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 health, and treating back pain is not an easy task.
Although the painful syndrome can occur in any part of the spine, the most common location is the lumbar region - according to researchers, the prevalence of low back pain reaches 76% among 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 relapse of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected segment of the back, pain syndrome is divided into neck pain, mid-back pain (chest pain), lower back pain (low back pain) or coccydynia (coccyx or sacrum pain).
According to the findings of a study involving 46, 000 volunteers from several European countries, chronic pain in various parts of the spine is inherent in 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8% of the population. population.
The duration of pain is either acute - lasting up to 12 weeks, or chronic - more than 12 weeks.
The pain can be dull or sharp, sometimes there is a burning and tingling sensation. Symptoms in 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 variant of the manifestations that accompany back pain. Limiting the range of some movements or increasing pain with a certain body position is also seen in some patients with spinal pain syndrome.
Back Pain: Why Does It Happen?
Examination cannot always determine the immediate cause of back pain, in which case the pain is referred to as "non-specific" or "mechanical". The cause of this pain is pathological changes in the musculoskeletal system, however, 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 in the context of the underlying disease accounts for about 2% of cases.
Nonspecific back pain has the following characteristics:
- tends to improve or worsen depending on body position - for example, the patient may feel better when sitting or lying down;
- pain is often made worse by movement;
- an attack may develop suddenly or increase gradually;
- back pain is sometimes a result of poor posture or awkward lifting, but it usually appears for no apparent reason;
- may be caused by a minor injury, such as sprained ligaments or muscles;
- it can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for developing non-specific back pain:
- heavy physical work;
- frequent bending and bending of the body;
- lifting weights, especially from the wrong position;
- passive lifestyle;
- industrial influences, eg vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance as it indicates the acute influence of an unfavorable factor.
The most common causes of acute back pain are:
- trauma to various structures of the spine;
- spondylolisthesis - displacement of the vertebrae in relation 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 corrects this pathological effect and resembles a developing disorder.
Conditions that can cause chronic back pain include:
- intervertebral disc displacement or prolapse;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints in the spine);
- radiculopathy - inflammation and degeneration of the nerves that run from the spinal cord to the muscles and joints;
- arthritis and osteoarthritis of the spinal joints of various origins.
- infectious process (eg, 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.
Back pain diagnosis
To understand what to do with severe back pain, it is desirable, first of all, to establish its cause. An accurate diagnosis is the key to a well thought out treatment plan.
After a thorough examination of the patient's complaints, history, and nature of symptoms, the physician may prescribe imaging and functional tests to confirm the diagnosis.
- spine x-rayused to detect degenerative diseases and fractures.
- computed tomographyprovides detailed cross-sectional images of the spine that show even small changes in the bones.
- MRI imageShows tissue and bone structures and is used to detect slippery or herniated discs, pinched nerves or spinal cord.
- when drivingmyelogramsA special biological preparation is used - a dye that is injected into the area around the spine for better visualization of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic testsallows assessing the electrical activity of nerves in the upper and lower extremities.
- Bone scintigraphy by positron emissionreveals, first of all, oncopathology of bones.
- Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone mineral density.
Ways to deal with back pain
The complex structure of the pain syndrome in the area of various parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.
The principles of therapy for a patient with chronic low back pain, based on evidence-based medicine, entail:
- explain to the patient the causes of pain and, as a rule, its benign origin;
- Ensure a sufficient level of daily physical activity;
- indication of effective and safe treatment, mainly for pain relief;
- correction of therapy in case of ineffectiveness after 1-3 months.
Non-drug treatment for back pain
In most cases, a patient with back pain gets better within 2-6 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 facilitates the resolution of these episodes.
The development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
According to duration, non-drug treatment of back pain can be divided into three phases.
I stage- passive physiotherapy during the acute period (6 weeks).
II stage- active exercise during the subacute period (6-12 weeks).
Stage III- physiotherapeutic influence of rehabilitation.
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 with pain management, such as:
- non-specific physical exercise, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physical therapy may also be recommended to strengthen the muscles of the abdomen and spine;
- massage therapy 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.
Medical treatment for pain
The most common medical treatments for back pain are:- Non-steroidal anti-inflammatory drugs and muscle relaxants.
- Steroid hormone injections into the joint cavity or epidural space of the spine, which reduces inflammation and back pain. However, this type of therapy is not intended for long-term use due to medication side effects.
When is surgery used?
Although the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may need surgical correction of spinal conditions. Generally, a patient with back pain can be operated on if the following criteria are met:- a structural problem has been diagnosed and confirmed by imaging (such as x-ray or MRI);
- conservative treatments such as physical therapy or medications have failed to provide adequate pain relief;
- back pain is debilitating - it interferes with participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- there is neurological damage.
Back pain prevention
Maintaining a healthy lifestyle is the key to preventing back pain. Being overweight puts a strain on your back, so it's important to maintain a healthy weight. Regular exercise strengthens the abdominal 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 refusing the use of products containing tobacco is another step towards a healthy spine. Correct posture, ergonomics in the workplace and avoiding a sedentary lifestyle are effective ways to prevent back pain.