Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and one of the most urgent problems of modern health care, and the treatment of back pain is not an easy task.
Although the pain syndrome can occur in any part of the spine, the most common location is the waist - according to researchers, the prevalence of low back pain is as high as 76% in 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% of them experience a recurrence of the pain syndrome.
Types and manifestations of the pain syndrome
Depending on the affected part of the back, the pain syndrome is divided into neck pain, lumbar (chest pain), lumbar (back pain) or coccydynia (pain in the coccyx or sacrum).
According to the findings of a study involving 46 thousand volunteers from several European countries, chronic pain in various parts of the spine is inherent in 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8%of the population.
The duration of the pain is acute - lasts up to 12 weeks, or chronic - more than 12 weeks.
The pain can be dull or shooting, sometimes there is a burning and tingling sensation. Symptoms in some diseases also extend to the hands and arms, legs or feet, depending on the level of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of the accompanying manifestations of low back pain. Limitation of the range of some movements or increased pain with a certain position of the body is also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
Examination may not always be able to determine the immediate cause of back pain, so the pain is referred to as "non-specific" or "mechanical". The cause of this 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 the 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 body position - for example, the patient may feel better when sitting or lying down.
- the pain is often worsened by movement.
- an attack can develop suddenly or gradually increase.
- Sometimes back pain is the result of poor posture or awkward lifting, but often it occurs for no apparent reason.
- it can be caused by a minor injury, such as sprained ligaments or muscles.
- it can occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for developing non-specific back pain:
- heavy physical work;
- frequent bending and tilting of the body.
- lifting weights, especially from the wrong position.
- passive lifestyle;
- industrial influences, for example, vibration.
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute effect of an adverse factor.
The most common causes of acute low back pain are:
- trauma to various structures in the spine;
- spondylolisthesis - displacement of the vertebrae between them.
- 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 remember that acute pain marks the beginning of a disorder, while chronic pain corrects this pathological effect and resembles a developing disorder.
Conditions that can cause chronic back pain include:
- intervertebral disc displacement or prolapse.
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints of the spine);
- radiculopathy - inflammation and degeneration of the nerves that run from the spinal cord to the muscles and joints.
- arthritis and arthrosis of the spinal joints of various origins.
- infectious process (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 with severe back pain, it is desirable, first of all, to establish its cause. An accurate diagnosis is the key to a well-designed treatment plan.
After a thorough examination of the patient's complaints, history and nature of 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.
- The CT scanprovides detailed cross-sectional images of the spine, which show even small changes in the bones.
- Magnetic resonance imagingIt shows tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves or spinal cord.
- During the conductmyelogramsa special biological preparation is used - a dye that is injected into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic testingallows you to assess the electrical activity of the nerves in the upper and lower extremities.
- Positron emission bone scanreveals, first of all, bone oncopathology.
- Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone density.
Ways to deal with back pain
The complex structure of the pain syndrome in the region of the various parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.
The principles of treatment for a patient with chronic back pain, based on evidence-based medicine, include:
- explaining to the patient the causes of pain and, as a rule, its benign origin.
- Ensuring an adequate level of daily physical activity.
- the appointment of effective and safe treatment, mainly for pain relief.
- correction of treatment in case of ineffectiveness after 1-3 months.
Non-drug treatment for back pain
In most cases, a patient with back pain improves within 2-6 weeks. The main goal of non-specific treatment is to reduce movement restrictions, minimize recurrences, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.
Development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
Depending on the duration, the non-pharmacological treatment of low back pain can be divided into three phases.
I direct- passive physiotherapy during the acute period (6 weeks).
II stage- active exercise during the subacute period (6-12 weeks).
Stage III- physiotherapeutic restorative effect.
Bed rest is prescribed for acute back pain only for a limited time.
Various physical activities and forms of complementary and alternative medicine can help manage pain, including:
- non-specific physical exercise, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physiotherapy may also be recommended to strengthen the abdominal and spine muscles.
- 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 traction methods.
Medical treatment for pain
The most common medical treatments for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduces inflammation and back pain. However, this type of treatment is not intended for long-term use due to side effects of the drugs.
When is 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 with 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 physical therapy or medications have failed to provide adequate pain relief.
- Back pain is debilitating - it interferes with participation in daily activities or physical activity.
- symptoms adversely affect physical or emotional health.
- there are objective, diagnostically confirmed reasons to believe that spinal surgery will be beneficial.
- there is neurological damage.
Prevention of back pain
Maintaining a healthy lifestyle is key to preventing back pain. Excess weight puts strain on your back, so it's important to maintain a healthy weight. Regular exercise strengthens the abs and back muscles. Smoking accelerates the aging of blood vessels and many body tissues, including contributing to the aging of the spine, so refusing to use products containing tobacco is another step towards a healthy back. Correct posture, ergonomics in the workplace and avoiding a sedentary lifestyle are effective ways to prevent back pain.