Backache

Low back pain is often called lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute back pain, which is usually accompanied by hypothermia and strain. Lumbago occurs in many people and is often the cause of temporary disability. Often, sports injuries or sprains can be the cause of lumbago, but sometimes the factor that provokes the onset of pain remains unknown. Lumbago is characterized by pain without radiation to the legs. Low back pain (lumbago) can appear acutely and gradually progress throughout the day. There is often stiffness in the morning and gradually the stiffness turns into pain syndrome. Bending of the spine (analgesic scoliosis) is also possible as a result of muscle spasm. The pain itself may be due to muscle spasm, which in turn is related to other causes. This can be overload or sprain, sports injuries, disc herniation, spondyloarthritis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the cause-and-effect relationship of the appearance of the disease with strain, hypothermia, but often the pain appears for no apparent reason. Sometimes, back pain can also appear after sneezing, bending over or putting on shoes. This can be alleviated by deforming diseases of the spine, such as scoliosis.

Unlike lumbago, the term lumbodynia does not mean acute pain, but subacute or chronic pain. As a rule, pain with lumbodynia appears gradually over several days. The pain can also appear in the morning hours and can decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (lowering, uncomfortable body position). Also for lumbodynia it is characteristic that the pain is relieved by lying in a certain position. Patients with lumbodynia have difficulty performing routine activities such as washing or wearing shoes due to muscle spasms. Due to the disease, a decrease in the volume of trunk movements is observed (bending forward or, to a lesser extent, tilting to the side or stretching). Due to the pain syndrome, the patient often has to change position when it is necessary to sit or stand. Unlike lumbago, muscle spasm is less pronounced and, as a rule, does not cover the entire lower back and there are often signs of spasm spreading to one side.

Causes of back pain

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of muscles, bones and intervertebral discs. SOMETIMESbackachecan be caused by diseases of the abdominal cavity, pelvis and chest. Such pains are called reflected pains. Abdominal diseases (eg appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), infections of the pelvic organs, ovaries - all of these diseases can occurbackache. . . Even a normal pregnancy can lead to pain in the lower back due to spasms in the pelvic area, muscle spasms due to stress and nerve irritation.

oftenbackacheassociated with the following diseases:

• Nerve root suppression, which causes symptoms of sciatic nerve pain and is most often caused by a disc herniation. As a rule, when the nerve root is compressed, the pain is acute, there is impaired radiation and sensitivity in the area of innervation of the nerve root. A disc herniation occurs mainly as a result of disc degeneration. There is a swelling of the gelatinous part of the disc from the central cavity and pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at the age of 30 years and above. But the very presence of a hernia does not always lead to an effect on nerve structures.
• Spondylosis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) occur, which can affect nearby nerves, leading to pain.
• Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience radiating pain in the lower back in both legs. Low back pain can occur as a result of standing or walking.
• Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs as a result of compression of the elements of the cauda equina (the final part of the spinal cord). A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atony). This syndrome requires urgent surgery.
• Pain syndromes like myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and soreness at certain points (stimulus points), a decrease in the volume of muscle movement in the painful areas. Pain syndrome is reduced by relaxing the muscles located in the painful areas. With fibromyalgia, aches and pains are common throughout the body. Fibromyalgia is not characterized by tightness and muscle pain.
• Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
• Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially bad in the morning.
• Tumors, most often cancer metastases, can be a source of concern in the lower back.
• Inflammation of the nerves and, accordingly, manifestations of pain (in the chest or lumbar region) can be caused by damage to the nerves themselves (for example, with herpes)
• Given the variety of causes of symptoms, such as acute or subacute back pain, it is very important to fully evaluate the patient and perform all necessary diagnostic procedures.

Symptoms

Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, lumboishalgia.

• The pain may radiate to the front, side, or back of the leg (lumbar ischalgia), or it may be localized only to the lumbar region (lumbago, lumbodynia).
• The feeling that the lower back hurts may intensify after straining.
• Sometimes the pain can get worse at night or when you are sitting for a long time, such as during a long drive.
• Perhaps the presence of numbness and weakness in the part of the leg, which is located in the innervation area of the compressed nerve.

