Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and one of the most pressing problems of modern healthcare, 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% in 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 syndrome
Depending on the affected segment of the back, the pain syndrome is divided into neck pain, middle back pain (chest pain), lower back pain (lumbar pain) or coccydynia (coccyx or sacrum pain).
According to the results of a study involving 46 thousand volunteers from several European countries, chronic pain in various parts of the spine is inherent in 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 - more than 12 weeks.
The pain can be dull or shooting, sometimes there is a burning and tingling sensation. Symptoms in some diseases also involve the arms and hands, legs or feet, depending on the level of spinal involvement. Numbness or weakness in the upper and lower limbs is another variant of the concomitant manifestations of back pain. Limitation of the range of some movements or increased pain in a certain position of the body is also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
Examination cannot always determine the immediate cause of back pain, in which case the pain is called "nonspecific" or "mechanical. "The cause of such pain is pathological changes in the musculoskeletal system, but no damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are observed - this subtype of the pain syndrome occurs in 98% of patients. Secondary pain on the background of the main disease is about 2% of cases.
Non-specific back pain has the following characteristics:
- it tends to improve or worsen depending on the position of the body - for example, the patient may feel better when sitting or lying down;
- pain often increases with movement;
- the attack may develop suddenly or gradually increase;
- sometimes back pain is the result of poor posture or awkward lifting, but often occurs 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 overexertion and usually starts to improve within a few weeks.
Risk factors for developing non-specific back pain:
- heavy physical work;
- frequent bending and tilting of the body;
- lifting weights, especially from an incorrect position;
- passive lifestyle;
- industrial influences, eg vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance because it indicates the acute impact of an adverse factor.
The most common causes of acute back pain are:
- trauma to various structures in the spine;
- spondylolisthesis - displacement of the 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 the 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 disease, while chronic pain fixes this pathological effect and reminds of a developing disease.
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 joints of the spine);
- radiculopathy - inflammation and degeneration of the nerves that pass from the spinal cord to the muscles and joints;
- arthritis and arthrosis of the spine joints of various 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
In order to understand what to do with severe back pain, it is desirable to first of all find out the cause of it. An accurate diagnosis is the key to a well-designed treatment plan.
After a thorough review of the patient's complaints, history, and nature of symptoms, the doctor may order imaging studies and functional studies to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- CTprovides detailed cross-sectional images of the spine that show even slight bone changes.
- Magnetic resonanceIt shows tissue and bone structures and is used to detect a slipped or herniated disc, pinched nerves or spinal cord.
- When conductingmyelogramsa special biological preparation is used - a dye that is injected into the area around the spine for better visualization of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers inside and around the spine.
- Electrodiagnostic studyallows you to assess the electrical activity of the nerves in the upper and lower extremities.
- Positron emission bone scanreveals, first of all, bone oncopathology.
- Densitometry - determination of bone density - according to indicationsin diseases and conditions leading to a decrease in bone mineral density.
Ways to deal with back pain
The complex structure of the pain syndrome in the area of different parts of the back and the stages of pathological changes dictate the need to combine drug and non-drug treatment.
Principles of therapy for a patient with chronic back pain based on evidence-based medicine suggest:
- explaining to the patient the causes of pain and, as a rule, its benign origin;
- Ensuring a sufficient level of daily physical activity;
- the appointment of effective and safe treatment, primarily for pain relief;
- correction of therapy in case of its ineffectiveness after 1-3 months.
Non-drug treatment of back pain
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, to minimize recurrences, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.
The development of the correct motor pattern and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
According to the duration, the non-drug treatment of back pain can be divided into three phases.
I stage- passive physiotherapy in the acute period (6 weeks).
II stage- active exercises during the subacute period (6-12 weeks).
Stage III- rehabilitative physiotherapy effect.
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 manage pain, such as:
- non-specific physical exercises, 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 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 methods.
Medical treatment of pain
The most common medical treatments for back pain 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 pain in the back. However, this type of therapy is not intended for long-term use due to the side effects of the drugs.
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 conditions. Generally, a patient with back pain can be operated on if the following criteria are met:- a structural problem has been diagnosed and confirmed by imaging (such as X-ray or MRI);
- conservative treatments such as physical therapy or medication have 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;
- there are objective reasons confirmed by diagnostic methods to believe that spine surgery will be beneficial;
- have neurological impairments.
Prevention of 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 of the body, including contributing to the aging of the spine, so giving up 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.