Pain on the back

Low back pain is often referred to as back pain or lupus. Backache or "lumbago" is an attack of acute back pain, which is usually associated with hypothermia and stress. Lumbar lumbar spine occurs in many people and is often the cause of temporary disability. Often, sports injuries or sprains can be the cause of back pain, but sometimes the cause of the pain remains unknown. Lumbago is characterized by pain without radiation to the legs. Back pain (back pain) can be acute and gradually develop during the day. There is often stiffness in the morning and gradually the stiffness turns into a pain syndrome. Spinal curvature (analgesic scoliosis) is also possible as a result of muscle spasm. The pain itself may be due to a muscle spasm, which in turn is related to other causes. This can be overload or sprain, sports injuries, herniated discs, sprains (joints), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the cause-effect relationship of the onset of malaise with exercise, hypothermia, but often the pain occurs for no apparent reason. Sometimes, back pain can occur even after sneezing, crouching or wearing shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.

Unlike lumbago, the term lumbodynia does not mean acute pain, but subacute or chronic pain. As a rule, the pain with lumbodenia appears gradually over several days. Pain can also occur in the morning and can be reduced with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting position, uncomfortable body position). It is also characteristic of lumbontinia that the pain is relieved by lying down in a certain position. Patients with lumbonia find it difficult to perform routine activities such as washing or wearing shoes due to muscle spasms. Due to the disease, there is a reduction in the volume of torso movements (forward tilt or, to a lesser extent, lateral tilt or extension). Due to the pain syndrome, the patient often has to change position when it is necessary to sit or stand. In contrast to the lumbar spine, the muscle spasm is less intense and, as a rule, does not cover the entire lower back and there are often signs of spasm on one side.

Causes of back pain

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of muscles, bones and intervertebral discs. Sometimespain on the backcan be caused by diseases of the abdominal cavity, small pelvis and chest. Such pains are called reflex pains. Diseases of the abdomen (eg appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), infections of the pelvic organs, ovaries - all of these diseases can occurpain on the back. . . Even a normal pregnancy can lead to lower back pain due to a sprain in the pelvic area, muscle spasm due to stress and nerve irritation.

Oftenpain on the backassociated with the following diseases:

• Compression of the nerve root, which causes symptoms of sciatica and is most often caused by a disc herniation. As a rule, when the nerve root is compressed, the pain is acute, it has radiation and reduced sensitivity in the innervation zone of the nerve root. Disc herniation occurs mainly as a result of disc degeneration. There is swelling of the gelatinous part of the disc from the central cavity and pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at the age of 30 years and older. But the very presence of a hernia does not always lead to an effect on the nerve structures.
• Spondylolisthesis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) appear, which can affect nearby nerves, leading to pain.
• Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with a spinal stenosis in the lumbar region may experience radiating pain in the lower back in both legs. Low back pain can occur as a result of standing or walking.
• Cauda Equina Syndrome. This is a medical emergency. Equine tail syndrome occurs as a result of compression of the equine elements (end part of the spinal cord). A patient with equine tail syndrome may experience pain and dysfunction of the bowel and bladder (urinary incontinence and lethargy). This syndrome requires urgent surgery.
• Pain syndromes such as myoperitoneal pain syndrome or fibromyalgia. Myoperitoneal pain syndrome is characterized by pain and soreness in certain points (activation points), a decrease in the volume of muscle movement in painful areas. The pain syndrome decreases with the relaxation of the muscles located in the painful areas. With fibromyalgia, aches and pains are common throughout the body. Fibromyalgia is not characterized by tightness and muscle pain.
• Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
• Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially worse in the morning.
• Tumors, most often cancerous metastases, can be a source of discomfort in the lower back.
• Inflammation of the nerves and, consequently, the manifestations of pain (in the chest or lumbar region) can be caused by damage to the nerves themselves (for example, with shingles)
• Given the variety of causes of symptoms, such as acute or subacute back pain, it is very important to fully evaluate the patient and perform all the necessary diagnostic procedures.

Symptoms

Pain in the lumbar region is the main symptom of lumbar spine, lumbar spine, low back pain.

