In most cases, back pain is caused by hypothermia or muscle strain due to strenuous movement or heavy lifting and may go away on its own. If the pain disrupts the normal rhythm of life, the improvement does not occur for a long time or other suspicious symptoms are present, then the diagnosis and treatment of back pain in the lumbar region should be entrusted to the doctor.
Depending on how long the pain has bothered the patient, doctors distinguish:
- acute pain - less than 4 weeks,
- subacute pain - from 4 to 12 weeks,
- chronic pain - more than 12 weeks.
At the appointment, the doctor explains to the patient exactly how the back hurts: it can be a sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pains and sensationsothers unpleasant of different degrees. of intensity. Based on the duration, location and nature of the pain, the doctor assumes what is its source.
Lumbar back pain: causes
Pain in the lumbar region can be associated with both spine problems and other organs and systems in the body. To understand how to cure your lower back, you need to determine what is causing the pain.
There is vertebrogenic pain caused by diseases of the spine:
- Osteochondrosis, manifested by problems with intervertebral discs, facet or facet joints. Disorders occur with age in every person: intervertebral discs lose moisture and elasticity, facial joints become denser and become less mobile.
- On the strain of the muscles and ligaments of the spine.
- Compression of spinal nerve roots - radiculopathies.
- Spinal cord injury.
- Instability of the spine due to weakness of the ligamento-muscular system.
Non-vertebral causes include:
Neurological disorders - Lumbosacral plexopathies are damage to the nerve plexus that creates the peripheral nerves of the lower extremities. It occurs with injuries and metabolic disorders.
- Dystonia is a violation of the tone of the muscles that support the spine. In this case, the pain may be accompanied by poor posture. The disease can be congenital.
Systemic diseases - Infections affecting the vertebrae, discs, membranes of the spinal cord or the spinal cord itself, for example, osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in bone density of the skeleton, fraught with vertebral fractures.
- Rheumatic diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.
Pain from internal organs. It is caused by causes outside the spine and radiates to the lower back, sometimes in the middle, sometimes laterally - depending on the source organ. This includes:- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pains in the back and flanks accompany renal colic when the stone moves along the ureter.
- Aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body forms a bulge. This can cause a throbbing sensation in the abdomen.
- Diseases of the hip joints - injuries, inflammation, degeneration.
Psychogenic pain Back pain can be associated with an anxiety disorder or depression.
Damage to the spinal cord or the lower roots of the spine, called the cauda equina, is a medical emergency. Compression of these structures can be caused by:
- herniated disc,
- injury,
- malignant or benign tumor,
- infection.
Spinal cord compression is associated with extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.
Symptoms
Often low back pain is nonspecific, that is, caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:
- Aching, pulling or squeezing pain.
- The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, for example, hanging curtains, changing light bulbs in a chandelier, bending overrepeatedly and for a long time: when washing floors, vacuuming, removing snow.
- There are no other symptoms.
The fact that pain can be a symptom of a dangerous condition is shown by"red flags":
- Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
- Pain at rest and at night, interfering with sleep. Nonspecific pain usually occurs with movement or prolonged static load, but goes away after resting in a comfortable position.
- General weakness is also not characteristic of nonspecific pain.
- Unexplained weight loss over the last few months. It can be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Increased body temperature, chills. It indicates severe inflammation of various origins.
- Severe or increasing numbness or weakness in the leg muscles.
- Impaired bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement combined with acute pain is a sign of compression of a nerve, and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord can be permanently lost.
- Lack of effect from treatment and the transition of acute to chronic pain.
- Characteristics of the medical history. For example, if back pain appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It does not matter how long ago the diagnosis was made. Or the pain has appeared in a person who has recently undergone a serious infection, surgery or has a significantly reduced immune system for some reason, for example, has taken a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, back pain can indicate various complications.
If you have identified at least one of the listed points, immediately consult a doctor for additional examination.
Diagnosing
Pain is a subjective symptom, so a study and examination by a doctor plays a big role in the diagnosis. The doctor prescribes additional examinations depending on the diagnosis he suggests. For an accurate diagnosis, do:
- Laboratory tests— complete blood count, biochemical blood analysis, general analysis of urine, analysis for the detection of infections, autoimmune diseases.
- Electroneuromyography- the study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
- Imaging using x-rays, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spine, the presence of hernias, compression of the spinal nerve roots.
- Ultrasonographykidneys and abdominal cavity - performed if pathology of internal organs is suspected.
- Assessment of bone condition: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.
If the doctor is absolutely sure that the lower back pain is non-specific, he can prescribe treatment based on the examination alone, without additional tests.
Often, with pain in the lower back, a person does not go to the doctor, but comes only for an MRI of the spine. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic herniated discs. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person suffers discomfort for a long time, takes painkillers uncontrollably and develops complications and side effects.
Which doctor should I contact?
First, if you have lower back pain, you can also consult a general practitioner. He will suggest what is causing the pain and, depending on this, refer you to another specialist. You can skip this step and immediately make an appointment with a neurologist.
If a neurologist, after a specialized examination, suspects a pathology outside the spine, he may refer to:
- rheumatologist,
- surgeon,
- urologist,
- gastroenterologist,
- endocrinologist,
- the oncologist.
Doctors of all these specialties periodically encounter the symptom of back pain, because it has a large number of possible causes.
If a diagnosis of mechanical pain is made, the patient will be treated by physical therapy specialists, a reflexologist, a physiotherapist and massage therapists.
How to cure back pain
- SurgeryThey are mainly used for signs of compression of the spinal cord or spinal nerve roots, when the patient experiences paresis of a limb or urinary disorder. These symptoms can be caused by an intervertebral hernia, tumor or injury. Also, consultation with a neurosurgeon may be recommended for the patient in case of chronic pain when conservative treatment is ineffective within 12 weeks. The decision to operate is made only after visualization of the spine.
Studies have shown that uncomplicated disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.
- Conservative treatmentincludes medicinal and non-medicinal methods.
Drug treatment is carried out using non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.
Non-drug treatment includes:
- Physiotherapy— is aimed at the rapid elimination of pain and inflammation, as well as the acceleration of tissue restoration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
- Acupuncture- inserting special sterile needles into biologically active points to reduce pain and relax muscles.
- Massage— improves the mobility of the spine and joints, promotes the proper distribution of the load on the back muscles.
- Physical therapy- allows you to relax and strengthen your back muscles. Exercises are effective for acute and chronic back pain.
If the patient has pain for more than 12 weeks, we talk about chronic pain. In its treatment, antidepressants with an analgesic effect, as well as cognitive behavioral psychotherapy, are added to all the above methods.
Bed rest offers no benefit in the treatment of mechanical low back pain and is not an alternative to the above methods. Furthermore, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly slows recovery.
Consequences
Acute nonspecific low back pain has a favorable prognosis. Of those who seek treatment immediately, 70-90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with an analgesic effect. If the pain is caused by the compression of the nerve roots of the spine by a hernia, then it can be accompanied by numbness in the limbs, as well as problems with urination and defecation.
Preventing
Help prevent back pain:
- Moderate exercise for 150 minutes a week: walking, swimming, exercises for the core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
- Maintaining a healthy weight.
- Warm up every 40-60 minutes with a long static position.
- Exercises for stretching the thigh muscles.
- Correct body position when lifting weights: you should sit, not bend forward.
- Prevention of decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis by densitometry. This is especially important for older people and postmenopausal women.
- Maintaining general somatic and psychological health.