Today, back pain is the second most common reason for patients seeking medical help. According to the American National Institutes of Health, one in five middle-aged people has pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (dorsalgia) is viewed as an interdisciplinary pathology, since both neurological and somatic diseases are symptomatic in the clinic.
What is the cause of back pain?
Back pain occurs in 90% of cases with diseases of the spine (vertebral pain). In other cases, the cause may be pathologies of the internal organs, spinal cord, etc. (non-vertebral pain).
Thus the vertebrogenic group includes:
- intervertebral hernia;
- sacra- or lumbarization;
- spondylosis;
- osteoporosis;
- tumor processes of the vertebrae;
- trauma (vertebral body fractures, spondylolisthesis).
The non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (myocardial infarction, pneumothorax, pancreatitis, urolithiasis, etc. );
- Tumors (neuromas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The type of back pain, its severity and duration vary depending on the underlying pathology.
- intervertebral hernia.A hernia protrusion appears between the vertebrae with the development of osteochondrosis. In this case, the pain can be sharp or painful and local in nature (depending on the height of the affected disc). Pain often extends to the limbs, accompanied by numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), disorders of the sensitive and motor spheres of the arms or legs can occur. Rarely, there are violations of urination, bowel movements and sexual function (with damage to the pelvic spine).
- Sacra or lumbarization.Sacralization is a congenital abnormality associated with the fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum is severed and becomes an additional lumbar vertebra. Usually pathologies are asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, there is lumbar pain in the sacrum area, which increases with movement and spreads to the lower extremities. The pathology is also characterized by the fact that it occurs at a young age (usually from 20-25 years of age).
- Spondylosis.Spondylosis (unlike the previous disease) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear and tear". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to a complete fusion of the vertebrae. The latter is dangerous with injuries to neurovascular bundles, muscles and surrounding organs. The disease is associated with chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only when moving, but also at rest, which leads to insomnia. An uncontrolled disease often leads to immobilization of the vertebral joints and pinching of the nerve fibers with the development of characteristic neurological disorders.
- osteoporosis.Osteoporosis is a metabolic disorder in which the processes of bone destruction outweigh bone formation. The clinical picture of the disease is sparse: usually the pathological process is asymptomatic and detected by chance (using X-rays). However, in the later stages of the disease, dull pain, as well as a curvature of posture, appear.
- Tumor processes of the vertebrae.Vertebral tumors are often asymptomatic until they become large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower spine) that can spread to the thighs and lower legs. Sooner or later, tumor growth leads to compression of the nerve roots, which manifests itself in neurological disorders: loss of sensitivity and limb movement.
- injuries.A common cause of acute pain, restricted mobility and neurological symptoms are injuries to the spine: fractures, bruises, dislocations / subluxations and "slipping" of the vertebrae due to damage to the ligamentous apparatus - spondylolisthesis. Typically, patients notice severe diffuse pain in the back, the presence of bleeding ("bruises"), local swelling, and restricted mobility.
- Psychogenic pain.A similar view arises against the background of full health after an emotional outbreak or a stressful situation. Patients describe pain in different ways, which is only limited by the patient's imagination. Sometimes there is a so-called. "Painful behavior" when people tend to use aids with constant mobility: crutches, canes and even wheelchairs.
- fibromyalgia.The pain syndrome in fibromyalgia is very similar to that in psychogenic pain. At the same time, pain is caused by stress, climate and emotional overload. But an important difference is that the pain should be observed for more than three months, accompanied by local sensitivity in characteristic points (the place of attachment of the occipital muscles, the middle of the trapezius muscles, etc. ). Diagnosis also requires the complete exclusion of all types of somatic diseases.
- Pathologies of internal organs.Back pain can often occur in diseases of various organs of the body. In the case of a heart attack, the pain syndrome is localized behind the sternum and spreads under the shoulder blade and the left arm as well as in the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, which radiates to the spine. Against the background of difficulty breathing and cyanosis of the face, a complex of symptoms arises. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character that appears in the upper abdomen in the form of a "belt" covering the sides and back. Back pain occurs along with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Typically, the pain is so severe that patients bend over for relief. Against the background of an attack, the urine turns dirty red due to blood contamination.
