Back Pain: Causes, Treatment

Pain in the lumbar spine and the surrounding areas that may interfere with are patients any time of the day, in, sitting, lying down or on-the-go, during physical exertion or at rest. A Symptom of this is not to say this so specifically, in such a large number of cases, requires special attention in the first line on the part of the patient: you must immediately consult a doctor.

To treat the doctor?

According to the statistics, up to 25% of the patients in medical treatment, especially in the context of the emergence of pain in the lumbar region. 8 out of 10 inhabitants of the globe are experiencing back pain, at least 1 time in my life. The most common age, a little less people in retirement are suffering from these symptoms people of working age and less - young people (according to different data, from 8 to 40% in Russia).

Internist, Neurologist, Rheumatologist

The first doctors, which the majority of patients with pain in the lower back, the Internist and neurologist. And here, young people have a Trauma in the recent past, is increasingly becoming a specialists.

And diagnostic and therapeutic tactics in these experts differ. Often, the therapist directs the patient to a neurologist, determined by a neurologist, "his" diagnosis and get the treatment rubs. The specialist often works "individually," and in addition to the use of non-steroidal anti-inflammatory drugs, applies the techniques of manual therapy and physiotherapy. The main thing for the patient – will not be lost in this Situation, not to interfere with the promises of instant healing, do not engage in the execution of the techniques to him again, in the case of lack of success, or, what is worse, the efforts on the background of such treatment of pain.

In the treatment conservatively, with medication, you should understand to revmatologu that treatment within four weeks without any result - a convincing argument for the Revision of the diagnosis, the treatment, and not to carry out repeated courses of therapy. The situations are frequent when the Patient with complaints of pain in the lower back gets symptomatic (i.e. pain-relieving) treatment after a certain amount of stencil scheme, without clarification of the real causes for this pain.

Causes for lower back pain

The main causes of pain in the lumbar region is

  • Changes in the structures of the spine, usually age-related (degenerative), osteochondrosis of the spine, a variety of hernias of the intervertebral discs or insufficient muscular work of the complex. Such pain can be primary, i.e., directly with the spine;
  • pathological changes of the organs, which are in addition to the pain area, but directly to the spine are not related (e.g., diseases of the internal organs, the skin). To belong to this category of causes inflammation of the joints, injuries, and disorders of the endocrine system (e.g. Diabetes), - in a word, everything that does not fit into the image of the "natural age-related changes" of the spine. Such pain can be as a secondary.
Pain-Back Pain

Examination by a doctor

Pain, the feeling of the severe mobility or increased painful muscle, the term "lyumbalgiya tension in the area between the lower ribs and the buttocks". If the specified symptoms pain in the leg, this condition is called lyumbalgiya.

First and foremost, the severity of the pain is important, that is, the duration of their occurrence. The pain of the provision of up to 12 weeks (3 months) is called acute, longer than 12 weeks – chronic. A chronic pain syndrome can lick with periods of exacerbations and improvement.

Of fundamental importance is how the pain is felt. This, or a feeling at a certain point, or the distribution ("projection", "irradiation") is pain along the nerves in the thighs, buttocks, knees, feet, or a slurred, "dull" pain. You need to understand are limited movements in the spine in the moments of emergence of pain, or uncontrolled movements (this suggests that mechanical damage, e.g. fracture of a vertebra). In what points is there pain? It occurs under load or at rest, during the night? A positive answer to the last question, in General, is the "red flag" for those skilled in the art, and forces us to reconsider the diagnosis of inflammatory diseases of the spine of the patient (you stay a little later). If the pain increases with the movement of the head, walking, jumping, it's probably the so – called projection of the pain, the cause of damage to nerve structures (most commonly sciatica).

Osteochondrosis of the spine, or spondilez – condition in which there is a compaction and deformation of the vertebrae, with the advent of smaller bony surfaces, like Spikes, at the edges of the vertebral body. For a long time it was spondilez assumed to be the result of natural progression of the degenerative processes of aging of the organism. However, it been shown conclusively that not only the age, the cause of degenerative disc disease. Lack of exercise, increased stress on the lumbar spine during work on the Computer, or in the case of a longer journey (for example, professional truck drivers) contribute to the development of osteoarthritis even in young people. Under the influence of all these factors, the intervertebral discs-the buffer to be thin, and the nerve roots, the spinal cord injured but regional Spikes of bone. The constant Irritation of this nerve root and causes pain. Latin book back radix called, therefore, an inflammation of the one called radikulit.

So-called inflammatory diseases of the spine – the area of interest to rheumatologists. This mysterious disease is "smouldering" for a couple of years, starting mostly at a young age and is especially true of the men, casting, and finally, in obezdvizhennost' i invalidizatsiyu of the patient. The patients of this group, typically "suffer to her last" and night-time pain and morning stiffness in the back, and weakness, decreased performance, and the growing. Unfortunately, performances of the first symptoms to the correct diagnosis on average it takes about seven years. During this time, changes in the spine can irreversible, and functional (motor) activity is low. The spine is immobile, it changes the shape, appears to hump. This pathology occurs not so often, such as osteochondrosis, for example, but the cost of treatment and the total period of incapacity of such patients disproportionately higher.

If, in addition to the back of the Patient's pain, talks about the inflammation of the joints (often the knee joints, the joints of the hands or feet), pain in the buttocks, unstable chair with unusual contaminants, blurred vision, or pain in the eyes, it is also an opportunity to immediately send it to a professional for the implementation of the specific additional examinations and the exclusion of the disease from the group spondiloartritov (e.g., seronegative spondylitis, or Crohn's disease).

