Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndrome can accompany diseases that affect the spine, kidneys and other organs and systems. Treatment and prevention of back pain includes both medication and non-medication. Improper delivery of medical care can cause chronic disease with complications.
Back pain is a separate symptom and not a disease entity. For example, back pain is pain located in the lumbar spine. There are also concepts such as chest pain or cervical back pain. Accurate localization of the pathological symptom is necessary for the selection of the correct regular treatment and the choice of preventive measures.
Definition
Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of immediate tissue or organ damage or when exposed to adverse psychological factors (stress, anxiety, depression).
Back pain is a multidisciplinary practice in medical practice. This is due to the fact that pain syndrome can occur due to pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver and others).
It should be noted that the pain syndrome may be accompanied by a deterioration of the patient's cognitive abilities - memory disorders may occur, the concentration decreases.
In most cases, the onset of back pain is a defensive reaction of the body due to the influence of adverse factors. The most common cause of back pain is sciatica, disc herniation or vertebral fall.
Epidemiology
According to World Health Organization (WHO) statistics, back pain is a concern for more than 40% of the population. In some countries, this percentage can reach 80%.
This problem can cause early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among employees. This is why pathology is a problem not only in medicine but also in the economic sphere of activity.
Most of the time, working people between the ages of 30 and 60 turn to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, resulting in acute and chronic pain.
In addition, men suffer from the disease more often than women. This is due to the peculiarities of work, physical work, as well as other risk factors. According to statistics, pain occurs much more often in the lumbar region.
Clinicians explain this by the fact that in this part of the spine physical activity exerts the greatest pressure.
Risk factors
Not only stress but also exercise can cause this condition. Among the main risk factors are the following:
- working age from 30 years and over;
- male;
- overweight and obesity (in which the body mass index exceeds 30);
- the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
- static physical activity, which does not differ from each other in terms of diversity.
- exposure to vibrations.
In addition, smoking is noted as a risk factor by some researchers. It is possible that an intense cough in a smoker may be an indirect cause of pain.
Classification
A neurologist, after a thorough examination and examination, determines the nature of the pain. There are several classifications, among which the back pain syndrome is divided according to the place of occurrence of the pathology, duration, reasons and other characteristics.
In terms of duration, the following types of pain can be distinguished:
- sharp,
- subacities,
- chronic.
Patients with acute pain are more often treated in outpatient clinics. Its duration does not exceed 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, this pain is called chronic.
Acute and subacute pain most of the time, with proper treatment, leads to complete recovery. Chronic pain syndrome can cause early disability of the patient. This is why at the first appearance of clinical signs of pathology, you should seek medical help from a doctor. To do this, you will need to undergo an initial consultation with a neurologist.
In terms of intensity, the following types of pain can be distinguished:
- weak
- average,
- strong.
By the nature of back pain, there are:
- pops,
- painful,
- hunting,
- pulling,
- stupid.
The nature of the pain depends on the pathology that caused the syndrome. Thus, with osteochondrosis, pulling the concerns of pain, which differs in radiation to the lower extremities. With sciatica, there is pain with a knife, which is often unilateral.
According to the detection of back pain, there are:
- local (local),
- reflected,
- radiating.
Local pain occurs when the abnormal focus is located directly on the back. The pain is caused by irritation, stretching or other effects on the receptors under the skin.
Local pain has its own characteristics. For example, after an injury to the lumbar spine, the pain syndrome is stable. Its character can change with a change in body position due to irritation of the receptors.
Reflex pain occurs with a pathology that affects the internal organs. It is associated with the anatomical features of the nerve. Thus, with the reflected type, pain appears in the area of the dermatomes. The most common cause of back pain may be pathology of the pancreas, uterus and appendages.
Among the characteristics of the reflex type of pain is the lack of connection with physical activity. If, by changing the position of the body with a local type of pain, the intensity of the symptom increased, then in this case there is no connection.
Radiation pain is associated with nerve or root irritation. In addition, in addition to the appearance of back pain, the patient may complain of decreased sensitivity, the appearance of goose bumps (paraesthesia). Often, during the examination, a neurologist can reveal abnormal reflexes, which are also associated with reduced nerve impulse transmission.
Cause of back pain
Pain syndrome can occur for several reasons:
- pathology of the musculoskeletal system (trauma, sprains, hypothermia and other external causes).
- diseases of the spine (osteochondrosis, hernia).
- diseases affecting the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others).
- benign and malignant neoplasms.
- mental disorders (depression, anxiety, stress cause the psychogenic type of pain).
In addition, everyday problems can be the cause of a pathological symptom. Thus, with an uncomfortable posture after waking up, the patient may complain of pain in the neck or lumbar spine.
