Lower back pain

Lower back pain is probably familiar to almost every modern person. Employability can be affected for a variety of reasons. These include back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. At the same time, you should not be inattentive, because back pain can not only reach incredible strength and make a person's life unbearable, but also turn out to be a symptom of the most dangerous diseases.

Back pain can be varied: acute or dull, aching or burning, local (occurring in one place) or spreading to the entire back. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly, and sometimes gradually, intensifying every day.

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

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computer or magnetic resonance imaging. Attacks of lumbosacral pain occur during life in about 80% of modern residents of European countries.

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

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pains are dozens and a layman will never be able to determine the true cause of the problems. In general, the medical classification distinguishes primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is the cause of the vast majority of cases of back pain in the lumbar region. The main cause is degenerative-dystrophic changes in various parts of the spine:

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

The secondary pain syndrome has much more diverse causes of pain:

• scoliosis, which is a curvature of the spine, as well as some other growth diseases;
• various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• a tumor located in the vertebrae, in the spinal cord itself, or in the retroperitoneal space, whether primary or metastatic;
• Fracture of one or more vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases that lead to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• Stroke conditions in which the blood supply to the spinal cord is severely damaged. In this case, there may also be a feeling that the lower back hurts;
• Diseases of the gastrointestinal tract. For example, acute appendicitis with an atypical course, intestinal obstruction;
• back pain is often of a reflected nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred back pain).

Acute and chronic back pain

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

Most often, the back hurts in the lumbar region, when pain is projected to this area from the pelvic organs, kidneys, pancreas, colon, or tumors behind the peritoneum. Many patients do not know what to do when their lower back hurts. But there is a clear recommendation on exactly what not to do: treat yourself. The causes of pain are so varied that only a qualified specialist doctor can make a correct diagnosis.

Possible causes of acute low back pain are:

• The pain is accompanied by an acute stretching of the muscles. In this case, pain signals are localized in the back, they are delivered by spasmodic long muscles. The pain does not tend to move to the groin or leg area. People's mobility is restricted.
• One of the most common and serious causes of severe back pain is a spinal fracture (fractures of the vertebrae, including compression fractures). As a rule, this happens with an unsuccessful fall, bending of the back and other injuries; but in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, vertebral fractures can appear literally "out of the blue. ", and also without fixation by the patient's sensations at the time of the fracture.
• An equally unpleasant situation, in which the lower back hurts badly, is the displacement of the intervertebral discs that has occurred in the vertebral area. Depending on the frequency of lesions, areas are distinguished: LV-SII - the most common; LIV-LV - second in frequency; LIII-LIV and higher are rarer cases.

Symptoms include severe lower back pain, constrained posture, limited mobility. Participation in the pathological process of the nerve roots is indicated by:

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increase or decrease in sensitivity);
3. Decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. Decrease in intensity or absence of a reflex (indicating damage to the L3-L4 area).

The general trend is for a protruding disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (ponytail), the functions of the bladder and rectum are disturbed. A similar condition can also occur with a severe bulging of the intervertebral disc.

The back hurts badly in the lumbar region with facet syndrome: in this case, the intervertebral disc remains unaffected, and the pain appears as a result of compression of the root itself at the exit of the spinal canal. The most frequently observed facet syndrome of the unilateral type in the area of the root L5; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower) and, as a result, a narrowing of the intervertebral foramen.

Also, severe lower back pain is associated with an epidural abscess, a serious condition that requires urgent diagnosis and prompt treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes especially strong with a mechanical impact on the area of \u200b\u200bthe pathology (pressure, knocking).

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

Diseases characterized by chronic low back pain:

• Deforming spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligaments and further bone growth; Bony outgrowths press on the roots and narrow the spinal canal. When aching lower back pain 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 necessary, the results of which establish the definitive diagnosis.
• Ankylosing spondyloarthrosis (or Bechterew's disease). At an early stage, it is characterized by reduced mobility, especially in the mornings, by a reduction in chest movements during breathing. There are drawing pains in the lower back; further the curvature of the spine in the thoracic region develops and progresses. An X-ray examination fixes anomalies of the sacroiliac joints: destruction, structural change, "bamboo" spine. A thorough examination and finding out the cause why the lower back hurts is necessary, since similar symptoms and limited mobility of the lower spine can also cause other diseases -Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic diseases (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid gland, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is the method of X-ray examination and myelography.
• Osteomyelitis also causes persistent, aching lower back pain. If this disease is suspected, an X-ray of bone tissue, a skin test with tuberculin and an ESR determination are performed to determine the presence / absence of tuberculosis bacteria or purulent (pyogenic) bacteria in the body, most often staphylococci - the causative agents of osteomyelitis.
• Tumors of the spinal cord (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can lead to persistent back pain, initially without accompanying neurological symptoms.

