Today, back pain is the second most common cause of patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease increases only with age. In medical practice, pain (dorsalgia) is considered an interdisciplinary pathology, because there is a symptom in the clinic of both neurological and somatic diseases.
What causes back pain?
90% of citizens have low back pain (vertebral pain). In other cases, the cause is internal organs, spinal cord, etc. There may be pathologies (non-vertebral pain).
Thus, the vertebrogenic group includes:
- intervertebral hernia;
- sacra or lumbarization;
- spondylosis;
- osteoporosis;
- tumor processes of the vertebrae;
- trauma (spinal fractures, spondylolisthesis).
The non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumors (neuromas) and metastases;
- epidural abscess;
- syringomyelia.
symptoms
The nature, intensity and duration of back pain vary depending on the underlying pathology.
- Intervertebral hernia.With the development of osteochondrosis, a herniated disc appears between the vertebrae. In this condition, the pain can be sharp or excruciating and local (depending on the level of the affected disc). The pain often extends to the limbs, accompanied by muscle and tingling. In advanced cases (when the hernia sac compresses the nerve roots), disorders in the sensitive and motor areas of the arms or legs may occur. Rarely, there is urinary incontinence, defecation and sexual dysfunction (with pelvic spinal cord injury).
- Sacra or spine.Sacralization is a congenital anomaly associated with the union of the last vertebra with the sacrum. In this case, the opposite defect occurs lumbarization when the first vertebra of the sacrum separates and becomes an additional lumbar vertebra. Pathologies are generally asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, there is back pain in the sacrum, which increases with movement and spreads to the lower extremities. The pathology is also characterized by its occurrence at a young age (usually 20-25 years).
- Spondylosis.Spondylosis (unlike previous disease) occurs mainly in the elderly. The disease develops as a result of old changes in the spine - its "wear and tear". Pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. Second, it is dangerous with damage to the nervous system, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only in movement, but also at rest, and causes insomnia. With an uncontrolled disease, there are often cases of nerve fiber compression with immobilization of the vertebral joints and the development of characteristic neurological diseases.
- Osteoporosis.Osteoporosis is a metabolic disease in which the processes of bone destruction take precedence over bone formation. The clinical manifestations of the disease are few: in general, the pathological process is asymptomatic and is detected by chance (by X-ray). However, in the later stages of the disease, stagnant pain and posture curvature occur.
- Vertebral tumor processes.Vertebral tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic low back pain (usually in the lower spine) can spread to the thighs and lower legs. Sooner or later, the growth of the tumor leads to compression of the nerve roots, which is manifested by neurological disorders: sensitivity and loss of movement in the limbs.
- Injuries.Common causes of acute pain, limited mobility, and neurological symptoms are spinal cord injuries: fractures, sprains, dislocations / subluxations, as well as "slipping" of the vertebrae due to damage to the ligament apparatus - spondylolisthesis. Typically, patients report acute diffuse pain in the back, the presence of bleeding ("bruising"), local swelling, and limited mobility.
- Psychogenic pain.A similar thought occurs in the background of complete health after an emotional outburst or a stressful situation. Patients describe pain in a variety of ways that are limited only by the patient's imagination. Sometimes there is something so-called. "Painful behavior" when people tend to use auxiliary support while maintaining mobility: crutches, crutches, and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is very similar to psychogenic pain. At the same time, pain is caused by stress, climate and emotional overload. However, an important difference is that the pain is observed for more than three months, accompanied by local tenderness at characteristic points (occlusion of the occipital muscles, the middle of the trapezius muscles, etc. ). In addition, the diagnosis requires the complete exclusion of all types of somatic diseases.
- Pathologies of internal organs.Back pain can often be caused by diseases of various organs of the body. Thus, with heart attack, the pain syndrome is localized behind the sternum, spreading to the scapula and under the left arm and into the spinal region. Pneumothorax (accumulation of air under the lining of the lungs) causes acute chest pain radiating to the spine. The symptom complex occurs against the background of difficulty breathing and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, it occurs in the form of a "belt" that covers the sides and back of the upper abdomen. Low back pain is accompanied by vomiting and indigestion. One complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Typically, the pain is so severe that it causes patients to bend over in search of comfort. Against the background of the attack, the urine turns dirty red due to blood impurities.
