Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and one of the most pressing problems in modern health care, and treating back pain is not an easy task.
Although the pain syndrome can occur in any part of the spine, the most common location is the lower back - according to researchers, the prevalence of low back pain reaches 76% in the adult population.
According to statistics, about 80% of people complain of at least one attack of lower back pain within a year, and in the next 12 months 75% of them experience a recurrence of pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected area of the back, the pain syndrome is divided into pain in the neck, middle back (chest pain), low back (lumbar pain) or coccyx pain (pain in the coccyx or sacrum).
According to the results of a study of 46, 000 volunteers from several European countries, 24% of the population have chronic pain in various parts of the spine, 18% in the lumbar region, and neck pain occurs in 8% of the population.
The duration of pain is acute - lasts up to 12 weeks or chronic - more than 12 weeks.
The pain can be dull or stabbing, sometimes there is a burning and tingling sensation. In some diseases, symptoms also extend to the arms and hands, legs, or feet, depending on the degree of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of the concomitant manifestations of back pain. Limitation of range of motion or increased pain with a certain body position 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 labeled "nonspecific" or "mechanical. "The cause of such pain are 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 subspecies of pain syndrome occurs in 98% of patients. Secondary pain against the background of the underlying disease accounts for about 2% of cases.
Non-specific back pain has the following characteristics:
- tends to improve or worsen depending on body position - for example, patient may feel better sitting or lying down;
- the pain is often aggravated by movement;
- an attack may develop suddenly or increase gradually;
- Sometimes back pain is the result of poor posture or awkward lifting, but it often occurs for no apparent reason;
- can be caused by a minor injury, e. g. B. by sprained ligaments or muscles;
- can occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for the development of non-specific back pain:
- Hard physical work;
- 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 importance 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) that 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 resolves this pathological effect and is a reminder of a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of the intervertebral disc;
- autoimmune diseases of the joints such as ankylosing spondylitis (swelling of the spinal joints);
- 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 (e. g. meningitis, tuberculosis);
- Diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- Metastases or certain types of cancer such as multiple myeloma, a type of bone marrow cancer.
Diagnosis of back pain
In order to understand what to do with severe back pain, it is first desirable to establish the cause. An accurate diagnosis is key to a well-designed treatment plan.
After a thorough evaluation of the patient's complaints, medical history, and the nature of the 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 spine, showing even slight changes in the bones.
- magnetic resonance imagingShows both tissue and bone structures and is used to detect a herniated disc, herniated disc, pinched nerve or spinal cord.
- When conductingmyelogramsA special biologic is used - a dye that is injected into the area around the spine to better visualize the spinal canal and discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic Testsallows you to assess the electrical activity of nerves in the upper and lower extremities.
- Positron Emission Bone Scanmainly reveals the oncopathology of the bones.
- Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone mineral density.
Ways to relieve back pain
The complex structure of the pain syndrome in the area of various parts of the back and the stages of pathological changes require a combination of drug and non-drug treatment.
The principles of therapy of a patient with chronic low back pain, based on evidence-based medicine, imply:
- explain to the patient the causes of the pain and, as a rule, its benign origin;
- Ensuring an adequate level of daily physical activity;
- the appointment of effective and safe treatment, primarily to relieve pain;
- Correction of therapy if ineffective after 1-3 months.
Non-drug treatment of back pain
In most cases, a patient with back pain will improve within 2-6 weeks. The main goal of nonspecific treatment is to reduce mobility limitations, minimize flare-ups, and while good physical condition cannot prevent all painful episodes, it does facilitate the resolution of these episodes.
Development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.
Depending on the duration, the non-drug treatment of back pain can be divided into three phases.
I direct- passive physiotherapy during the acute phase (6 weeks).
Stage II- active movement during the subacute phase (6-12 weeks).
Stage III- rehabilitative 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 activity, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching are recommended to improve long-term results. Physiotherapy may also be recommended to strengthen the abdominal and spinal muscles;
- therapeutic massage is used for short-term pain relief, but does not lead to long-term improvement in function;
- the use of acupuncture, manual therapy and methods of spinal traction.
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, reducing 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 the operation?
While the vast majority of people with back or neck pain recover over time without medication or nonsurgical treatment, some patients may require surgical correction of spinal disorders. In principle, 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 (eg, X-ray or MRI);
- conservative treatments such as physical therapy or medication have not provided adequate pain relief;
- Back pain is debilitating - it interferes with participating in daily activities or physical activity;
- Symptoms affect physical or emotional health;
- there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- There is neurological damage.
Prevention of back pain
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 in the body, and also contributes to the aging of the spine. Therefore, refusing tobacco-containing products is another step towards a healthy back. Correct posture, ergonomics in the workplace and avoiding a sedentary lifestyle are effective ways to prevent back pain.