• The pain may radiate below the front, side or back of the leg (lumbar sciatica) or may be located only in the lumbar region (lumbar region, lumbar region).
• The feeling of back pain may intensify after exercise.
• Sometimes the pain can get worse at night or when you sit for a long time, such as during a long car trip.
• Perhaps the presence of numbness and weakness in the leg, which is located in the nerve zone of the compressed nerve.

For early diagnosis and treatment, a number of criteria (symptoms) deserve special attention:

• Recent history of injury, such as a fall from a height, car accident or similar incident.
• The presence of minor injuries in patients over 50 years of age (eg falling from a low height as a result of slipping and landing on the buttocks).
• History of long-term steroid use (for example, in patients with bronchial asthma or rheumatic diseases).
• Any patient with osteoporosis (mainly older women).
• Every patient over the age of 70: at this age, there is a high risk of cancer, infections and diseases of the abdominal organs, which can cause back pain.
• History of oncology
• The presence of infectious diseases in the recent past
• Temperature above 100 F (37, 7 C)
• Drug use: Drug use increases the risk of infectious diseases.
• Low back pain worsens at rest: as a rule, this nature of pain is associated with oncology or infections and this pain may also be associated with ankylosing spondylitis (ankylosing spondylitis).
• Significant weight loss (for no apparent reason).
• The presence of any acute nerve dysfunction is a signal for urgent medical attention. For example, it is a violation of walking, foot dysfunction, as a rule, are symptoms of acute nerve damage or compression. Under certain conditions, such symptoms may require urgent neurosurgery.
• Bowel or bladder dysfunction (both incontinence and urinary retention) can be a sign of an urgent medical need.
• Failure of recommended treatment or increased pain may also require seeking medical help.

The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.

Diagnostics

A medical history is important for an accurate diagnosis, as various conditions can cause back pain. The time of onset of pain, the relationship with physical exertion, the presence of other symptoms such as cough, fever, bladder or bowel dysfunction, the presence of seizures, etc. Physical examination is performed: localization of pain points, presence of muscle spasm, study of the neurological condition. If there is a suspicion of diseases of the abdominal cavity or pelvic organs, then an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvis and pelvic organs, urine blood tests).

If the physical origin of low back pain is ruled out, then instrumental research methods such as x-rays, CT scans or magnetic resonance imaging may be prescribed.

X-ray is the initial method of examination and allows you to determine the presence of changes in bone tissue and indirect evidence of changes in the intervertebral discs.

Computed tomography allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially in contrast).

MRI is the most informative research method that allows the diagnosis of morphological changes in various tissues.

Densitometry is necessary when osteoporosis is suspected (usually in women over 50)

EMG (ENMG) is used to determine the conduction violation along the nerve fibers.

Laboratory tests (blood, urine, blood biochemistry) are prescribed mainly to rule out inflammatory processes in the body.

Pain treatment

Once the diagnosis and confirmation of spinal genesis with back pain and lumbar spine is established, a specific treatment for low back pain is prescribed.

In acute pain, rest is necessary for 1-2 days. Resting in bed can reduce muscle strain and muscle spasm. In most cases, when the pain syndrome is due to a muscle spasm, the pain syndrome subsides within a few days without the use of medication, just for rest.

Medication. For the pain syndrome, drugs of the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also has some risks. Since all drugs in this group have many side effects, taking drugs in this group should be short-lived and under the mandatory supervision of a doctor.

Muscle relaxants can be used to relieve spasm. But the use of these drugs is effective only in the presence of convulsions.

Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of severe side effects, steroid use should be selective and short-lived.

Manual therapy. This technique can be very effective in the presence of muscle blocks or dislocation of the facial joints. Mobilizing the limbs can reduce both muscle spasm and lower back pain.

Physiotherapy. There are many modern physiotherapy procedures that can reduce pain and inflammation, improve microcirculation (for example, electrophoresis, cryotherapy, laser therapy, etc. ).

Exercise therapy. Exercise is not recommended for acute lower back pain. The connection of exercise therapy is possible after the reduction of the pain syndrome. In the presence of chronic pain, exercise can be very effective in strengthening the muscular corset and improving the biomechanics of the spine. Exercises should only be selected by an exercise doctor, as often independent exercise can lead to increased pain. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can maintain the functionality of the spine and significantly reduce the risk of pain syndromes.