Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and one of the most pressing problems of modern health care, and the treatment of back pain is a difficult task.
Although pain can occur anywhere in the spine, the most common location is the lower back - 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 pain in the neck, in the middle (chest pain), in the middle (lumbago) or in coccydynia (pain in the tailbone 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 characteristic of 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.The symptoms of 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 option for accompanying manifestations of low back pain.Limitation in the range of certain movements or increased pain in certain places of the body is also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
When examining, it is not always possible to determine the direct cause of back pain, so the pain is called "non-specific" 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 the pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease accounts for 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 often worsens with movement.
- the attack may 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 a sprained ligament or muscle.
- it can occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for developing non-specific back pain:
- hard physical labor;
- frequent bending and bending of the body;
- lifting heavy objects, especially from the wrong position.
- sedentary lifestyle;
- industrial effects such as 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:
- injury 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 onset of a disorder, while chronic pain records this pathological effect and is reminiscent of 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 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 vertebral 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 low back pain syndrome
To understand what to do with severe back pain, it is recommended, first of all, to find out its cause.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.
- X-ray of the spineused to detect degenerative diseases and fractures.
- CT scanprovides detailed cross-sectional images of the spine, showing even subtle bone changes.
- Magnetic resonance imagingshows both tissue and bone structures and is used to locate slipped or herniated discs, compressed nerves or the spinal cord.
- During the conductmyelogramsA special biological dye is used 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.
- Bone positron emission scanreveals, first of all, bone oncopathology.
- Densitometry - determination of bone density - shownfor diseases and conditions that lead to a decrease in bone density.
Methods to combat back pain
The complex structure of pain in different parts of the back and the stages of pathological changes dictate the need for a combination of pharmaceutical and non-pharmacological 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 adequate levels of daily physical activity;
- prescribing effective and safe treatment, mainly for pain relief.
- correction of treatment if ineffective 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, facilitate the resolution of these episodes.
Development of the correct motor pattern and physical therapy are important areas of non-pharmacological pain correction.
Based on duration, non-drug treatment for 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- physical therapy rehabilitation results.
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 relieve pain, including:
- non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy to strengthen the abdominal and back muscles may also be recommended.
- 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.
Pharmaceutical treatment of pain
The most common drug treatment methods 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 the side effects of the drugs.
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 (eg 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.
- 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.
Prevention of back pain
Maintaining a healthy lifestyle is key to preventing back pain.Being overweight puts stress 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 tissues in the body, including contributing to the aging of the spine, so stopping the use of tobacco products 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.