It diseases, is manifested by pain in the lower back and completely undisturbed by the vertebrates or the neural structures. Such a disease – myofascial pain syndrome. The patients (and they are mostly young patient) to show over a longer period of time in an uncomfortable Position, or physical overload, before the development of the pain. In the case of the medical examination of sharp strong pain on pressure on certain points around the spine. This condition reduces the quality of life of patients, but minor changes in the muscle tissue (the local load), the roots no danger for the nerves and for the internal organs. To generally achieve a therapeutic effect, with the goal of muscle relaxants, low doses of non-steroidal anti-inflammatory drugs, local administration (injection) in the "sensitive spot Steroid inflammation" - inflammatory drug.

Investigation

It is assumed that, when a Patient with complaints of pain in the lower back "worrying signs" (discussed below), can then be used in the extended investigation, he does not need, and the treatment of a therapist carried out, analysis and also x-ray. But, as practice shows, virtually every Patient can be detected, such a "character", which means that the need to donate blood at least shared (and better - and on immunological) analysis and carry out x-rays of the lumbar spine in two planes (in the ideal case with the "capture" of the bones of the pelvis).

  • - Blood tests may reveal elevated erythrocyte sedimentation rate (ESR), signs of inflammation, perhaps immune origin, or infection. The increase in the level of leukocytes also speaks of an infection or inflammation, severe anemia – about the possible presence of a tumor process.
  • - Urine analysis in cases of suspected disease of the kidneys. Pain in the lumbar area is periodically, often "" up to the lower ribs. If it will lead to changes in the analysis of urine sonography of the kidney, and the other tactics discussed in Detail with the therapist or urologist.
  • - X-ray – price value of instrumental checks, is the method of choice for the diagnosis in this case. On the x-ray image can be seen, injury to the structures of the spine, signs of inflammation of the vertebral joints, due to circumstantial evidence to determine where the compression of the nerve. "Transparency" vortex on the x-ray image leads to the idea of, osteoporosis (fragility) of the skeleton. As you know, on the background of osteoporosis, the most common such complication occurs as a fracture of a vertebra. If the fracture has unfortunately taken place, it is also on the x-ray image visible. The possibilities of this research method are enormous, but if the pathology is found, it must be determined how severe the damage is, whether the Patient is in a surgical procedure on the spine. This is required in order to have more accurate research – stratification (tomography). There are two types of computed tomography x – ray computed tomography and nuclear spin tomography.
  • Computed tomography (CT). The method of investigation, so you can get spine to literally see from the inside. All of the bony structures, which are not visible with conventional radiography, on the tomogram are good visible. With the help of the obtained data and a special Computer program can be a 3D reconstructed model any type of structure.
  • Magnetic resonance imaging (MRI). No X-Ray Examination Method. Unlike computed tomography, also the fact that it is for the doctor to be more thorough, you rate the condition of the soft structures of the spine (in CT is well visible only the bony elements): the spinal cord, roots, nerves. In more detail in the present investigation, a visible hernia, changes in the blood vessels and the muscles. Usually it is for a specialist for MRI remains the last word in the diagnosis and definition of further tactics.

Signs to watch out for

Secondary back pain, i.e., no connection with the osteochondrosis – a disturbing Symptom, and forces as quickly as possible to start search of the underlying disease process causing pain. Shortly we will be on the signs, a reference to a possible secondary (i.e. not directly in connection with the spine), type of pain, and require increased vigilance by the physician and by the patient:

  • quick sudden weight loss (may occur, suspected Tumor);
  • Infections of the kidneys and bladder (in this case, the pain is a Symptom for Pyelonephritis);
  • increased pain at rest or after a night's sleep (this Symptom is especially interested in, rheumatologists, there may be a sign of developing Bechterew's disease);
  • increased body temperature;
  • Changes in the blood picture (increasing the coagulability of the blood, which in the embodiment of coagulogram, increased leukocytes, or drop in hemoglobin and increased ESR (erythrocyte sedimentation rate) in General, the analysis, higher levels of C-reactive Protein in the analysis);
  • diagnosis "osteoporosis", or medications, the the amount of calcium in the bones;
  • Age over 50 years (the risk of development of osteoporosis in women in menopause) or less 20 years, this is especially true for young men;
  • the reference to a Trauma, regardless of the period of limitation (e.g., height of fall more than 2 m and for older people, relevant to the infringement is already the case, the amount of one's own body);
  • Signs of a serious neurological abnormalities (violation of the sensitivity of the skin, urination or defecation in the rule is evidence of a deep lesion of the spinal cord);
  • the inefficiency of the "routine" treatment within 4 weeks.
Pain

Save the activity and mobility

Common mistakes – compliance with bed rest in case of acute back pain. Movement in this pathology of the locomotor system is not only necessary, but necessary! In all cases, except for the compression radicular syndrome (the diagnosis of a neurologist), the remaining in a horizontal Position increases the cost of treatment and duration of recovery will tighten. Yes, and in the case of radicular syndrome, the entire period of bed rest should not be longer than two days.

In inflammatory diseases of the spine and the sacroiliac joints, physical activity – the principal means to the progressive disability. We will remind, the group of diseases has a gradually progressive character, and exercises to maintain the flexibility and the development and strengthening of the muscle "corset" for the spine screams as equally effective treatment, such as special therapy with anti-inflammatory drugs of different groups, the choice of specialists.