- tumor processes.A neuroma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, there is usually back pain, as well as a loss of tenderness and motor activity below the lesion level. It's also worth noting that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases from breast cancer, prostate, lung, kidney, etc.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, which is supplemented by neurological disorders: paresis (decreased muscle strength), loss of sensitivity, pelvic disorders, etc. are common. A purulent process occurs against the background of infections, wounds, immunodeficiencies or the like on a complication of lumbar puncture (or epidural anesthesia).
- syringomyelia.Syringomyelia is a nervous system pathology that causes cavities in the spinal cord. Injuries, tumors, compression of the brain, etc. provoke the disease. In the initial stages, there is slight pain in the spine that does not cause discomfort. Then there is weight loss, muscle weakness, sensitivity to pain is lost, there is no sweating and the bones become fragile. Often there are injuries to the joints and the bony skeleton (burns, fractures, cuts), which, however, pass imperceptibly due to a lack of sensitivity to pain.
Diagnosis
A qualitative examination and physical examination of the patient through palpation (touch), percussion (percussion) and auscultation (listening) is required as a diagnosis. With some pathologies, it is necessary to carry out laboratory blood tests (myocardial infarction, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you need instrumental diagnostic methods: ultrasound or magnetic resonance tomography. While X-ray and computed tomography are used to examine the skeleton directly.
In some cases, less common techniques may be required: bone scintigraphy, electromyography, etc.
Treatment of back pain
To relieve acute back pain, apply ice (every 4 hours for 20 minutes), exclude physical activity, and immobilize the spine as much as possible. If the pain is unbearable, pain medication can be taken. However, it should be remembered that anesthetics "lubricate" the clinic of the disease. As a result, this can make it difficult to diagnose the disease. Only the attending physician can prescribe medication.
Disc herniation
The main treatment is based on the use of anti-inflammatory drugs (diclofenac, ibuprofen) and pain relievers (ketorolac). In some cases, surgical removal of the intervertebral hernia and an endoprosthesis of the disc may be required.
Sacra or lumbarization
If pain occurs, blockades with anesthetics, as well as physiotherapy (paraffin applications, electrophoresis, etc. ) are prescribed. With the ineffectiveness of conservative treatment, reconstructive operations are indicated.
Spondylosis
Anti-inflammatory drugs (meloxicam, indomethacin) and physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndromes.
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 estrogens, calcitonin, and parathyroid hormones is used.
tumor processes
The treatment of tumor diseases consists of chemotherapy and surgery. In this case, the level of support depends on the clinical case.
Injury
In the case of minor injuries, a gentle regime and warm-up are required. Reduction or skeletal traction is required in some situations. When neurological symptoms appear, operations with fixation of bone fragments are performed.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy and the use of antidepressants (fluoxetine, sertraline).
Fibromyalgia
Since the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (paroxetine, amitriptyline), anticonvulsants (pregabalin), hypnotics (zopiclone) or sedatives (diazepam). Self-tuning for positive thinking, avoiding stressful situations and being in a warm, dry climate are also important.
Pathologies of the internal organs
Each of the possible internal pathologies requires individual treatment tactics. Emergency care for a heart attack involves taking nitroglycerin (one tablet every 5 minutes until the ambulance arrives). with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing with an open lung wound; with renal colic - antispasmodic agents (drotaverine, metamizole sodium) and warming.
Epidural abscess
The treatment consists of an urgent operation to normalize the pressure in the spinal canal and to empty the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgical interventions.
Syringomyelia
Usually, patients are advised to protect their skin from cuts and burns (the latter often occur because patients become less sensitive and experience no trauma). Pain relievers, antidepressants (fluoxetine), and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is possible to revise the cavities that have formed in the spinal cord.
Back contraception
In order to prevent back pain, it is necessary to prevent the occurrence of any of the above pathologies. For this you need:
- normalize lifestyle: reduce body weight to normal; compose a proper diet rich in trace elements and vitamins; Ensure proper physical activity without overexertion.
- Give up bad habits: smoking and drinking alcohol.
- Correct postural curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, club feet, etc. ).
- Timely diagnosis and treatment of comorbidities of the musculoskeletal system or internal organs.
- Prevent or properly treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The main disease can be extremely serious and, if left untreated, can result in disability and even death for the patient!