Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most pressing problems in modern healthcare, and the treatment of back pain is a difficult task.
Although pain can occur in any part of the spine, the most common location is the lower back;According to researchers, the prevalence of low back pain reaches 76% among the adult population.
According to statistics, in 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 pain syndrome.
Types and manifestations of pain syndrome.
Depending on the segment of the back affected, the pain syndrome is divided into pain in the neck, in the middle of the back (chest pain), in the lower back (low back pain) or in coccydynia (pain in the tailbone or sacrum).
According to the results of a study in which 46 thousand volunteers from various European countries participated, chronic pain in various parts of the spine is characteristic of 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8% of the population.
The duration of pain is acute (up to 12 weeks) or chronic (more than 12 weeks).
The pain can be dull or stabbing, sometimes there is a burning and tingling sensation.The symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the level of spinal involvement.Numbness or weakness in the upper and lower extremities is another option for the manifestations that accompany back pain.Restriction in the range of certain movements or increased pain in certain body positions is also seen in some patients with spinal pain syndrome.
Back pain: why does it happen?
During the examination, it is not always possible to determine the direct cause of back pain, in which case the pain is called "nonspecific" or "mechanical."The cause of this pain is pathological changes in the musculoskeletal system, but 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 due to the underlying disease accounts for approximately 2% of cases.
Nonspecific back pain has the following characteristics:
- tends to get better or worse depending on body position;For example, the patient may feel better when sitting or lying down;
- the pain often worsens with movement;
- the attack can develop suddenly or increase gradually;
- Sometimes back pain is the result of poor posture or awkwardly lifting something, but many times it appears for no apparent reason;
- It may be caused by a minor injury, such as a ligament or muscle sprain;
- It can occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for developing nonspecific back pain:
- hard physical work;
- frequent bending and bending of the body;
- lifting heavy objects, especially from an incorrect position;
- sedentary lifestyle;
- industrial impacts such as vibrations;
- pregnancy;
- Age-related changes in the musculoskeletal system.
Acute pain has physiological significance, since it indicates the acute influence of an unfavorable factor.
The most common causes of acute back pain are:
- injury to various spinal structures;
- spondylolisthesis: displacement of the vertebrae relative to each other;
- sciatica: inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the lower back to the feet.
- 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 signals the onset of a disorder, while chronic pain records this pathological effect and recalls a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of an intervertebral disc;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
- radiculopathy: inflammation and degeneration of the nerves running from the spinal cord to the muscles and joints;
- Arthritis and osteoarthritis of the spinal joints of various origins.
- infectious process (for example, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- metastasis or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain syndrome.
To know what to do about severe back pain, it is advisable to first establish its cause.An accurate diagnosis is the key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history, and the nature of the symptoms, the doctor may prescribe imaging studies and functional tests to confirm the diagnosis.
- spine x-rayIt is used to detect degenerative diseases and fractures.
- computed tomographyprovides detailed cross-sectional images of the spine, showing even subtle changes in the bones.
- magnetic resonance imagingshows tissue and bone structures and is used to identify herniated or slipped discs, pinched nerves, or the spinal cord.
- When performingmyelogramsA special biological dye is used and injected into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the state of the nerve fibers in and around the spine.
- Electrodiagnostic testsallows you to evaluate the electrical activity of the nerves in the upper and lower extremities.
- Positron emission bone scanreveals, first of all, the oncopathology of the bones.
- Densitometry (bone density determination) shownfor diseases and conditions that lead to a decrease in bone mineral density.
Methods to combat back pain.
The complex structure of pain in various parts of the back and the stages of pathological changes dictate the need for a combination of pharmacological and non-pharmacological treatment.
The principles of therapy for a patient with chronic back pain, based on evidence-based medicine, involve:
- explain to the patient the causes of pain and, as a rule, its benign origin;
- ensure sufficient levels of daily physical activity;
- prescribe effective and safe treatment, primarily to relieve pain;
- correction of therapy if ineffective after 1 to 3 months.
Non-pharmacological treatment for back pain.
In most cases, a patient with back pain improves within 2 to 6 weeks.The main objective of non-specific treatment is to reduce movement restrictions, minimize relapses and, although good physical condition cannot prevent all painful episodes, it does facilitate the resolution of these episodes.
The development of correct motor stereotype and physical therapy are important areas of non-pharmacological pain correction.
Depending on the duration, non-pharmacological treatment of back pain can be divided into three phases.
Stage I- passive physiotherapy during the acute period (6 weeks).
Stage II– active exercises during the subacute period (6-12 weeks).
Stage III- rehabilitation physiotherapeutic effects.
Bed rest is prescribed for acute back pain only for a limited period of time.
Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:
- Non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching is recommended to improve long-term results.Physical therapy may also be recommended to strengthen abdominal and spinal muscles;
- therapeutic massage is used for short-term pain relief, but does not produce long-term functional improvement;
- the use of acupuncture, manual therapy and spinal traction methods.
Pharmacological treatment of pain.
The most common methods of drug treatment for back pain are:- Non-steroidal anti-inflammatory drugs and muscle relaxants.
- Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduces inflammation and pain in the back.However, this type of therapy is not designed for long-term use due to the side effects of the medications.
When is surgical treatment 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 disorders.In general, a patient with spinal pain can undergo surgery if the following criteria are met:- the structural problem has been diagnosed and confirmed by imaging (e.g., X-ray or MRI);
- Conservative treatments such as physical therapy or medications have failed to provide adequate pain relief;
- back pain is debilitating and prevents you from participating in daily activities or physical activity;
- the symptoms negatively affect physical or emotional health;
- there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- neurological damage occurs.
Prevent back pain
Maintaining a healthy lifestyle is the key to preventing back pain.Excess weight puts pressure on your back, so it's important to maintain a healthy weight.Regular exercise strengthens your abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues in the body, even contributing to the aging of the spine, so stopping consuming products containing tobacco is one more step towards a healthy back.Correct posture, ergonomics in the workplace and avoiding a sedentary lifestyle are effective ways to prevent back pain.