Back pain (synonymous with back pain) is one of the most common reasons for medical consultation - the second after acute respiratory diseases1. Most of the time, these complaints reach a neurologist, therapist or general practitioner. According to international studies, from 19 to 43% of the adult population surveyed recently, noticed back pain in the last month, from 27 to 65% - last year. Those who have been through this at least once in their life are 59-84% 1. Almost every fifth adult inhabitant of our planet can experience severe back pain at this time. Its most common location is the lower back and lower back.
Why does back pain occur?
Among the main reasons for the development of back pain are:
Vertebral causes - associated with spinal pathology:
pathology of intervertebral discs, including hernias;
spinal canal narrowing;
joint diseases;
the consequences of injuries;
congenital malformations and developmental anomalies;
metabolic disorders;
spondylitis - inflammatory processes in the intervertebral joints.
Non-vertebrogenic - not associated with spinal pathology:
ligament and muscle sprains associated with heavy loads;
myofascial syndrome - chronic muscle pain;
muscle tissue inflammation - myositis;
diseases of Organs internal organs;
large vessel pathology, eg, aneurysm (sharp expansion) of the abdominal aorta;
hip joint arthrosis - a dystrophic inflammatory disease;
mental disorders, etc.
Depending on the origin, the following types of pain are differentiated:
Specific- is associated with a specific disease that can be detected by standard examination methods. This type takes up up to 3% 1 of all cases. They can be spinal compression fractures, tumors, infectious processes, diseases of Organs pelvic organs (especially with back pain in women).
At the same time, there are some symptoms, so-called "warning signs", which speak of serious illnesses and require further examination. These include:
rapid and irrational loss of body weight and/or indication of a history of oncopathology (tumors);
weakness in the lower extremities, impaired sensation and function of Organs pelvic organs (cauda equina syndrome);
the use of antibiotic therapy, increased body temperature (infectious processes);
previous trauma or previous diagnosis of osteoporosis, age over 55 years (spine fracture);
young age - up to 20 years;
long-term preservation of painful sensations and their intensity despite treatment;
combined with general weakness or gait disturbances, aggravated at night, it does not change with a change in body position.
root- close in frequency (up to 27%). It develops as a result of pinching and/or inflammation of the spinal cord root, which exits through openings in the spine. This type may be indicated by increased pain from coughing, sneezing, physical exertion, and other types of activity.
Non-specific- more often acute, it is difficult to immediately determine the specific cause of its development, usually the consequences of dystrophic changes in bone, cartilaginous tissue of the spine, as well as in the muscles and ligaments that make up the back support apparatus. In the International Classification of Diseases (ICD-10), there is a special section for the definition of such syndromes - dorsopathies.
This back pain accounts for up to 85% 1 of all cases and is primarily associated with disturbance to the normal functioning of individual spinal structures, any of which can become a source of pain impulses. Pain can be compressive (due to compression of the nerve roots) and reflex - from all other tissues, including spasmodic muscles.
Another type of pain syndrome is described, which is not associated with any organic damage to the spine and paravertebral tissues. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.
Location distinguishes:
what is the name of
where it hurts
neck pain
neck ache
cervicocranilagia
neck + head
cervicobrachialgia
neck and hands
chest pain
thoracic back pain and chest pain under the shoulder blades in the back
lumbodynia
lower back and lumbosacral region
sciatica
lower back + leg
sacralgia
sacrum
coccygodynia
coccyx
In addition to the reasons, it is possible to identify factors that can cause the development of the pain syndrome:
severe physical overload, resulting in excessive stretching of muscles and ligaments;
uncomfortable or static postures that a person assumes for a long time;
untrained muscles and their overload, inactivity;
trauma and microtrauma;
hypothermia;
prolonged immobility such as bed rest;
alcohol abuse;
diseases of Organs internal organs;
joint pathology;
overweight;
individual characteristics: curvature of the spine, stooped posture;
poor nutrition, digestive diseases, which may be accompanied by decreased absorption of vitamins, mineral metabolism, significant intake of salts that affect the joints;
occupational hazards: thermal effects, temperature fluctuations, vibration, working with weights, etc.
The back pain development mechanism is associated with intervertebral joint blockage, which can be caused by loads, both static and dynamic, microtrauma and non-physiological postures. As a result, in one place the muscles contract and overextend, and in another they overextend. All of this leads to the development of muscle pain, changes in pain sensitivity, and the formation of pathological pain impulses.
Also, muscle spasm can be a reflex reaction to spinal pathology or internal organ ailments. In this case, it is seen as a defensive reaction, but at the same time it starts a new circle of pain. Furthermore, with the prolonged preservation of the spasm, the transmission of nerve impulses to muscle fibers is interrupted, they become more excitable, calcium deficiency may occur, and circulatory disturbances further aggravate the situation.
