Lower back pain

Low back pain may be familiar to almost every modern person. Employment can be affected for a variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be negligent in this, because back pain can not only reach tremendous strength, make a person's life unbearable, but also be a symptom of the most dangerous disease.

Low back pain can be varied: acute or dull, aching or burning, local (appearing in one place) or spreading throughout the back. Unpleasant sensations also appear in different ways: sometimes suddenly, suddenly, and sometimes gradually, increasing every day.

The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms, and other factors. But in any case, you can't leave this disease to chance. Timely treatment will help avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to carry out a spinal examination and several additional procedures: X-ray examination, computed or magnetic resonance imaging. Attacks of pain, lumbosacral, appear during life, in about 80% of the modern population of European countries.

Acute or chronic back pain in the lumbar region is a consequence of various neurological, degenerative-dystrophic diseases of women and men. In some cases, low back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional can never determine the true source of the problem. In general, medical classification separates primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of morphofunctional musculoskeletal changes. He is the cause of most cases of back pain in the lumbar region. The most significant causes are degenerative-dystrophic changes that occur in different parts of the spine:

• osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
• Spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for spinal mobility, or the synovial joints.

Secondary pain syndromes have a much more diverse cause of pain:

• scoliosis, which is a curvature of the spine, as well as some other growth disorders;
• various inflammations that are not contagious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• tumors located in the spine, in the spinal cord itself or in the retroperitoneal space, regardless of whether it is primary or caused by metastases;
• fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases that cause damage to the spine and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• a stroke condition in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
• diseases of the digestive tract. For example, acute appendicitis with atypical course, intestinal obstruction;
• Often back pain is of a reflected nature. Similar problems can occur in some diseases of the organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred back pain).

Acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced low back pain is also often observed: in this case, there is a translation of pain sensations from deeper located organs and structures of the body; in other words, it seems to the patient that the lower back hurts, but is actually a completely different part of the body that is affected.

Most often, the back hurts in the lumbar region, when the pain is projected into this area from the pelvic organs, kidneys, pancreas, large intestine, or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there are clear recommendations, what exactly should not be done: self-medicating. The causes of pain are so diverse that only a qualified specialist can make the correct diagnosis.

Possible causes of acute low back pain include:

• The pain is accompanied by an acute stretch of the muscle. In this case, pain signals are localized in the back, they are supplied by spasmodic long muscles. The pain does not tend to move to the groin or leg area. Human mobility is limited.
• One of the most common and severe causes of severe back pain is a vertebral fracture (spinal fracture, including compressional ones). As a rule, this happens with an unsuccessful fall, bending of the back and other injuries; but if the patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there is a cancerous tumor and its metastases in the spinal region or other lesions of the skeletal system, a vertebral fracture can occur literally "suddenly" , and even without fixation by sensationspatient at the time of fracture.
• An equally unpleasant situation in which the lower back hurts sharply is the displacement of the intervertebral discs occurring in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second frequency; LIII-LIV and above are rarer cases.

Symptoms include severe low back pain, forced posture, limited mobility. Participation in the pathological processes of the nerve roots is indicated by:

1. radicular pain, usually unilateral;
2. impaired sensitivity (numbness, increased or decreased level of sensitivity);
3. a decrease or loss of the Achilles reflex (in case of damage to the S or S2 roots);
4. decreased intensity or absence of knee jerks (indicating damage to the L3-L4 area).

The general trend is for a protruding intervertebral disc affecting the underlying root (eg, LIV-LV misalignment causing L5 root pathology). With the defeat of the cauda equina (horsetail), the function of the bladder and rectum is impaired. Also, a similar condition can occur with a strong protrusion of the spinal discs.

Sharp back pain in the lumbar region with facet syndrome: in this case, the disc remains unaffected, and pain appears as a result of compression of the root itself in the outflow tract of the spinal canal. The most frequently observed facet syndrome of the unilateral type is in the L5 root area; appears on the basis of an increase in the aspects of the intervertebral joints (upper and lower), and, as a result, narrowing of the intervertebral foramen.

