Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and is one of the most urgent problems of modern healthcare, and treating 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 lumbar 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 recurrence of the pain syndrome.
Types and manifestations of pain syndromes
Depending on the affected segment of the back, the pain syndrome is divided into neck pain, middle back pain (thoracic pain), low back pain (lumbar pain) or coccydynia (pain in the coccyx or sacrum).
According to the findings of a study involving 46 thousand volunteers from several European countries, chronic pain in different 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 - lasting up to 12 weeks, or chronic - longer than 12 weeks.
The pain can be dull or shooting, sometimes there is burning and stinging.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 accompanying manifestations of back pain.Limitation of the range of certain movements or increased pain in certain positions of the body is also observed 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, so in this case 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 nerves 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 about 2% of cases.
Non-specific 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 often worsens with movement;
- the attack may develop suddenly or increase gradually;
- Sometimes back pain is the result of bad posture or lifting something awkwardly, but often it appears 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 work;
- frequent bending and bending of the body;
- lifting heavy objects, especially from the wrong position;
- sedentary lifestyle;
- industrial influences such as vibrations;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, because it indicates the acute influence of some unfavorable factor.
The most common causes of acute back pain are:
- injuries of various structures in the spine;
- spondylolisthesis - movement of the vertebrae in relation to each other;
- sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body), 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 resembles a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of the intervertebral disc;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
- radiculopathy - inflammation and degeneration of the nerves that go from the spinal cord to the muscles and joints;
- arthritis and arthrosis of spinal joints of different origins.
- infectious process (for example, meningitis, tuberculosis);
- diseases of internal organs (aneurysm of the abdominal aorta or gynecological pathology);
- metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain syndrome
In order to understand what to do with severe back pain, it is advisable to first of all determine its cause.An accurate diagnosis is the key to a well-designed treatment plan.
After a careful review of the patient's complaints, history and nature of symptoms, the doctor may prescribe imaging studies and functional tests to confirm the diagnosis.
- X-ray of the spineit 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 resonanceshows tissue and bone structures and is used to identify slipped or herniated discs, pinched nerves or the spinal cord.
- When conductingmyelogramsA special biological dye is used that is injected into the area around the spinal column 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 testingenables the assessment of the electrical activity of the nerves in the upper and lower extremities.
- Positron emission bone scanreveals, above all, bone oncopathology.
- Densitometry - determination of bone density - shownfor diseases and conditions that lead to a decrease in bone mineral density.
Methods for fighting 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 drug and non-drug treatment.
Principles of therapy for a patient with chronic back pain, based on evidence-based medicine, include:
- explaining to the patient the cause of the pain and, as a rule, its benign origin;
- ensuring sufficient levels of daily physical activity;
- prescribing effective and safe treatment, primarily for pain relief;
- correction of therapy if ineffective after 1-3 months.
Back pain treatment without drugs
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 recurrence, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.
Developing the correct motor stereotype and physical therapy are important areas of non-pharmacological pain correction.
Based on duration, non-drug treatment of back pain can be divided into three phases.
Phase I- passive physiotherapy during the acute period (6 weeks).
Phase II- active exercises during the subacute period (6-12 weeks).
Phase 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 are recommended to improve long-term results.Physical therapy to strengthen the abdominal and spinal muscles may also be recommended;
- therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
- application of acupuncture, manual therapy and spinal traction methods.
Treatment of pain with drugs
The most common methods of treating back pain with drugs 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 therapy 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 is diagnosed and confirmed by imaging (eg X-ray or magnetic resonance imaging);
- Conservative treatments such as physical therapy or medication 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 useful;
- neurological damage occurs.
Preventing back pain
Maintaining a healthy lifestyle is the 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 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 stopping the use of tobacco products is another step towards a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.