Pain of spinal origin
With this type of pain, pathological changes of a degenerative type are observed in the spine. Thus, the vertebral bodies, the intervertebral discs can be damaged. Most often, pain of spinal origin can be related to a disease that affects the joints.
According to statistics, patients seeking medical help complain of the appearance of acute pain associated with damage to the spine. The cause can be a herniated disc, a spine or a lumbar spine.
In less than 1% of all doctor visits, tumors are found in the spine. Malignant metastases are rare, but can also cause back pain of varying intensity.
Disease |
ICD-10 code |
Specific features |
|---|---|---|
Osteochondrosis |
M42 |
A disease in which the intervertebral discs and vertebrae are destroyed. It is characterized by appearancecramps and short-term pain with radiation.Exposure to external factors in the form of exercise or coughing helps increase pain. |
Intervertebral hernia |
M51 |
A disease in which a swelling forms in the spinal canal. It looksan intense pain syndrome that occurs during coughing, sneezing and exercise. |
Radicitis |
M54. 1 |
A disease in which degenerative changes in the roots are observed. It is characterized by appearancepain associated with a change in body position or physical exercise. . . In addition to pain syndrome, sensitivity disorders are added. |
Discogenic lumbodynia |
M54. 4 |
A pathology characterized by the sudden onset of severe pain in the lumbar spine.The pain is shooting and is very intense. |
Spondylosis |
M47 |
A disease that manifests itself with degenerative changes in the vertebrae. It has a chronic type of course,pain in pain with radiation to the lower extremities, neck. |
It should be noted that each disease has its own characteristics. This is why, at diagnosis, attention should be focused not only on the recall data, but also on the test results. For this, modern diagnostic tools are used, which allow not only to identify the pathological focus, but also to determine its boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.
They are vertebrate causes that cause back pain. In addition to the diseases listed above, pain can occur during trauma and stretching of the musculoskeletal system. Thus, with excessive physical exercise or weight lifting, an acute pain may suddenly appear.
Pain of non-vertebral origin
According to statistics, patients complain of pain of non-vertebral origin in no more than 2% of cases. This category includes diseases and physical conditions in which there is back pain.
The most common diseases that cause pain syndrome are pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. Among the first group, the following can be distinguished:
- blockage of arteries,
- angina pectoris,
- aortic aneurysm (in the abdominal or thoracic region).
Among the second group:
- Stomach Ulcer,
- duodenal ulcer,
- cholelithiasis,
- biliary tract dyskinesia,
- inflammatory changes in the pancreas.
Cardiovascular disease often causes back pain. Thus, with angina, the patient worries about pain in the area of the heart, which radiates to the shoulder, arm or back. This is why, during an attack, patients may complain of back pain.
With angina, the pain syndrome has its own characteristics. First, the pain is overwhelming. Second, it appears behind the chest radiating to the back, arms or shoulders. Third, the pain syndrome disappears after immediate administration of the drug. It should be noted that physical activity and stress cause an attack.
An aortic aneurysm is the rupture of a blood vessel that weakens and then swells. In this case, the patient, when seeking medical help, complains of dull pain in the area of the heart with radiation to the back and lower extremities. Symptoms such as dizziness, weakness, and a sudden drop in blood pressure will also be disturbing. Back pain with an aortic aneurysm can occur with both the thoracic localization of the pathological focus and the abdominal one.
It should be noted that aneurysm pain is not related to physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are started immediately, including the use of medication and surgery.
Back pain can be caused not only by cardiovascular disease. In diseases affecting the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarities of the nerve - inflammatory and degenerative changes in this area cause back pain.
Back pain during pregnancy
Pregnancy is a normal condition, however, the course may be accompanied by pain and other unpleasant symptoms. This is due to changes in the position of the organs, hormonal changes, weight gain in the early and late stages.
During pregnancy, back pain can be caused by physiological and pathological changes.
Among the first group, there are:
- natural weight gain during pregnancy, which increases the load on the osteoarticular system.
- enlargement of the uterus with the formation of a "childish" place, in which the internal organs are displaced.
- a change in center of gravity in late pregnancy, when the uterine fundus descends.
The immediate cause of back pain during pregnancy can be the pre-menstrual period. It is characterized by the appearance of irregular contractions. In this case, due to the active work of the pelvic floor muscles, back and waist pain may occur. However, due to the production of female sex hormones as well as oxytocin, a pregnant woman may not feel these pains.
Nevertheless, the appearance of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If pathology is suspected, a pregnant woman may be asked to remain in the hospital for further follow-up.
The appearance of severe back pain during pregnancy can be the cause of a serious illness. This is because during this period, ectopic diseases in a woman can get worse. The most commonly diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile duct can cause pain.
An exacerbation of pyelonephritis or cystitis is associated not only with the entry of microbial flora into sterile organs. Most often, ectopic diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy worsens the symptoms.
