Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most urgent 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% among 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 relapse 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), lower back (lumbar pain) or coccydynia (pain in the coccyx or sacrum).
According to the findings 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 pain in the neck 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 may be dull or shooting, sometimes there is a burning and tingling sensation. Symptoms in some diseases also extend to the arms and hands, legs, or feet, depending on the level of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of the accompanying manifestations of back pain. Limitation of the range of some movements or increased pain with a certain position of the body is also observed in some patients with vertebral pain syndrome.
Back pain: why does it happen?
Examination may not always be able to determine the immediate cause of back pain, in which case the pain is referred to as "non-specific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, 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 underlying disease is about 2% of cases.
Non-specific back pain has the following characteristics:
- tends to get better or worse depending on the position of the body - for example, the patient may feel better when he sits or lies down;
- the pain is often aggravated by movement;
- an attack can develop suddenly or gradually increase;
- sometimes back pain is the result of poor posture or awkward lifting, but often appears for no apparent reason;
- may be caused by a minor injury, such as sprained ligaments or muscles;
- may occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for developing non-specific back pain:
- heavy physical labor;
- frequent bending and tilting of the body;
- lifting weights, especially from the wrong position;
- passive lifestyle;
- industrial influences, for example, vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain is of physiological significance, as it indicates the acute influence of an unfavorable 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 feet
- 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 is important to remember that acute pain signals the onset of a disorder, while chronic pain fixes this pathological effect and reminds of a developing disorder.
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 run 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 (abdominal aortic aneurysm or gynecological pathology);
- metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Back pain diagnosis
To understand what to do with severe back pain, it is desirable, first of all, to establish 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 prescribe 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 spinal column, which show even slight changes in the bones.
- Magnetic resonance imagingShows both tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves or spinal cord.
- When conductingmyelogramsa special biological preparation is used - a dye that is injected into the area around the spinal column 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 testingallows you to evaluate the electrical activity of the nerves in the upper and lower extremities.
- Positron emission bone scanreveals, first of all, oncopathology of bones.
- Densitometry - determination of bone density - indicatedin 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 various 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 therapy for a patient with chronic back pain, based on evidence-based medicine, imply:
- 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 the relief of pain;
- correction of therapy in case of its ineffectiveness after 1-3 months.
Non-drug treatment for 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 relapses, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.
The development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
According to the duration, non-drug treatment of back pain can be divided into three phases.
I stage- passive physiotherapy during the acute period (6 weeks).
II stage- active exercise during the subacute period (6-12 weeks).
Stage III- rehabilitation physiotherapeutic influence.
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 with pain management, such as:
- non-specific physical exercise, such as daily walking, cycling, swimming. For uncomplicated 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 methods.
Medical treatment for pain
The most common medical treatments for back pain are:- Non-steroidal 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 side effects of the drugs.
When is surgery used?
While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may need surgical correction of spinal diseases. Generally, a patient with spinal 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 physiotherapy or medications have failed to provide adequate pain relief;
- back pain is debilitating - it interferes with participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- there are objective, confirmed by diagnostic methods, reasons to believe that spinal surgery will be beneficial;
- there is neurological damage.
Prevention of back pain
Maintaining a healthy lifestyle is the 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 contributing to the aging of the spine, so refusing to use tobacco-containing products is another step towards a healthy back. Correct posture, workplace ergonomics, and avoiding a sedentary lifestyle are effective ways to prevent back pain.