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 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 back - according to researchers, the prevalence of back pain in the adult population reaches 76%.
According to statistics, within 1 year, about 80% of people complain of pain in the lower back at least once, and in the next 12 months, 75% of them experience a recurrence of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected segment of the back, the pain syndrome is divided into pain in the neck, middle back (chest pain), low back (back pain) or coccydynia (pain in the coccyx or sacrum).
According to the results of a study involving 46, 000 volunteers from several European countries, chronic pain in different parts of the spine is characteristic of 24% of the population, 18% in the lumbar region, and 8% in the neck region. of the population.
The duration of the pain is acute - lasting up to 12 weeks or chronic - more than 12 weeks.
The pain can be dull or burning, sometimes there is a burning and tingling sensation. In some diseases, the symptoms also spread to the arms and hands, legs or feet, depending on the level of involvement of the spine. Numbness or weakness in the upper and lower extremities is another variant of the accompanying manifestations of back pain. Some patients with vertebral pain syndrome also experience pain that increases with limitation of range of motion or a certain position of the body.
Back pain: why does it happen?
Examination cannot always determine the immediate cause of back pain, in which case the pain is called "non-specific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the neck, chest, 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 against the background of the main disease accounts for about 2% of cases.
Non-specific back pain has the following characteristics:
- tends to improve or worsen depending on the state of the body - for example, the patient may feel better while sitting or lying down;
- pain is often aggravated by movement;
- the attack may develop suddenly or increase gradually;
- sometimes back pain is the result of poor posture or awkward lifting, but often appears for no apparent reason;
- can be caused by a minor injury such as ligaments or muscles;
- it can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for the development of non-specific back pain:
- heavy physical labor;
- frequent bending and bending of the body;
- lifting weights, especially from the wrong position;
- passive lifestyle;
- industrial effects, such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute effect of an unfavorable factor.
The most common causes of acute back pain are:
- trauma to various structures of 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 waist 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 roots of the intercostal nerves;
It should be remembered that acute pain indicates the beginning of the disorder, while chronic pain corrects this pathological effect 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 joints of the spine);
- radiculopathy - inflammation and degeneration of the nerves that go from the spinal cord to the muscles and joints;
- arthritis and arthrosis of the joints of the spine of various origins.
- infectious process (for example, meningitis, tuberculosis);
- diseases of internal organs (aneurysm of the abdominal aorta or gynecological pathology);
- certain types of cancer, such as metastases or multiple myeloma, a subtype of bone marrow cancer.
Back pain diagnosis
In order to understand what to do with severe back pain, it is desirable to first determine its cause. An accurate diagnosis is the key to a well-designed treatment plan.
After a thorough examination of the patient's complaints, history, and nature of symptoms, the doctor may order imaging tests and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- CT scanprovides detailed cross-sectional images of the spine showing even slight changes in the bones.
- Magnetic resonance imagingIt shows both tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves, or the spinal cord.
- While drivingmyelogramsa special biological preparation is used - a dye injected into the area around the spinal column for better visualization of the condition of the spinal canal and intervertebral discs, as well as the nerve fibers in and around the spine.
- Electrodiagnostic testallows to evaluate the electrical activity of the nerves in the upper and lower limbs.
- Positron emission bone scanprimarily reveals bone oncopathology.
- Densitometry - determination of bone density - is indicateddiseases and conditions that cause a decrease in bone mineral density.
Ways to deal with back pain
The complex structure of the pain syndrome in the region of different 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 evidence-based medicine-based therapy for a patient with chronic low back pain include:
- explaining to the patient the causes of pain and, as a rule, its benign origin;
- Ensuring a sufficient level of daily physical activity;
- prescribing an effective and safe treatment to relieve pain in the first place;
- Correction of therapy if ineffective after 1-3 months.
Drug-free treatment of back pain
In most cases, a patient with back pain gets better within 2-6 weeks. The main goal 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.
Development of correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of pain syndrome.
According to the duration, the drug-free treatment of back pain can be divided into three stages.
I scene- passive physiotherapy in the acute period (6 weeks).
II stage- active training in the subacute period (6-12 weeks).
III stage- rehabilitation physiotherapeutic effect.
Bed rest is only prescribed for a limited period of time for acute back pain.
Various physical activities and forms of complementary and alternative medicine can help manage pain, such as:
- non-specific physical exercises such as daily walking, cycling, swimming. For uncomplicated low back pain, regular physical activity and light stretching exercises are recommended to improve long-term outcomes. Physiotherapy may also be recommended to strengthen the muscles of the abdomen and spine;
- 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 techniques.
Medical treatment for pain
The most common medical treatments for back pain include:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injections of steroid hormones into the joint cavity or epidural space of the spine reduce inflammation and lower back pain. However, this type of therapy is not intended for long-term use due to the side effects of the drugs.
When is the operation used?
Although the vast majority of people with back or neck pain get better over time without medication or non-surgical treatment, some patients may need surgical correction of spinal conditions. In general, a patient with back pain can undergo surgery if they meet the following criteria:- diagnosing a structural problem and confirming it with imaging (such as X-ray or MRI);
- conservative treatments such as physiotherapy or drugs failed to provide adequate pain relief;
- back pain is debilitating - prevents participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- objective, confirmed by diagnostic methods, there are reasons to believe that spinal surgery will be useful;
- there is neurological damage.
Prevention of back pain
Maintaining a healthy lifestyle is key to preventing back pain. Being overweight puts 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 of the body, including the aging of the spine, so quitting tobacco products is another step towards a healthy back. Correct posture, ergonomics at work and avoiding a sedentary lifestyle are effective ways to prevent back pain.