Back pain

Back pain is one of the most common reasons patients seek help from medical organizations. Pain syndrome can accompany diseases of the spine, kidneys, and other organs and systems. Treatment and prevention of back pain include both medication and non-medication. Early medical care can make the disease chronic with the development of complications.

Back pain is a symptom in its own right, not a nosological unit. Lumbodynia, for example, is a pain that is localized in the lumbar spine. Concepts such as thoracalgia or cervicalgia are also differentiated. The exact localization of the pathological symptom is necessary for choosing the right treatment tactics and choosing preventive measures.

definition

Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of direct damage to a tissue or organ or when exposed to unfavorable psychological factors (stress, anxiety, depression).

Back pain is a multidisciplinary practice in medical practice. This is due to the fact that pain syndrome can occur due to the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver and others).

It should be borne in mind that the pain syndrome can be accompanied by a deterioration in the patient's cognitive abilities - memory disorders can occur, concentration decreases.

In most cases, the occurrence of back pain is a defensive reaction of the body due to the influence of unfavorable factors. The most common cause of back pain is sciatica, herniated disc, or spondylosis.

Epidemiology

According to statistics from the World Health Organization (WHO), back pain is a problem for more than 40% of the population. In some countries this number can be up to 80%.

This problem can lead to early disability for the patient. In addition, pain syndrome is a common cause of temporary disabilities in working people. Therefore, pathology is a problem not only in the medical but also in the economic field.

Most often, people of working age between 30 and 60 turn to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, as a result of which acute and chronic pain appear.

In addition, men are more likely to suffer from the disease than women. This is due to the specifics of work, physical work, as well as other risk factors. According to statistics, pain in the lumbosacral area is much more common.

Clinicians explain this fact by saying that physical activity puts the most pressure on this part of the spine.

Risk factors

Not only stress and exercise can cause this pathology. The most important risk factors include:

• Working age from 30 years;
• masculine;
• Overweight and obesity (in which the body mass index exceeds 30);
• the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
• static physical activity that does not differ from one another in its diversity;
• Exposed to vibrations.

In addition, some researchers cite smoking as a risk factor. It is possible that an intense cough in a smoker can be an indirect cause of pain.

classification

After a thorough examination and examination, a neurologist determines the type of pain. There are several classifications among which the pain syndrome appearing in the back is divided according to the location of the appearance of the pathology, duration, reasons and other features.

With regard to the duration, the following types of pain are distinguished:

• Spicy,
• subacute,
• chronic.

Most patients with acute pain are treated in the outpatient department. Its duration is no more than 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, then this pain is called chronic.

Acute and subacute pain, with proper treatment, most often lead to full recovery. Chronic pain syndrome can lead to early disability of the patient. For this reason, at the first appearance of clinical signs of pathology, you should consult a doctor. To do this, you should have an initial consultation with a neurologist.

With regard to the intensity, the following types of pain are distinguished:

• weak
• Average,
• strong.

Due to the nature of back pain, there are:

• Blasting,
• Pain,
• Shoot,
• draw,
• stupid.

The type of pain depends on the pathology that caused the syndrome. So, with osteochondrosis, pulling pain concerns, which differ in the irradiation of the lower extremities. With sciatica, sharp pain occurs, which is often one-sided.

Depending on the location of back pain, there are:

• local (local),
• reflected,
• irradiate.

Local pain occurs when the pathological focus is directly in the back. Pain is caused by irritation, stretching, or other effects on receptors under the skin.

Local pain has its own characteristics. For example, after an injury in the lumbosacral area of the spine, the pain syndrome is constant. Its character can change with a change in body position due to irritation of the receptors.

Reflected pain occurs with a pathology that affects the internal organs. Associated with the anatomical features of the innervation. With the reflected type, pain occurs in the area of the dermatomes. The most common cause of back pain can be the pathology of the pancreas, uterus and its appendages.

Among the characteristics of the reflected type of pain, a distinction is made between the lack of connection with physical activity. If a change in body position with a local type of pain has increased the intensity of the symptom, there is no connection in this case.

Radiant pain is associated with irritation to a nerve or root. In addition, in addition to the appearance of back pain, the patient may complain of a decrease in sensitivity, the appearance of goose bumps (paresthesia). During the examination, a neurologist can often uncover pathological reflexes that are also associated with impaired transmission of a nerve impulse.

Cause of back pain

The pain syndrome can manifest itself for several reasons:

• Musculoskeletal pathology (trauma, sprains, hypothermia and other external causes);
• Spinal diseases (osteochondrosis, hernia);
• Diseases that affect the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others);
• benign and malignant neoplasms;
• mental disorders (depression, anxiety, stress cause the psychogenic type of pain).

In addition, everyday problems can become the cause of the appearance of a pathological symptom. In an uncomfortable sleeping position, the patient can complain of pain in the neck or lumbar spine after waking up.