Causes of back pain of an intermittent nature. Many diseases of the internal organs cause periodic, sharp or drawing pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back, there is no clear localization of pain and the pain does not increase with the maximum possible range of motion. When asked what to do if your lower back hurts not all the time, but occasionally, the answer is simple: don't wait for it to hurt "as it should, " see a doctor.

There is a clear influence of the pathology of one or another organ on a specific section of the spine. So, from the pelvic organs, the pain radiates to the sacrum, with diseases of the organs 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 segments from the upper part of the lumbar zone or lowerpart of the breast zone.

Diseases - the causes of back pain and the area of \u200b\u200bthe distribution of pain:

• If the pelvic organs are affected, in the case of endometriosis, ovarian or uterine cancer, the lower back hurts. In men, such intermittent pain can be caused by chronic prostatitis or the development of prostate cancer.
• Various kidney diseases cause pain at the joints of the ribs and spine.
• Tumors of the stomach, duodenum, gastric ulcer, pancreas (especially if the disease spreads beyond the peritoneum) - the pain spreads to the region of the spinal segments T10-L2;
• Pain in the lower back with ulcerative colitis, diverticulitis, or colon tumors;
• An aortic dissection (dissecting aneurysm) should be ruled out if there is back pain in the chest/lumbar area.

Diagnosis for back pain

With back pain and lumbago, it is recommended to undergo computed tomography (shows the state of the bone tissue of the spine) and magnetic resonance imaging (allows to assess the state of soft tissues), and ultrasound examination of internal organs .

One method of diagnosis is x-rays, which are relatively inexpensive and can be useful in detecting a range of conditions, from broken bones to kidney stones. Many of the changes found are only indicative of the correct diagnosis, and additional studies may be needed to confirm them. In addition, some radiological changes may be concomitant findings that are not causal to the pain.

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

Sometimes, according to the results of an orthopedic examination of a patient with a pain symptom against the background of spinal osteochondrosis, the following additional diagnostic procedures can be prescribed:

• X-ray of the lumbosacral spine with functional tests;
• CT scan of the lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by an annulus fibrosus composed of fibrocartilage 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 intervertebral discs decreases, the vertebral bodies move closer together, reducing the size of the intervertebral foramina and endangering the nerves and vessels in them (osteochondrosis).

The protrusion of the intervertebral disc (herniated disc) with its further protrusion into the lumen of the spinal canal (herniated disc) most often leads to compression of the nerve roots and causes pain along the compressed nerve (pain radiating to the leg, arm, back of the head, neck, intercostal spaces depending on theLevel of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.

A bulging or herniated disc is often accompanied by muscle pain along the nerve path (along the arm or leg). One or (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal segment can also be affected. In spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). An X-ray of the lumbosacral spine with functional tests may be needed to clarify the diagnosis.

Most often, the bundles of nerves that form the sciatic nerve due to their anatomical location suffer from compression from a herniated or bulging disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

The focus 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 passing through it and the spinal cord. Therefore, in the case of a spinal canal stenosis, a complete treatment with a whole arsenal of different treatment methods and, in the case of ineffectiveness, surgical treatment is always required.

Which doctor should I contact?

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

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

When diagnosing a herniated disc, which is a complication of osteochondrosis, surgical intervention is usually required. The fracture that compresses the nerve root is removed, restored, and the pain passes over time.

It's best to relax your spine and paravertebral muscles by sleeping on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last too long, since this is fraught with a weakening of the paravertebral muscles, which only aggravates the problem. Even with severe pain, you should try to maintain at least mild physical activity.

How to relieve back pain

The appearance of a pain symptom is often due to muscle spasms, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

Therefore, in case of severe, unexpected pain in the lower back, it is recommended to take a muscle relaxant tablet and rub the back with a warming anesthetic sealant. When using funds, you should strictly follow the instructions.

In cases where an unpleasant symptom is due to inflammatory diseases of the internal organs, it is recommended not to delay contacting a doctor if at a certain time it is impossible to see a specialist and the pain is too severe can Pentalginor take No-shpu. The sore spot should not be heated with a heating pad, since heat contributes to the spread of the inflammatory process and, as a result, increases the symptoms associated with it.

Ointment for back pain

Preparations in the form of ointments are widely 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 prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, rubbing the lower back with ointments based on ketoprofen, a substance with a strong analgesic effect, is indicated.

The main plus of local preparations lies in their effect not on the whole body, but on a specific area that needs 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 of treatment for diseases of the lower spine. The exercises shown to patients are quite simple and do not involve a special load on the body. For example, the usual hanging on the crossbar of the horizontal bar has a positive effect on the condition of the spine, helps relax muscles and eliminates lumbago - pain caused by pinching nerve roots. Therapeutic exercises for back diseases accompanied by pain in the lower part include exercises:

• raising the legs (so that the knee touches the chin);
• "bicycle", performed lying on the back;
• go on your knees.

Every day it is recommended to do exercises for no more than 10-15 minutes with pronounced pain - to refuse to do them.