Back pain is one of the most common reasons people seek help from medical organizations. Pain syndrome can accompany diseases affecting the spine, kidneys, and other organs and systems. The treatment and prevention of back pain includes both medication and non-medication. The untimely provision of medical care can lead to chronicity of the disease with the development of complications.
Back pain is a separate symptom, not a nosological entity. For example, lumbodynia is pain localized in the lumbar spine. In addition, concepts such as thoracalgia or neck pain are distinguished. The exact localization of the pathological symptom is necessary in order to choose the right tactics of treatment and the choice of preventive measures.
Definition
Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of direct injury 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 the pain syndrome can occur due to the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver and others).
It should be noted that the pain syndrome may be accompanied by deterioration of the patient's cognitive abilities - memory impairment may appear, concentration decreases.
In most cases, the onset of back pain is a defensive reaction of the organism due to the influence of unfavorable factors. The most common cause of back pain is sciatica, herniated disc or spondylosis.
Epidemiology
According to statistics provided by the World Health Organization (WHO), back pain concerns more than 40% of the population. In some countries, this figure can reach 80%.
This problem can lead to early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among workers. That is why pathology is a problem not only in the medical field, but also in the sphere of economic activity.
Most often, people of working age between 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 appears.
In addition, men suffer from the disease more often than women. This is due to the peculiarities of work, physical labor, as well as other risk factors. According to statistics, 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 that physical activity exerts the most pressure.
Risk factors
Not only stress and exercise can provoke the appearance of this pathology. Some of the main risk factors include:
- working age from 30 years and over;
- Male;
- overweight and obesity (in which the body mass index exceeds 30);
- the presence of other conditions (for example, frequent migraines or diseases of the heart and blood vessels);
- static physical activity, which does not differ from each other in diversity;
- vibration exposure.
In addition, smoking is noted as a risk factor by some researchers. It is possible that a severe cough in a smoker is an indirect cause of pain.
Classification
A neurologist, after a detailed examination and examination, establishes the nature of the pain. There are several classifications, among which the pain syndrome that occurs in the back is subdivided depending on the place of onset of the pathology, duration, reasons and other features.
In terms of duration, the following types of pain are distinguished:
- sharp,
- subacute,
- chronic.
Patients with acute pain are most often treated on an outpatient basis. 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 said to be chronic.
Acute and subacute pain most often, with proper treatment, leads to complete recovery. Chronic pain syndrome can lead to early disability of the patient. That is why at the first clinical signs of pathology, you should consult a doctor. To do this, you must undergo an initial consultation with a neurologist.
In terms of intensity, the following types of pain are distinguished:
- weak
- mean,
- strong.
By the nature of back pain, there are:
- burst,
- painful,
- filming,
- pulling,
- stupid.
The nature of the pain depends on the pathology that caused the syndrome. So, with osteochondrosis, anxious pulling pain, which differs in irradiation of the lower extremities. With sciatica, throbbing pain appears, which is often one-sided.
Depending on the location of the back pain, there are:
- local (local),
- reflexive,
- radiating.
Local pain occurs when the pathological focus is located directly in 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 in the lumbosacral region of the spine, the pain syndrome is constant. Its character may change with a change in the position of the body due to irritation of the receptors.
Reflective pain occurs with pathology that affects internal organs. Associated with the anatomical features of innervation. So, with the reflective type, pain occurs in the area of dermatomes. The most common cause of back pain may be the pathology of the pancreas, uterus and its appendages.
Among the features of the reflective type of pain is the lack of connection with physical activity. If, with a change in the position of the body with a local type of pain, the intensity of the symptom increased, then in this case there is no connection.
Radiating pain is associated with irritation of a nerve or root. In addition, in addition to the appearance of pain in the back, the patient may complain of a decrease in sensitivity, the appearance of goosebumps (paresthesia). Often during the examination, a neurologist can reveal pathological reflexes, which are also associated with impaired transmission of nerve impulses.
Cause of back pain
Pain syndrome can occur for several reasons:
- pathology of the musculoskeletal system (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 and others);
- benign and malignant neoplasms;
- mental disorders (depression, anxiety, stress cause psychogenic pain).