According to the duration of the back pain, there may be:
acute - lasting up to 6 weeks;
subacute - from 6 to 12 weeks;
Chronic - last 12 weeks or more.
Symptoms
The symptoms of back pain depend on the cause, the mechanism of development and the presence of concomitant diseases.
For nonspecific pain, the following signs are characteristic:
aching or pulling pain, sometimes squeezing;
increases with load or movement of the spine, as well as in certain positions, may decrease when kneading or rubbing muscles, as well as after resting in a comfortable position;
possible pain in the sides of the back or back pain;
during probing, compaction, contour changes, tension is determined, but there are no disturbances in sensation in the painful area, decreased muscle strength, reflexes do not change.
When the nerve root is compressed (radiculopathy), the pain differs in intensity, it can be sharp, often radiates to the leg, and it can be stronger in the limb than in the back. On physical examination, symptoms of damage to a specific nerve root are seen - muscle weakness, impaired sensation in a particular area.
Diagnosis
The diagnostic algorithm for acute and chronic back pain is a little different.
Acute pain
To determine treatment tactics, the physician should, if possible, determine the cause of the pain syndrome: pinched nerves or their roots, trauma, tumor, inflammation, infection, osteoporosis, internal organ diseases, etc. As a rule, these types of pain have very vivid and specific clinical manifestations. After examination and palpation, patients are referred to the appropriate specialists or for additional examinations, for example:
X-ray examination;
Magnetic resonance imaging and computed tomography of the spine;
scintigraphy - a method of visualization using the introduction of a contrast agent;
densitometry - determination of bone density;
laboratory tests to determine tumor markers, rheumatic tests, biochemical blood tests, etc.
Patients with non-specific acute pain usually do not need further research.
Chronic pain
Since the mechanisms of its development have not been sufficiently studied, it can be problematic to identify the origin, especially if it is a dysfunctional species that reflects the pathology of other organs. It can be a manifestation of diseases such as irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and others. In either case, a full interview and patient examination is performed to decide on other treatment tactics.
For pain syndrome that occurs in the context of dystrophic changes in the joints, after any mechanical stress or under the influence of other factors, it is possible to use MRI to track the dynamics of the spinal state.
How To Cope With Acute Back Pain
Physicians who adhere to the principles of evidence-based medicine use the following tactics to treat patients with acute back pain:
inform the patient about the causes of the pain syndrome;
exclude bed rest and recommend maintenance of usual activity;
prescribe effective drug and non-drug treatment;
monitor dynamics and adjust therapy.
When choosing a drug, one should pay attention to its analgesic effect, speed of action and safety. First, non-specific anti-inflammatory drugs (NSAIDs) are prescribed, as their effectiveness has already been proven for back pain. One such drug is naproxen.
Naproxen is available as an oral tablet and gel for external use. The drug is indicated as an analgesic for back pain associated with trauma, overload, inflammation. It also has anti-inflammatory and antipyretic effects, the duration of the effect can last up to 12 hours. If you do not have the opportunity to visit a doctor soon and the pain causes significant discomfort, you can take naproxen as follows: 2 tablets as a starting dose and 2 tablets every 12 hours or 1 tablet every 8 hours. The hospitalization course without consulting the doctor is not longer than 5 days.
Maintaining pain intensity, it is possible to prescribe other groups of analgesics and sedatives (sedatives).
Non-drug treatments include:
heating;
manual therapy;
physiotherapy;
massage;
physiotherapy;
acupuncture and other alternative methods.
Chronic Back Pain Treatment
If the location of the pain and the source of the pain impulses can be identified, then local therapy is used—blockages, intradiscal influences, and other procedures. For the rest of the patients, this treatment for back and lower back pain is not used, so a different treatment regimen is used. Its main objective is to reduce pain intensity and preserve quality of life.
In addition, as in acute pain, medications from the NSAID group are prescribed, including naproxen, other analgesics, muscle relaxants and vitamin B3. Antidepressants are recommended as needed. Manual therapy must be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic methods of treatment are used.
Prophylaxis
To prevent back pain, it is necessary to identify all possible risk factors and work to eliminate them.
For all types of pain, the following will be helpful:
adequate physical activity and muscle strengthening, including the back;
timely treatment of chronic diseases of internal organs;
maintain a physiological posture while working;
stop smoking and alcohol;
regular preventive exams;
proper treatment and prevention of infections;
Balanced diet;
wear comfortable shoes and clothing;
correct organization of the workplace and life to protect the back;
prevention of stress and emotional overload.
Comprehensive treatment and comprehensive rehabilitation of patients with back pain help to preserve their quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.