Vertebral pain

With this type of pain, pathological changes of the degenerative type are observed in the spine. This can damage the vertebral bodies and intervertebral discs. In most cases, vertebral pain can be associated with a disease of the joints.

According to statistics, patients seeking medical help complain of the appearance of acute pain associated with damage to the spine. The cause can be a herniated disc, spondylosis or lumbago.

In less than 1% of all doctor visits, neoplasms are found in the spine. Metastases from malignant tumors are rare, but can also cause back pain of varying intensity.

illness	ICD-10 code	particularities
Osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by the appearancePulling and short-term pain with radiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain.
Intervertebral hernia	M51	A disease in which a bulge forms in the spinal canal. It appearsa sharp pain syndrome that occurs with coughing, sneezing, and physical exertion.
Radiculitis	M54, 1	A disease in which degenerative changes are observed on the roots. Characterized by the appearanceaching pain associated with a change in posture or exercise. . . In addition to the pain syndrome, there are also sensitivity disorders.
Discogenic Lumbodynia	M54. 4th	A pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is sharp and very pronounced.
Spondylosis	M47	A disease that is manifested by degenerative changes in the vertebrae. Has a chronic course, Pain in pain with irradiation of the lower extremities, neck.

It should be noted that each disease has its own distinctive features. Therefore, when making a diagnosis, attention should be paid not only to anamnestic data, but also to examination results. To do this, modern diagnostic instrumental methods are used, which make it possible not only to identify the pathological focus, but also to determine its limits and the degree of inflammation or destruction of the anatomical structures of the spine.

It is vertebrogenic causes that cause back pain to appear. In addition to the diseases listed above, pain can occur in the event of trauma and stretching of the musculoskeletal system. Excessive physical exertion or lifting weights can suddenly lead to acute pain.

Pain of non-vertebral origin

According to statistics, patients complain of pain of non-vertebral origin in no more than 2% of cases. This category includes diseases and somatic conditions that cause back pain.

The most common diseases that provoke the appearance of pain syndrome are the pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. The following are distinguished under the first group:

• Occlusion of arteries,
• Stress angina,
• Aortic aneurysm (in the abdomen or chest area).

Under the second group:

• Gastric ulcer,
• Duodenal ulcer,
• Cholelithiasis,
• Biliary tract dyskinesia,
• inflammatory changes in the pancreas.

Cardiovascular diseases often cause back pain. In angina pectoris, the patient is worried about pain in the heart area radiating to the shoulder, arm or back. Therefore, patients may complain of sore back pain during a seizure.

With angina pectoris, pain syndrome has its own characteristic features. First, the pain is overwhelming. Second, it appears behind the breastbone and radiates into the back, arms, or shoulders. Third, the pain syndrome disappears after the drug is administered immediately. It should be noted that physical activity and stress create the appearance of attack.

An aortic aneurysm is a split in a blood vessel that weakens and then bulges. In this case, when seeking medical help, the patient complains of the appearance of dull pain in the area of the heart with irradiation of the back and lower extremities. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also be disturbing. Back pain with aortic aneurysm can occur both in the thoracic localization of the pathological focus and in the abdominal one.

It should be noted that aneurysm pain is not associated with physical activity. Instrumental methods are used to diagnose the disease. If an aneurysm is detected, treatment is initiated immediately, including the use of drugs and surgical methods.

Back pain cannot only be caused by cardiovascular diseases. In diseases of the organs of the retroperitoneal space, patients can also complain of a pain syndrome. This is due to the peculiarities of innervation - inflammatory and degenerative changes in this area provoke the appearance of back pain.

Back pain in pregnancy

Pregnancy is a physiological condition, but its course can be accompanied by the appearance of pain and other unpleasant symptoms. This is due to changes in the location of the organs, hormonal changes, weight gain in the early and late stages.

During pregnancy, back pain can be caused by physiological and pathological changes.

The first group includes:

• natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• Enlargement of the uterus with the formation of a "child" place, in which the internal organs are displaced;
• a change in the center of gravity in late pregnancy, when the fundus of the uterus subsides.

The immediate cause of back pain during pregnancy can be the lead time. It is characterized by the appearance of irregular contractions. In this case, due to the active work of the pelvic floor muscles, there may be pain in the back and lower back. However, due to the production of female sex hormones, as well as oxytocin, a pregnant woman may not experience this pain.

However, the occurrence of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If a pathology is suspected, a pregnant woman may be asked to remain in the hospital for further observation.

The occurrence of severe back pain during pregnancy can be the cause of a serious illness. This is because it is during this time that extragenital diseases can worsen in a woman. The most common diagnoses are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or biliary tract can cause pain.

An exacerbation of pyelonephritis or cystitis is associated not only with the invasion of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the organ walls, hormonal changes during pregnancy. The stress that often accompanies pregnancy makes symptoms worse.

