Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, it is one of the most urgent problems of modern healthcare, and treating back pain is not an easy task.
Although the pain syndrome can occur in any part of the spine, the most common localization is the lower back - according to researchers, the incidence of low back pain reaches 76% among the adult population.
According to statistics, within 1 year, about 80% of people complain of at least one attack of pain in the lower back, and in the next 12 months, 75% experience a relapse of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected segment of the back, the pain syndrome is divided into cervical, middle back pain (chest pain), low back pain (lumbar pain) or coccydynia (coccyx or sacrum pain).
According to the results of a study involving 46, 000 volunteers from several European countries, chronic pain in various parts of the spine occurs in 24% of the population, in the lumbar region - in 18%, and neck pain in 8%. the population.
The duration of the pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.
The pain can be dull or throbbing, sometimes burning and tingling. The symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the degree of involvement of the spine. Numbness or weakness in the upper and lower limbs is another variant of the accompanying manifestations of back pain. Some patients with vertebral pain syndrome may experience limitation of range of motion or increased pain with certain body positions.
Back pain: why does it happen?
The examination may not always be able to determine the direct cause of the back pain, in which case the pain is called "non-specific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients. Secondary pain against the background of the underlying disease is about 2% of cases.
Non-specific back pain has the following characteristics:
- it tends to get better or worse depending on the position of the body - for example, the patient feels better when sitting or lying down;
- the pain is often aggravated by movement;
- the attack may develop suddenly or gradually increase;
- sometimes back pain is the result of poor posture or awkward lifting, but often occurs for no apparent reason;
- it can be caused by a minor injury, such as a ligament or muscle strain;
- it can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for the development of non-specific back pain:
- hard physical work;
- frequent bending and tilting of the body;
- lifting weights, especially from a bad position;
- passive lifestyle;
- industrial effects such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain is of physiological significance, as it indicates the acute effect of an adverse factor.
The most common causes of acute back pain are:
- trauma in various structures of the spine;
- spondylolisthesis - relative displacement of the vertebrae;
- sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the lower back to the legs
- cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
- intercostal neuralgia - caused by compression or irritation of the nerve roots of the intercostal nerves;
It is important to note that acute pain marks the onset of a disorder, whereas chronic pain records this pathological effect and is reminiscent of an emerging disorder.
Conditions that cause chronic back pain include:
- displacement or prolapse of the intervertebral disc;
- autoimmune joint diseases, such as ankylosing spondylitis (swelling of the joints of the spine);
- radiculopathy - inflammation and degeneration of nerves leading from the spinal cord to muscles and joints;
- arthritis and arthrosis of the spine of various origins.
- infectious processes (for example, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain
In order to understand what to do about severe back pain, it is first necessary to determine its cause. An accurate diagnosis is the key to a well-designed treatment plan.
After a thorough examination of the patient's complaints, anamnesis and the nature of the symptoms, the doctor may prescribe imaging tests and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- CT scanprovides detailed cross-sectional images of the spine showing even slight bone changes.
- Magnetic resonance imagingIt shows the structure of tissues and bones and is used to detect herniated discs, pinched nerves or the spinal cord.
- When drivingmyelogramsthey use a special biological preparation - a dye that is injected into the area around the spinal column to better visualize the condition of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic testingallows the evaluation of the electrical activity of the nerves of the upper and lower limbs.
- Positron emission bone scanabove all, it explores bone oncopathology.
- Densitometry - determination of bone density - indicatedin diseases and conditions leading to a decrease in bone mineral density.
Ways to treat back pain
The complex structure of the pain syndrome in different parts of the back and the stages of pathological changes require the need for a combination of drug and non-drug treatment.
The principles of therapy for patients with chronic back pain are based on evidence-based medicine:
- explains to the patient the causes of pain and its generally benign origin;
- Ensuring an adequate level of daily physical activity;
- appointment of effective and safe treatment, primarily for pain relief;
- correction of the therapy in case of its ineffectiveness after 1-3 months.
Non-pharmacological treatment of back pain
In most cases, a patient with back pain will improve within 2-6 weeks. The main goal of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical condition cannot prevent all painful episodes, it helps resolve these episodes.
The formation of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
The non-pharmacological treatment of back pain can be divided into three phases according to the duration.
I put it on stage- passive physiotherapy during the acute period (6 weeks).
Section II- active exercise during the subacute period (6-12 weeks).
section III- rehabilitation physiotherapy effect.
Bed rest can only be prescribed for a limited time in case of acute back pain.
Various physical activities and forms of complementary and alternative medicine can help manage pain, such as:
- non-specific physical exercises such as daily walking, cycling, swimming. In case of uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physiotherapy can also be recommended to strengthen the muscles of the abdomen and spine;
- Therapeutic massage is used for short-term pain relief but does not lead to long-term functional improvement;
- the use of acupuncture, manual therapy and spinal stretching methods.
Medical treatment of pain
The most common medical treatments for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injection of steroid hormones into the synovial cavity or epidural space of the spine, which reduces inflammation and back pain. However, this type of therapy is not suitable for long-term use due to the side effects of the drugs.
When is the surgery used?
While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may require surgical correction of spinal conditions. In general, a patient suffering from spinal pain can be operated on if the following criteria are met:- a structural problem has been diagnosed and confirmed by imaging (such as X-ray or MRI);
- conservative treatments such as physiotherapy or drugs did not provide adequate pain relief;
- back pain is debilitating - interferes with participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- there are reasons to believe that spine surgery will be beneficial, confirmed by objective diagnostic methods;
- there is damage to the nervous system.
Prevention of back pain
Maintaining a healthy lifestyle is the key to preventing back pain. Excess weight puts strain on the back, so it is important to maintain a healthy weight. Regular exercise strengthens the abdominal and back muscles. Smoking accelerates the aging of blood vessels and many tissues of the body, thus contributing to the aging of the spine, so refusing to use tobacco-containing products is another step towards a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.