Also, severe low back pain accompanies an epidural abscess, a serious disease that requires prompt diagnosis and prompt treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes very strong with a mechanical effect on the area of \u200b\u200bthe pathology (pressure, knocking).

If there are signs of spinal cord compression, highly effective medical measures are recommended, including surgery. Another reason why lower back pain can be a disease of the hip joint - especially coxarthrosis. In this case, the pain is characteristic, spreading to the lower part of the lower back, buttocks, and also to the legs to the knees.

Diseases characterized by chronic low back pain:

• Deforming spondylosis is a disease in which there are dystrophic changes in the lumbar vertebrae, calcification of its ligamentous apparatus and further bone growth; Bone growth compresses the roots and narrows the spinal canal. In cases when pain in the lower back is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which can be caused by narrowing of the spinal canal, should be considered. An examination is required, the results of which establish the final diagnosis.
• Ankylosing spondylarthrosis (or Bechterew's disease). In the early stages, it is characterized by limited mobility, especially in the morning, with a reduction in chest movement when breathing. There is a pulling pain in the lower back; further development of spinal curvature in the thoracic region. X-ray examination corrects anomalies of the sacroiliac joints: damage, structural changes, "bamboo" spine. A thorough examination and finding out the reason why the lower back hurts is necessary, since the same symptoms and limited mobility of the lower spine can also lead to other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumor, metastases), metabolic disorders (including NBO). The causes of such back pain need to be ruled out: metastatic carcinoma of the lung, breast, prostate and thyroid gland, kidney, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). Exceptions were made by the methods of X-ray examination and myelography.
• Osteomyelitis also causes prolonged pain and tenderness in the lower back. If this disease is suspected, X-rays of bone tissue, a skin test with tuberculin and determination of the ESR are carried out to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causative agents of osteomyelitis.
• Tumors of the spinal cord (intradural tumors) of various types. Diseases such as lipomas, neurofibromas, meningiomas can trigger constant back pain, initially without accompanying neurological symptoms.

The causes of back pain are intermittent. Many diseases of the internal organs provoke periodic, sharp or pulling pains in the lower back. At the same time, the patient does not feel stiffness in the back region, there is no obvious localization of pain, and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back pain is not persistent, but from time to time, the answer is simple: do not wait until it hurts "as it should be", but consult a doctor.

There is a clear influence of the pathology of one or another organ on a certain part of the spine. So, from the pelvic organs, the pain radiates to the sacrum, in diseases of the organ located in the lower part of the abdominal cavity, it radiates to the lower back (segments L3-L5), and in the upper part - to the upper segment of the lumbar zone or the lower part of the lumbar zone. chest.

Diseases - causes of low back pain, and areas of distribution of pain:

• If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, such intermittent pain may be due to chronic prostatitis or the development of carcinoma of the prostate.
• Various kidney diseases provoke pain at the junction of the ribs and spine.
• Tumors of the stomach, duodenum, gastric ulcer, pancreatic tumor (especially if the disease spreads beyond the peritoneum) - pain radiates to the region of the spinal segment T10-L2;
• With ulcerative colitis, diverticulitis, or tumors of the colon, the lower back is painful;
• If the back pain is in the thoracic/lumbar region, an aortic dissection (aneurysm dissection) should be excluded.

Diagnosis for low back pain

For low back pain and lumbago, it is recommended to undergo computer (shows the condition of the spinal tissues) and magnetic resonance (allows you to assess the condition of soft tissues) tomography and ultrasound scans of the internal organs .

One method of diagnosis is radiography, which is relatively inexpensive and useful in detecting various abnormalities, from fractures to kidney stones. Many of the changes detected only suggest a correct diagnosis, and additional studies may be needed to confirm this. In addition, some radiological changes may be concomitant findings that are not a cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the neurological status of the patient is assessed, as well as possible violations of the biomechanics of the spine are identified by mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, patients with spinal osteochondrosis and pain in the back and lower back can be diagnosed and treated.