Back pain with coronavirus

An infection with the coronavirus can also cause severe back pain. COVID-19 causes specific symptoms, including a sudden rise in temperature, an unproductive cough, chest pain, and weakness and fatigue. However, some patients also complain of back pain that occurred with the onset of the coronavirus infection.

The main reasons include:

• Exposure to toxins on the body;
• exacerbation of chronic diseases of the musculoskeletal system;
• the appearance of new, previously undiagnosed pathologies of the spine;
• viral radiculopathy.

The intoxication syndrome often accompanies diseases of the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains, and aches and pains. With the coronavirus, as with other respiratory diseases, unspecific back pain can occur. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the pain intensity subsides after a few days.

The body's active fight against infection can make chronic diseases worse. In addition, against the background of a respiratory disease, previously hidden pathologies can appear. Because of this, patients may be concerned about back pain.

The occurrence of viral radiculopathy is also distinguished among the main reasons. It can't just be associated with the formation of an intervertebral hernia. Radiculopathy is of concern when a viral agent causes inflammation or irritation to the roots of the spinal cord.

Diagnostic measures

If you have back pain, you should see a medical facility right away. To diagnose any disease in this area, you should see a neurologist.

The specialist at the reception should perform a neurological examination of the patient after a detailed collection of anamnestic data. In the information gathering phase, attention is paid to the following aspects:

• the first appearance of back pain;
• the association of pain with physical activity;
• the presence of concomitant diseases;
• localization of the pain syndrome;
• the duration of the pain;
• the appearance of other symptoms.

After taking the anamnesis, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the patient's walking with pathology, the position of the spine and checks the presence or absence of reflexes.

To examine the patient's gait, the neurologist asks the patient to walk a few meters in the office and do some tests. If the patient cannot transfer support to his leg while walking, makes unnecessary movements, this is one of the clear signs of a neurological disease.

The position of the spine must also be assessed. A neurologist pays attention to the presence or absence of kyphosis, lordosis, and scoliosis. With the help of tests, the specialist assesses the patient's reaction to the irritation of the reflexes.

When back pain occurs, the disease may be accompanied by a change in sensitivity. Because of this, a neurologist assesses the state of tactility, temperature, and other types of sensitivity. The specialist also pays attention to the occurrence of pathological sensations, for example crawling or tingling in the back.

After the examination, the neurologist may prescribe a number of additional studies. Instrumental examination is necessary when it is necessary to determine the exact localization of the pathological focus. Modern methods allow a safe and painless examination, the result of which the patient receives after a few days.

To diagnose the causes of back pain, a neurologist can send a patient for the following diagnostic measures:

• Magnetic resonance imaging (MRI);
• Computed tomography (CT);
• X-ray of the abdominal organs.

In some cases, additional tests may not be required to make a diagnosis. Having received the results of instrumental diagnostics, the neurologist selects the optimal treatment tactics.

Back pain treatment

Treatment of acute or chronic back pain should be mandatory under medical supervision. Independent use of drugs can lead not only to ineffective treatment, but also to the appearance of complications of the disease. It is therefore recommended that you seek medical help if you have back pain. After passing the diagnostic tests, the patient is prescribed treatment based on the features of the clinic, pathogenetic mechanisms and the course of the disease.

A few years ago it was recommended in medicine for back pain to keep strict bed rest. Now there is no need to restrict the patient's movement. In addition, it is recommended to wear special bandages and to use crutches or stilts when walking.

Modern treatments for back pain are based on evidence-based medicine. In addition to using drugs, they also use non-drug treatments.

The following groups of drugs are used in medical practice as drug therapy for back pain:

• Non-steroidal anti-inflammatory drugs;
• Muscle relaxants to reduce muscle tone;
• Analgesics.

The groups of active ingredients listed can be used both in monotherapy and in combination to achieve a medicinal effect. In addition to medication for back pain, manual therapy is recommended.

In the event that the patient's pain syndrome is very pronounced, it is necessary to limit daily activity and follow the recommendations of other doctors, but in general it is advisable to maintain the level of previous physical activity.

In the case of chronic back pain, in addition to the treatment methods listed, methods of physiotherapeutic exercises (movement therapy) can also be used. In addition, a neurologist can recommend massage sessions. Particular attention is paid to cognitive behavioral therapy in addition to taking antidepressants.

The duration of treatment is determined by a neurologist. If treatment has been ineffective, consider switching drug groups and doing additional research.

forecast

With timely diagnosis and the right treatment tactics, back pain can subside after a few weeks. With a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.

prophylaxis

To prevent the occurrence of back pain, you should adhere to a healthy lifestyle and properly distribute physical activity so as not to cause overloading of different parts of the spine. In addition, comorbidities should be diagnosed and treated in good time.