Nowadays, back pain is the second most common reason for patients seeking medical attention. According to the US National Institutes of Health, one in five middle-aged people has pain.
At the same time, the morbidity rate increases with age only. In medical practice, pain (back pain) is considered an interdisciplinary pathology, since there is a symptom in the clinic of both neuropathy and somatic disease.
What Causes Back Pain?
Back pain in 90% of cases occurs with diseases of the spine (spinal pain). In some other cases, the cause may be due to pathologies of internal organs, spinal cord, . . . (non-vertebrae pain).
So the backbone group includes:
disc herniation- ;
- sacra- or lumbization;
- degenerative vertebrae;
- osteoporosis; Tumor processes
- of the vertebra;
- trauma (spina bifida, spondylolisthesis)
Non-vertebral group includes:
- psychological pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formation (neuroma) and metastasis;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its intensity and duration, varies depending on the underlying medical condition.
- Disc herniation.A cranial convex appears between the vertebrae with the development of osteonecrosis. In this case, the pain may be sharp or painful and of a local nature (depending on the extent of the affected disc). The pain often extends to the extremities, accompanied by numbness and tingling. In severe cases (when the skull sac compresses the nerve roots), motor dysfunction and sensitivity of the arms or legs may appear. Rarely there are violations of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacra or sterilization.Cellulitis is a birth defect involving the fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is paralysis, when the first vertebra of the sacrum is detached and becomes an additional lumbar vertebrae. Usually there are no symptoms, but the clinic is caused by excessive physical activity or heavy lifting. In such cases, there is a lumbar pain in the sacral region, which increases with movement, spreading down the lower extremities. Pathology is also characterized by an appearance in a young age (usually in the age of 20-25).
- Spondylolisthesis.Spondylolisthesis (unlike previous diseases) mainly occurs in the elderly. This disease develops due to changes in the aging of the spine - its "wear and tear". Pathology accompanied by the development of bone tissue in the form of osteoporosis, can lead to complete fusion of the vertebrae. Then there is danger with damage to the nerve bundles, muscles and surrounding organs. This disease is accompanied by chronic pain and gets worse at the end of the day. Sometimes pain syndrome manifests itself not only with exercise but also during rest leading to insomnia. With an uncontrolled disease, there are frequent cases of immobilization of the vertebral joints, as well as compression of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis.Osteoporosis is a metabolic disorder in which bone destruction is more dominant than bone formation. The clinical picture of the disease is minimal: usually the pathological process has no symptoms and is detected by chance (by X-ray). However, in the later stages of the disease, dull pain, as well as posture curvatures appear.
- Tumor formation of the vertebra.Spinal tumors usually have no symptoms until they have grown large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower spine), which can spread down the thighs and lower legs. Sooner or later, the tumor develops, leading to compression of the nerve roots, manifested by neurological disorders: loss of sensitivity and movement in the limbs.
- Injured.Common causes of acute pain, limited mobility, and neurological symptoms are spinal injuries: fractures, bruises, dislocations / spinal deflection, as well as "slippage" of the spine due todamage to the ligamentous apparatus - vertebrae. Usually, the patient notices a strong diffuse pain in the back, the presence of hemorrhage ("bruising"), local swelling and limited movement.
- Psychological pain.A similar view occurs in the context of full health after an outbreak or emotional stress. The patient describes the pain in different ways, only limited by the patient's imagination. Sometimes there is a so-called. "Painful behavior" when people, while maintaining mobility, tend to use auxiliary aids: crutches, canes and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is very similar to the psychological pain syndrome. At the same time, aches and pains are also caused by stress, climate, and overload. However, an important difference is that pain should be observed for more than three months, accompanied by local sensitivity at the characteristic points (occipital attachment, between radial muscles, etc. ). In addition, the diagnosis requires the complete elimination of all types of somatic diseases.
- Pathologies of internal organs.Back pain often can occur with diseases of different organs of the body. So, with a heart attack, pain syndrome is localized behind the sternum, spreading below the collarbone and left arm, as well as in the spine. With pneumothorax (accumulation of air under the lung mucosa), acute chest pain occurs, spreading to the spine. A symptom complex arises against the background of dyspnea and cyanosis. In inflammatory pancreatitis (inflammation of the pancreas), pain syndrome has another characteristic, arising in the upper abdomen in a "lumbar" pattern, covering the sides and back. Back pain appears with vomiting and indigestion. One complication of urolithiasis is pain in the kidneys - an acute, paroxysmal pain syndrome. Usually, the pain is so intense that the patient has to bend over to find ways to relieve the pain. Against the background of an attack, urine turns a dirty red color due to impurities in the blood.
