Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most urgent problems in modern health care, and the treatment of back pain is a difficult task.
Although pain 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% 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 recurring pain syndrome.
Types and manifestations of pain syndromes
Depending on the part of the back affected, the pain syndrome is divided into pain in the neck, middle back (chest pain), lower back (back pain) or coccydynia (pain in the tailbone 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 characteristic of 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 sensation and tingling.Symptoms of some diseases also spread 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 option to accompany the manifestation of back pain.Restrictions in certain range of motion or increased pain in certain body positions are also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
When examining, it is not always possible to determine the direct cause of back pain, where the pain is called "non-specific" or "mechanical."The cause of this pain is pathological changes in the musculoskeletal system, but damage to the cervical, thoracic, lumbar and sacral nerve roots and certain diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease accounts for about 2% of cases.
Non-specific back pain has the following characteristics:
- tend to improve or worsen depending on body position - for example, the patient may feel better when sitting or lying down;
- pain often worsens with movement;
- attacks can develop suddenly or gradually increase;
- Sometimes back pain is the result of poor posture or lifting something awkward, but often appears for no apparent reason;
- may be caused by a minor injury, such as a sprained ligament or muscle;
- may occur after stress or overwork and usually start to get better within a few weeks.
Risk factors for developing non-specific back pain:
- hard physical labor;
- frequent stooping and stooping;
- lifting heavy objects, especially from the wrong position;
- sedentary lifestyle;
- industrial effects such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, because it indicates the acute influence of unfavorable factors.
The most common causes of acute back pain are:
- injuries to various structures in the spine;
- spondylolisthesis - displacement of vertebrae relative to each other;
- sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the human body), running from the lower back to the legs
- 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 root of the intercostal nerve;
It is important to remember that acute pain marks the beginning of a disorder, while chronic pain records the effects of this pathology and reminds of a developing disorder.
Conditions that can cause chronic back pain include:
- intervertebral disc displacement or prolapse;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
- radiculopathy - inflammation and degeneration of nerves that run from the spinal cord to muscles and joints;
- arthritis and arthrosis of spinal joints of various origins.
- infectious processes (for example, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- metastasis or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain syndrome
To understand what to do with severe back pain, it is advisable, first of all, to determine the cause.An accurate diagnosis is key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history, and nature of symptoms, the doctor may order imaging studies and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- Computed tomographyprovides a detailed cross-sectional image of the spinal column, showing subtle changes in the bones.
- Magnetic resonance imagingshows both tissue and bone structure and is used to identify a slipped or herniated disc, pinched nerve or spinal cord.
- While runningmyelogramsSpecial biological dyes are used that are injected into the area around the spinal column to better visualize the spinal canal and intervertebral 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 scanning of bonereveals, first of all, bone oncopathology.
- Densitometry - the determination of bone density - is indicatedfor diseases and conditions that lead to decreased bone mineral density.
Ways to combat back pain
The complex structure of pain in various parts of the back and the stage of pathological changes determine the need for a combination of drug and non-drug treatment.
The principles of therapy for patients with chronic back pain, based on evidence-based medicine, imply:
- explain to the patient the causes of pain and, as a rule, its benign origin;
- ensuring an adequate level of daily physical activity;
- prescribing effective and safe treatments, especially for pain relief;
- correction of therapy if it is not effective after 1-3 months.
Non-drug treatment for back pain
In most cases, patients with back pain improve within 2-6 weeks.The main goal of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical fitness cannot prevent all painful episodes, it facilitates the resolution of these episodes.
Developing correct motor stereotypes and physical therapy is an important area of non-pharmacological pain correction.
Based on its duration, non-drug treatment for back pain can be divided into three phases.
Stage I- passive physiotherapy during the acute period (6 weeks).
Stage II– active exercise during the subacute period (6-12 weeks).
Stage III- rehabilitative physiotherapeutic 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 relieve pain, such as:
- non-specific physical exercise such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy 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 functional improvement;
- the use of acupuncture, manual therapy and spinal traction methods.
Pain medication treatment
The most common drug treatment methods for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injection 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 drug.
When is surgical treatment 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 disorders.In general, patients with spinal pain can undergo surgery if the following criteria are met:- structural problems have been diagnosed and confirmed by imaging (eg, X-ray or MRI);
- Conservative treatments such as physical therapy or medications have failed to provide adequate pain relief;
- back pain is debilitating and prevents you from participating in daily activities or physical activity;
- symptoms negatively affect physical or emotional health;
- there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- nerve damage occurs.
Prevent back pain
Maintaining a healthy lifestyle is 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 body tissues, including contributing to the aging of the spine, so stopping the use of 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.