- Tumor processes.Neuroma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, back pain, as well as sensitivity and motor activity below the level of the lesion, decrease. It should be noted that this tumor process is generally negative. However, a similar clinical picture is associated with breast cancer, prostate, lung, kidney, etc. May cause metastases.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, accompanied by neurological disorders: paresis (loss of muscle strength), loss of sensation, pelvic disorders, etc. a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system in which cavities form in the spinal cord. Injuries, tumors, brain compression, etc. Causes disease. In the early stages, there is a slight pain in the spine that does not cause discomfort. Then there is weight loss, muscle weakness, pain sensitivity, no sweating, and bones become brittle. Often there are injuries (burns, fractures, cuts) in the joints and skeleton, but the pain is not felt due to lack of sensitivity.
Diagnostics
As a diagnosis, a qualitative examination and physical examination of the patient by palpation (feeling), percussion (percussion) and auscultation (listening) is required. For some pathologies it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
You will need instrumental diagnostic methods to visualize soft tissues and internal organs: ultrasound or magnetic resonance imaging. However, X-rays and computed tomography are used for direct examination of the skeleton.
In some cases, less common methods may be needed: bone scintigraphy, electromyography, etc.
Back Pain Treatment
Apply ice to relieve acute back pain (20 minutes every 4 hours), exclude physical activity, and immobilize the spine if possible. If the pain is unbearable, painkillers may be taken. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. Later, it can complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
Herniated disk
The main drug treatment is based on the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and painkillers (Ketorolac). In some cases, surgical removal of the intervertebral hernia may be required, as well as endoprosthesis of the intervertebral disc.
Sacra or lumbarization
When pain occurs, blockade with anesthetics and reconstructive surgery with the ineffectiveness of conservative treatment with physiotherapy (paraffin applications, electrophoresis, etc. ) are indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin), as well as physiotherapy (ultrasound, electrophoresis) are used to relieve inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a diet high in calcium and vitamin D.
Perhaps prescribing these substances in the form of drugs. In some cases, hormone therapy with estrogens, calcitonin and parathyroid hormones is used.
Tumor processes
Treatment of tumors consists of chemotherapy and surgery. The amount of care in this situation depends on the specific clinical situation.
Injury
In case of minor injuries, a gentle regimen and warm-up is prescribed. In some cases, reduction or skeletal traction is required. When neurological symptoms appear, operations are performed with fixation of bone fragments.
Psychogenic pain
Psychogenic pain relief consists of complex psychotherapy in addition to taking antidepressants (fluoxetine, Sertraline).
Fibromyalgia
Given that the cause of the disease is still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), hypnotics (Zopiclone) or tranquilizers (Diazepam). Positive thinking is also important to avoid stressful situations and to adapt to a hot, dry climate.
Pathologies of internal organs
Each of the possible internal pathologies requires individual treatment tactics. An ambulance for a heart attack takes Nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in the case of an open wound of the lung; With renal colic - antispasmodics (Drotaverine, Metamizole sodium) and warming.
Epidural abscess
Treatment consists of emergency surgery to normalize the pressure in the spinal canal and empty the cerebral cortex. Antibiotic therapy (amoxicillin, cefotaxime) supports surgery.
Syringomyelia
Generally, patients are advised to protect their skin from cuts and burns (the latter often occurs because patients lose sensitivity and do not feel trauma). Painkillers, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is needed to repair the gaps in the spinal cord.
Prevention
In order to prevent back pain, it is necessary to prevent the occurrence of any of the above pathologies. To do this you need:
- Normalize your lifestyle: reduce your weight; Organize a proper diet rich in trace elements and vitamins; Ensure proper physical activity without excessive stress.
- Avoid bad habits: smoking and alcohol consumption.
- Straight posture curvature (scoliosis, lordosis) and orthopedic pathologies (straight legs, feet, etc. ).
- Timely diagnosis and treatment of diseases of the musculoskeletal system or internal organs.
- Prevent or treat spinal cord injuries properly.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The underlying disease can be extremely serious and can lead to disability and even death if left untreated!