Sometimes, according to the results of the examination by an orthopedist of a patient with painful symptoms against the background of osteochondrosis of the spine, the following additional diagnostic procedures can be prescribed:

• radiograph of the lumbosacral spine with functional tests;
• CT scan of the lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by the annulus fibrosus, which is made up of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.

The thickness of the disc decreases, the vertebral bodies approach each other, reducing the intervertebral foramen and harming the nerves and vessels located in them (osteochondrosis).

Protrusion of the disc (protrusion of the intervertebral disc) with further prolapse into the lumen of the spinal canal (herniated disc) most commonly causes nerve root compression, causing pain along the compressed nerve (pain radiating to the legs, arms, back of the head, neck, spaceintercostal nerves depending on the degree of compression of the nerves) with a weakening of muscle strength in the area of \u200b\u200btheir innervation and a violation of sensitivity.

Often, a protrusion or herniation of the intervertebral disc is accompanied by muscle pain along the nerves (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal segments may also be impaired. With spinal instability, the spine moves forward (anterolisthesis) or backwards (retrolisthesis). To clarify the diagnosis, an X-ray of the lumbosacral spine with functional tests may be required.

Most often, the nerve bundle that forms the sciatic nerve due to its anatomical location suffers from hernia compression or protrusion of the intervertebral disc. The sciatic nerve consists of L5, S1, S2, S3 fibers - spinal nerves.

Foci of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord that pass through them. That is why in the case of spinal canal stenosis, it is always necessary to carry out a complete treatment using a whole arsenal of different treatment methods, and if ineffective, surgical treatment.

Which doctor should I contact?

With pain in the spine, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Lower back pain is combined with various infections, injuries to the limbs. Pain in the lower back with diseases of the heart and lungs is not excluded. This is determined by in-depth examination. After the patient is diagnosed, he is usually prescribed drugs that reduce back pain, normalize blood circulation and help restore nervous tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.

Surgical intervention is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. Hernias pressing on the nerve roots are removed, restored, and the pain passes over time.

It is best to relax your spine and paravertebral muscles if you sleep on a firm mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this is fraught with a weakening of the paravertebral muscles, which will only exacerbate the problem. Even with severe pain, you should try to maintain at least weak physical activity.

How to relieve back pain

The occurrence of painful symptoms is often due to muscle spasms, which can be eliminated with the help of special tools - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

So, with strong and unexpected pain in the lower back, it is recommended to take muscle relaxant tablets, rub the back with a warming anesthetic gel. When using the funds, you must strictly follow the instructions.

In cases where unpleasant symptoms are caused by the presence of inflammatory diseases of the internal organs, it is recommended not to delay contacting a doctor, if at some point it is impossible to visit a specialist, and the pain is too intense, you can take Pentalgin or No-shpu. The sore spot should not be warmed with a heating pad, as heat contributes to the spread of the inflammatory process, and, as a result, intensifies the accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have a pronounced anti-inflammatory, mild analgesic, and antipyretic effect.

The course of treatment is determined taking into account the severity of pain symptoms. Ointments for back pain are used as the main or adjunct treatment. With pronounced symptoms of osteochondrosis, rubbing the lower back with an ointment based on Ketoprofen, a substance with a strong analgesic effect, is indicated.

The main advantage of local preparations is that they have an effect not on the whole body as a whole, but on specific areas that require treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in tablet form.

Exercises for back pain

Gymnastics is considered an additional method for the treatment of diseases of the lower spine. The exercises shown to the patient are quite simple and are not accompanied by special loads on the body. For example, ordinary hanging on horizontal bars has a beneficial effect on the condition of the spine, helps to relax muscles and relieve lumbago - pain caused by pinching its nerve roots. Therapeutic exercises for back ailments, accompanied by pain in their lower part, include exercises:

• raise the leg (so that the knee touches the chin);
• "bicycle", performed lying on your back;
• walk on your knees.

Every day it is recommended to give exercise no more than 10-15 minutes, with noticeable pain - to refuse to do it.