by a neurologist. In case the treatment was ineffective, you should change the group of drugs, as well as do additional research.
prediction
With timely diagnosis and chosen treatment tactics, back pain can be reduced after a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.
Prophylaxis
To prevent the onset of back pain, you need to adhere to a healthy lifestyle and properly distribute physical activity so as not to create an overload in different parts of the spine. In addition, concomitant diseases must be diagnosed and treated in a timely manner.