Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most urgent problems in modern health care, and the treatment of back pain is not an easy task.
Although the pain syndrome can occur in any part of the spine, the most common localization is the lower back - 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 recurring pain syndrome.
Types and manifestations of pain syndromes
Depending on the affected back, the pain syndrome is divided into pain in the neck, middle back (chest pain), lower back (back pain) or 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 present in 24% of the population, in the lumbar region - 18%, and pain in the neck occurs in 8% of the population.
The duration of the pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.
The pain may be dull or shooting, sometimes there is a burning sensation and tingling. Symptoms in some diseases also spread to the arms and hands, legs, or feet, depending on the degree of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of accompanying back pain manifestations. Limitation of the range of some movements or increased pain with a certain position of the body is also observed in some patients with vertebral pain syndrome.
Back pain: why does it happen?
Examination may not always be able to determine the immediate cause of back pain, where the pain is referred to as "non-specific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, lumbar and sacral nerve roots and certain diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients. Secondary pain against the background of the underlying disease is about 2% of cases.
Non-specific back pain has the following characteristics:
- tend to be better or worse depending on the position of the body - for example, the patient may feel better when he sits or lies down;
- pain is often aggravated by movement;
- attacks can develop suddenly or gradually increase;
- sometimes back pain is the result of poor posture or awkward lifting, but often appears for no apparent reason;
- may be caused by a minor injury, such as a sprained ligament or muscle;
- may occur after stress or overwork and usually begin to improve within a few weeks.
Risk factors for developing non-specific back pain:
- heavy physical labor;
- frequent bending and tilting of the body;
- lifting weights, especially from the wrong position;
- passive lifestyle;
- industrial influences, for example, vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, because it indicates the acute influence of unfavorable factors.
The most common causes of acute back pain are:
- trauma to various structures in the spine;
- spondylolisthesis - displacement of 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 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 root of the intercostal nerve;
It is important to remember that acute pain marks the beginning of the disorder, while chronic pain corrects the effects of this pathology and reminds the 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 spinal joints);
- radiculopathy - inflammation and degeneration of nerves that run from the spinal cord to muscles and joints;
- arthritis and arthrosis of spinal joints of various origins.
- infectious processes (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
To understand what to do with severe back pain, it is necessary, first of all, to establish its cause. An accurate diagnosis is key to a well-designed treatment plan.
After a thorough examination of the patient's complaints, history and nature of symptoms, the doctor may prescribe imaging tests and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- CT scanprovides a detailed cross-sectional image of the spinal column, which shows little change in the bones.
- Magnetic resonance imagingShows both tissue and bone structure and is used to detect slipped or herniated discs, pinched nerves or spinal cord.
- When conductingmyelogramsa special biological preparation is used - a dye injected into the area around the spinal column for better visualization of the spinal canal and intervertebral disc, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic testsallows you to assess the electrical activity of nerves in the upper and lower extremities.
- Positron emission bone scanreveals, first of all, bone oncopathology.
- Densitometry - the determination of bone density - is indicatedin diseases and conditions that lead to decreased bone mineral density.
Ways to deal with back pain
The complex structure of pain syndromes in various regions of the back and the stage of pathological changes determine the need for a combination of drug and non-drug treatment.
The principles of therapy for patients with chronic back pain, based on evidence-based medicine, imply:
- explain to the patient the causes of pain and, as a rule, its benign origin;
- Ensure an adequate level of daily physical activity;
- appointment of effective and safe treatment, especially for pain relief;
- therapy correction if not effective after 1-3 months.
Non-drug treatment for back pain
In most cases, patients with back pain improve within 2-6 weeks. The main goal of non-specific treatment is to reduce movement restrictions, to minimize relapses, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.
The development of correct motor stereotypes and exercise therapy are important areas of non-pharmacological correction of pain syndromes.
According to the period, the non-drug treatment of back pain can be divided into three phases.
i stage- passive physiotherapy during the acute period (6 weeks).
level II- 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. Physiotherapy may also be recommended to strengthen the abdominal and spinal muscles;
- 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.
Medical treatment for pain
The most common medical treatments for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injection 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 intended for long-term use due to the side effects of the drug.
When is surgery used?
Although the 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 disease. In general, patients with spinal pain can be operated on if the following criteria are met:- structural problems have been diagnosed and confirmed by imaging (such as x-ray or MRI);
- conservative treatment such as physiotherapy or medication has failed to provide adequate pain relief;
- debilitating back pain - it interferes with participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- there are objective, confirmed by diagnostic methods, reasons to believe that spinal surgery will be beneficial;
- there is nerve damage.
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 abdominal and back muscles. Smoking accelerates the aging of blood vessels and many body tissues, including contributing to the aging of the spine, so refusing to use tobacco-containing products is another step towards a healthy back. Correct posture, workplace ergonomics, and avoiding a sedentary lifestyle are effective ways to prevent back pain.