For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:

• A recent history of injuries, such as a fall from a height, a traffic accident or similar incidents.
• Presence of minor injuries in patients over 50 years of age (for example, falling from a low height as a result of slipping and lowering the buttocks).
• History of long-term steroid use (for example, these are patients with bronchial asthma or rheumatic diseases).
• Any patient with osteoporosis (mostly older women).
• Every patient over 70 years old: at this age there is a high risk for cancer, infections and diseases of the abdominal organs, which can cause pain in the lower back.
• History of oncology
• The presence of infectious diseases in the recent past
• Temperature above 100 F (37, 7 C)
• Drug use: Drug use increases the risk of infectious diseases.
• Pain in the lower back worsens at rest: as a rule, this nature of pain is associated with oncology or infections, and such pain may also be with ankylosing spondylitis (ankylosing spondylitis).
• Significant weight loss (for no apparent reason).
• The presence of any acute nerve dysfunction is a signal for urgent medical attention. For example, this is a gait disorder, foot dysfunction, as a rule, are symptoms of acute nerve damage or compression. In certain circumstances, such symptoms may require urgent neurosurgical surgery.
• Bowel or bladder dysfunction (both incontinence and urinary retention) can be a sign of a medical emergency.
• Failure of recommended treatment or increased pain may also require seeking medical attention.

The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.

Diagnosing

Medical history is important to make an accurate diagnosis, as different conditions can cause pain in the lower back. Time of onset of pain, connection with physical exertion, presence of other symptoms such as cough, fever, bladder or bowel dysfunction, presence of seizures, etc. A physical examination is performed: identification of pain points, presence of muscle spasm, a neurological status study is performed. If there is a suspicion of diseases of the abdominal cavity or pelvic organs, then an examination is done (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, blood urine tests).

If the somatic genesis of back pain is ruled out, then instrumental research methods such as radiography, CT or MRI may be prescribed.

X-rays are the initial method of examination and allow you to determine the presence of changes in bone tissue and indirect signs of changes in intervertebral discs.

CT allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).

MRI is the most informative research method that allows the diagnosis of morphological changes in various tissues.

Densitometry is necessary when osteoporosis is suspected (usually in women over 50)

EMG (ENMG) is used to determine conduction disturbances along nerve fibers.

Laboratory tests are prescribed (blood tests, urine tests, blood biochemistry) mainly to rule out inflammatory processes in the body.

Pain treatment

Once the diagnosis and confirmation of vertebral genesis with lumbago and lumbodynia is established, a definite treatment for back pain is prescribed.

In acute pain, rest is needed for 1-2 days. Resting in bed can reduce muscle strain and muscle spasm. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome subsides within a few days without the use of medication, just because of rest.

Treatment. NSAIDs are used for pain syndrome. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also has certain risks. Since all drugs in this group have many side effects, taking drugs in this group should be short-lived and under the mandatory supervision of a doctor.

Muscle relaxants can be used to relieve spasm. But the use of these drugs is effective only in the presence of a spasm.

Steroids can be used to treat pain, especially when there are signs of sciatica pain. But due to the presence of pronounced side effects, steroid use should be selective and short-lived.

Manual therapy. This technique can be very effective in the presence of muscle blocks or subluxation of the aspect joints. Mobilizing motor segments can reduce both muscle spasm and back pain.

Physiotherapy. There are many modern physiotherapy procedures that can reduce pain and inflammation, improve microcirculation (for example, electrophoresis, cryotherapy, laser therapy, etc. ).

Exercise therapy. Exercise is not recommended for acute back pain. Connection of exercise therapy is possible after the reduction of pain syndrome. In the presence of chronic pain, exercises can be very effective in strengthening the muscle corset and improving the biomechanics of the spine. Exercises should only be chosen with an exercise therapy physician, as often independent exercises can lead to increased manifestations of pain. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can maintain spinal functionality and significantly reduce the risk of pain syndromes.