In addition, everyday problems can become the cause of the appearance of a pathological symptom. So, with uncomfortable posture while sleeping 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 a degenerative type are observed in the spine. Thus, vertebral bodies, intervertebral discs can be damaged. Most often, pain of spinal origin can be associated with a disease affecting the joints.
According to statistics, patients who consult a doctor complain of the appearance of sharp pain associated with damage to the spine. The cause may be a herniated disc, spondylosis or lumbago.
In less than 1% of all cases of consultation with a doctor, neoplasms of the spine are detected. Metastases from malignant tumors are rare, but they can also cause back pain of varying intensity.
Sickness | CIM-10 code | Particularities |
|---|---|---|
Osteochondrosis |
M42 |
A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by appearanceshort-term tightness and pain with irradiation.Exposure to external factors in the form of exercise or coughing contributes to the increase in pain. |
Intervertebral hernia |
M51 |
A disease in which a bulge forms in the spinal canal. It seemsan acute pain syndrome that occurs with coughing, sneezing, and physical exertion. |
Radiculitis |
M54. 1 |
A disease in which degenerative changes are observed in the roots. Characterized by appearanceaching pain associated with a change in body position or physical exertion. . . In addition to the pain syndrome, there are also sensitivity disorders. |
Discogenic lumbodynia |
M54. 4 |
Pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is throbbing and very pronounced. |
Spondylosis |
M47 |
A disease manifested by degenerative changes in the vertebrae. Has a chronic type of course,pain while hurting with irradiation to the lower limbs, neck. |
It should be noted that each disease has its own characteristics. That is why, when making the diagnosis, attention should be paid not only to anamnestic data, but also to the results of examinations. For this, modern diagnostic instrumental methods are used, which allow not only to identify the pathological focus, but also to determine its limits and the degree of inflammation or destruction of the anatomical structures of the spine.
These are vertebrogenic causes that cause back pain to appear. In addition to the diseases listed above, pain may appear during trauma and stretching of the musculoskeletal system. So, with excessive physical exertion or lifting weights, a sharp aching pain may appear suddenly.
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 diseases and somatic conditions in which there is pain in the back.
The most common diseases that provoke the appearance of pain syndrome are the pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. Among the first group, we can distinguish:
- occlusion of the arteries,
- exertional angina,
- aortic aneurysm (in the abdominal or thoracic region).
Among the second group:
- stomach ulcer,
- duodenal ulcer,
- gallstones,
- dyskinesia of the bile ducts,
- inflammatory changes in the pancreas.
Cardiovascular disease often causes the onset of back pain. So, with angina, the patient is worried about the pain in the region of the heart, which radiates to the shoulder, arm or back. That is why, during a crisis, patients may complain of painful back pain.
With angina, the pain syndrome has its own characteristics. First, the pain is overwhelming. Second, it appears behind the breastbone radiating to the back, arms, or shoulder. Third, the pain syndrome goes away after immediate administration of the drug. It is worth noting that physical activity and stress provoke the onset of an attack.
An aortic aneurysm is a split in a blood vessel that weakens and then swells. In this case, the patient, when consulting a doctor, complains of the appearance of a dull pain in the region of the heart with irradiation of the back and lower extremities. Symptoms such as dizziness, weakness, sudden drop in blood pressure will also be bothersome. Back pain with aneurysm of the aorta can appear both with the thoracic localization of the pathological focus and with the abdominal localization.
It should be noted that the pain in the aneurysm is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are immediately put in place, including the use of drugs 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 a 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 state, however, the course may be accompanied by the appearance of pain and other unpleasant symptoms. This is due to changes in the location of organs, hormonal changes, early and late stage weight gain.
During pregnancy, back pain can be caused by physiological and pathological changes.
Among the first group, there are:
- natural weight gain during pregnancy, which increases the load on the osteoarticular system;
- enlargement of the uterus with the formation of a "child" place, in which the internal organs are displaced;
- a change in the center of gravity at the end of pregnancy, when the fundus of the uterus descends.
The immediate cause of back pain during pregnancy can be the preliminary period. It is characterized by the appearance of irregular contractions. In this case, due to the active work of the muscles of the pelvic floor, pain in the back and lower back may appear. However, due to the production of female sex hormones, as well as oxytocin, a pregnant woman may not experience these pains.