Back pain with coronavirus
Coronavirus infection can also cause severe back pain. COVID-19 causes specific symptoms, such as a sudden rise in temperature, unproductive cough, chest pain, and weakness and fatigue. However, some patients complain of back pain, which occurred along with the onset of coronavirus infection.
Among the main reasons are:
- exposure to toxins in the body.
- exacerbation of chronic diseases of the musculoskeletal system;
- the appearance of new, previously undiagnosed pathologies of the spine.
- viral root disease.
Intoxication syndrome often accompanies diseases that affect the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains. With coronavirus, as with other respiratory diseases, non-specific back pain can occur. This is one of the manifestations of intoxication syndrome. With effective medication, the intensity of the pain decreases after a few days.
The body's active fight against infection can cause chronic diseases to worsen. In addition, in the background of a respiratory disease, previously hidden pathologies may appear. This is why patients may be worried about back pain.
Among the main reasons, the occurrence of viral root disease is also distinguished. It can be associated not only with the formation of an intervertebral hernia. Root disease is a concern when a viral agent causes inflammation or irritation of the spinal cord roots.
Diagnostic measures
If you have back pain, you should seek medical help immediately. To diagnose a disease in this area, you need to visit a neurologist.
The receptionist, after a detailed collection of souvenirs, should perform a neurological examination of the patient. At the stage of gathering information, attention is paid to the following aspects:
- the first appearance of back pain.
- the connection of pain with physical activity.
- the presence of concomitant diseases;
- localization of pain syndrome.
- the duration of the pain;
- the appearance of other symptoms.
After collecting the memory, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the patient walking with pathology, the position of the spine, checks the presence or absence of reflexes.
To study the patient's gait, the neurologist asks the patient to walk a few meters to the office, as well as to do some tests. If, while walking, the patient can not carry support on his leg, he performs unnecessary movements - this is one of the clear signs of a neurological disease.
In addition, the position of the spine must be assessed. A neurologist pays attention to the presence or absence of kyphosis, lordosis and scoliosis. The specialist evaluates with the help of tests the patient's response to the stimulus of the reflexes.
When back pain occurs, the disease may be accompanied by a change in sensitivity. This is why a neurologist evaluates the state of tactile, temperature and other types of sensitivity. The specialist also pays attention to the appearance of pathological sensations, for example, a feeling of crawling or tingling in the back.
After the examination, the neurologist may prescribe a series of additional studies. Instrumental examination is necessary when necessary to determine the exact location of the abnormal focus. Modern methods allow a safe and painless examination, the results of which the patient receives after a few days.
To diagnose the causes of back pain, a neurologist can refer a patient for the following diagnostic measures:
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- X-ray of the abdominal organs.
In some cases, no additional tests may be needed for the diagnosis. After receiving the results of the diagnostic instruments, the neurologist selects the optimal treatment regimen.
Treatment of back pain
Treatment of acute or chronic back pain should be mandatory under the supervision of a physician. Independent use of drugs can lead not only to ineffective treatment, but also to the occurrence of complications of the disease. This is why it is advisable to seek medical help from a specialist in case of back pain. After passing the diagnostic tests, the patient will be prescribed treatment based on the characteristics of the clinic, the pathogenetic mechanisms and the course of the disease.
A few years ago, in medicine, when back pain appeared, it was recommended to observe strict bed rest. Now there is no need to restrict the patient's movement. In addition, it is recommended that you wear special bandages and use crutches or stilts when walking.
Modern treatments for back pain are based on evidence-based medicine. They use not only drugs, but also non-pharmacological methods of treatment.
The following groups of drugs are used as drug therapy in medical practice for back pain:
- non-steroidal anti-inflammatory drugs.
- muscle relaxants to reduce muscle tone.
- analgesics
Said groups of drugs can be used both in monotherapy and in combination to achieve a therapeutic effect. Along with medications for back pain, manual therapy is recommended.
If the patient's pain syndrome is very severe, it will be necessary to limit daily activity, as well as to follow the recommendations of other doctors, but in general, the level of previous physical activity should be maintained.
For chronic back pain, in addition to the mentioned treatment methods, physiotherapy exercise methods (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Particular attention is paid to cognitive-behavioral therapy along with taking antidepressants.
The duration of treatment is determined by a neurologist. In case the treatment was ineffective, you should change the group of drugs, as well as do additional research.
Forecast
With early diagnosis and well-chosen treatment tactics, back pain can subside after a few weeks. In a chronic course, a long-term remission can be achieved if the recommendations of the treating physician are followed.
Prophylaxis
In order to avoid back pain, you must follow a healthy lifestyle and distribute physical activity properly, so as not to create overload in various parts of the spine. In addition, co-morbidities must be diagnosed and treated in a timely manner.