- Tumor processes.An adenoma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, back pain often occurs, as well as loss of sensitivity and motor activity below the damage level. It should also be noted that this tumor process is usually benign. However, a similar clinical picture can be caused by metastasis of breast, prostate, lung, and kidney cancer, etc. v.
- Epidural abscess.Epidural abscess is a buildup of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome accompanied by neurological disorders: paralysis (decreased muscle strength), loss of sensitivity, pelvic disorders, . . . Pus production often occurs against the background of infection, wound, immunodeficiency or as a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system in which cavities appear in the spinal cord. Injuries, tumors, brain compression, . . . cause disease, in the first stage there will be a slight ache in the spine, not bringing discomfort. This is followed by weight loss, muscle weakness, loss of sensitivity to pain, no sweating, and easy fracture. Often there are injuries to the joints, bones (burns, fractures, cuts), however, due to insensitivity to pain, they pass away not easily noticed.
Diagnosis
For diagnosis, it is necessary to conduct qualitative examination and physical examination of the patient by touching (sensory), percussion (percussion) and listening to the fetal heart (hearing). For some pathologies, it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs you will need instrumental diagnostic methods: ultrasound or magnetic resonance imaging. X-rays and computed tomography are used to examine the skeleton directly.
In some cases less common techniques may be required: bone scintigraphy, electromechanical measurements, etc. v.
Back Pain Treatment
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), not be physically active, and immobilize your spine if possible. If the pain cannot be tolerated, a pain reliever can be taken. However, it is worth remembering that the clinic's "lubricating" anesthesia. This can then complicate a diagnosis. Only a attending physician can prescribe medication.
Removable disc
Drug therapy is mainly based on the use of anti-inflammatory drugs (Diclofenac, ibuprofen) and pain relievers (Ketorolac). In some cases, surgical removal of a herniated disc, as well as laparoscopic surgery of the disc, may be required.
Sacra or lumbization
When pain occurs, anesthetics are prescribed, as well as physiotherapy (using paraffin, electrophoresis, etc. ). With the inefficiency of conservative treatment, regenerative activities are indicated.
Spondylolisthesis
Anti-inflammatory drugs (Meloxicam, Indomethacin), as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammatory and pain syndrome.
Osteoporosis
Treatment for osteoporosis begins with a diet high in calcium and vitamin D.
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogen, calcitonin, and parathyroid hormone is used.
Tumor process
Treatment of tumor diseases including chemotherapy and surgery. In this case, the amount of assistance depends on the specific clinical case.
Injury
In case of minor injuries, gentle and start-up mode is required. In some cases, it is necessary to reduce or decrease the pulling force of the bone. When neurological symptoms appear, surgery with bone fragmentation is performed.
Psychological pain
Helps to relieve psychological pain including complex psychotherapy, as well as taking antidepressants (fluoxetine, Sertraline).
Fibromyalgia
Since the cause of the disease is unknown, symptomatic therapy is indicated: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), sleeping pills (Zopiclone) or an antidepressants. God (Diazepam). It is also important to train yourself to be positive, avoid stressful situations, and to stay in a warm, dry climate.
Pathology of internal organs
Every possible medical condition requires its own treatment strategies. Urgent care for a heart attack is to take Nitroglycerin (one pill every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; pneumothorax - a tight bandage (sealing) in the case of an open wound of the lung; with cramping pain - antispasmodics (Drotaverin, Metamizole sodium) and warming.
Epidural abscess
Urgent surgical treatment to normalize pressure in the spinal canal and meningeal drainage. Antibiotic therapy (Amoxicillin, Cefotaxime) supports surgical intervention.
Syringomyelia
Usually, patients are advised to protect their skin from cuts and burns (this usually happens because the patient loses sensitivity and does not feel trauma). Pain relievers, antidepressants (Fluoxetine), and antipsychotics (Chlorpromazine) are also prescribed. In some cases, surgical intervention is possible to correct the formed cavities of the spinal cord.
Prevent return
To prevent back pain, it is necessary to prevent the occurrence of each of the above conditions. To do this, you need:
- Normalizing lifestyle: reducing body weight to normal level; follow a proper diet rich in trace elements and vitamins; ensure proper physical activity without overexertion.
- Give up bad habits: smoke and drink alcohol.
- Correct posture scoliosis (scoliosis, neck scoliosis) and orthopedic disorders (flat feet, clubfoot, etc. ).
- Timely diagnose and treat concurrent diseases of musculoskeletal system or internal organs.
- Prevent or properly treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It should be remembered that back pain is not an individual illness, but a symptom of a disease. The main illness can be extremely serious and if left untreated can lead to disability and even death for the patient!