Nevertheless, the appearance of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If pathology is suspected, a pregnant woman may be asked to stay in the hospital for further observation.
The onset of severe back pain during pregnancy can be the cause of serious illness. This is due to the fact that during this period extragenital diseases in a woman can worsen. The most commonly diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile ducts can cause pain.
An exacerbation of pyelonephritis or cystitis is associated not only with the penetration 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 makes symptoms worse.
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, weakness, and fatigue. However, some patients also complain of back pain, which appeared with the onset of the coronavirus infection.
Some of the main reasons are:
- exposure to toxins on the body;
- exacerbation of chronic diseases of the musculoskeletal system;
- the emergence of new pathologies of the spine not previously diagnosed;
- viral radiculopathy.
Intoxication syndrome often accompanies diseases affecting the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pain. With the coronavirus, as with other respiratory illnesses, nonspecific back pain can develop. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the intensity of pain decreases after a few days.
The body's active fight against infection can provoke an exacerbation of chronic diseases. In addition, against the background of a respiratory disease, previously hidden pathologies may appear. This is why patients may be concerned about back pain.
Among the main reasons, the appearance of viral radiculopathy is also distinguished. It can be associated not only with the formation of an intervertebral hernia. Radiculopathy 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 help from a medical organization. To diagnose a disease in this area, you should consult a neurologist.
The specialist at the reception, after detailed collection of anamnestic data, should conduct a neurological examination of the patient. At the information gathering stage, attention is paid to the following aspects:
- the first onset of back pain;
- the link between pain and physical activity;
- the presence of concomitant diseases;
- localization of pain syndrome;
- the duration of the pain;
- the appearance of other symptoms.
After collecting the anamnesis, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the walking 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 meters in the office, as well as to perform some tests. If, while walking, the patient can not transfer the 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 is attentive to the presence or absence of kyphosis, lordosis and scoliosis. The specialist uses tests to assess 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 tactile, thermal and other sensitivity. In addition, the specialist pays attention to the appearance of pathological sensations, for example, a feeling of crawling or tingling in the back.
After the examination, the neurologist may order a number of additional studies. Instrumental examination is necessary when it is necessary to establish 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 send a patient for the following diagnostic measures:
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- X-ray of abdominal organs.
In some cases, additional tests may not be necessary to make a diagnosis. After receiving the results of instrumental diagnostics, the neurologist chooses 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 drugs can lead not only to ineffective therapy, but also to the development of complications of the disease. This is why it is recommended to consult a specialist in case of back pain. After passing the diagnostic tests, the patient will be prescribed treatment depending on the characteristics of the clinic, pathogenic 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. From now on, it is no longer necessary to restrict the patient's movements. In addition, wearing special bandages and using crutches or stilts when walking are also recommended.
Modern treatments for back pain are based on evidence-based medicine. They not only use drugs, but also non-drug treatment methods.
The following groups of drugs are used as drug therapy in medical practice for back pain:
- nonsteroidal anti-inflammatory drugs;
- muscle relaxants to reduce muscle tone;
- pain relievers.
The listed groups of drugs can be used both as monotherapy and in combination to achieve medicinal effect. In addition to back pain medication, manual therapy is recommended.
In the event that the pain syndrome of the patient is very pronounced, it will be necessary to limit daily activity and 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, physiotherapy (exercise therapy) exercise methods can also be used. Additionally, a neurologist may recommend massage sessions. Particular attention is paid to cognitive behavioral therapy as well as to taking antidepressants.
The duration of treatment is determined by a neurologist. In the event that the treatment was ineffective, you need to change the group of drugs and conduct additional research.
Forecast
With a timely diagnosis and properly chosen treatment tactics, back pain may go away after a few weeks. In a chronic course, long-term remission can be obtained if the recommendations of the attending physician are followed.
Prophylaxis
In order to prevent the onset of back pain, you need to adhere to a healthy lifestyle and distribute physical activity well, so as not to create an overload on different parts of the spine. In addition, concomitant diseases should be diagnosed and treated in a timely manner.