Low back pain (synonymous with dorsalgia) is one of the most common reasons to see a doctor - the second after acute respiratory illness. Often such complaints come from a neurologist, therapist or general practitioner. According to an international study, 19-43% of adults surveyed recently reported back pain in the last month, and 27-65% in the last year. 59-84% of people have experienced it at least once in their life. Almost every fifth adult on the planet can experience severe back pain at this time. Their most common localization is the lower back and lower back.
Why does back pain occur?
Among the main reasons for the development of low back pain:
- Vertebral causes - associated with spinal pathology:
- pathology of intervertebral discs, including hernia;
- narrowing of the spinal canal;
- joint diseases;
- consequences of injuries;
- congenital malformations and developmental anomalies;
- metabolic diseases;
- Spondylitis - inflammatory processes in the intervertebral joints.
- Nonvertebrogenic - not associated with pathology of the spine:
- tightness of the ligaments and muscles associated with heavy loads;
- myofascial syndrome - chronic muscle pain;
- inflammation of muscle tissue - myositis;
- diseases of the internal organs;
- pathology of large vessels, such as aneurysm of the abdominal aorta (acute dilatation);
- osteoarthritis of the hip joint - inflammatory-dystrophic disease;
- mental disorders, etc.
The following types of pain differ depending on their origin:
- Special- is associated with a specific disease that can be detected by standard examination methods. This type accounts for up to 1% of all cases. These can be compression fractures of the spine, tumors, infectious processes, diseases of the pelvic organs (especially in women with low back pain).
At the same time, there are a number of certain symptoms, such as "red flags", that indicate a serious illness and require in-depth research. These include:
- indication of rapid unreasonable weight loss and / or oncopathological history (tumors);
- weakness in the lower extremities, sensitivity and dysfunction of the pelvic organs (cauda equina syndrome);
- use of antibiotic therapy, increase in body temperature (infectious processes);
- previous trauma or previous diagnosis of osteoporosis, over 55 years (spinal fracture);
- young age - up to 20 years;
- long-term protection of painful sensations and their intensity despite treatment;
- if combined with general weakness or gait disturbance at night, it does not change with a change in body position.
- Radical- next in frequency (up to 27%). It develops as a result of compression and / or inflammation of the spinal cord root that emerges from the holes in the spine. This type can be manifested by increased pain during coughing, sneezing, physical exertion and other activities.
- Non-specific- more often acute, it is difficult to immediately determine the specific cause of development, it is generally the result of dystrophic changes in the bone, spinal cartilage tissue, as well as the ligaments that make up the apparatus of muscles and ligaments. back. The International Classification of Diseases (ICD-10) has a special section for the definition of such syndromes - dorsopathy.
Such dorsalgia is up to 85% of all cases and is mainly associated with a violation of the normal functioning of individual structures of the spine, any of which can become a source of pain impulses. The pain can be excruciating (from nerve root compression) and reflex - from all other tissues, including spasmodic muscles.
Another type of pain syndrome that is not associated with organic lesions of the spinal and paravertebral tissues is described. This is called non-functional pain. This can be caused by psychological problems and chronic stress.
Localization distinguishes:
| What is the name | Where does it hurt? |
| cervical | Sore throats |
| cervicocranilagia | neck + head |
| cervicobrachialgia | gives neck and hand |
| thoracic | thoracic back and chest pain, pain under the back shoulder blades |
| lumbodinia | lumbar and lumbosacral region |
| sciatica | lower back + legs |
| sacral | sacrum |
| coccidiosis | coccyx |
In addition to the causes, it is possible to identify the factors that can lead to the development of pain syndrome:
- heavy physical overload resulting in excessive stretching of muscles and ligaments;
- anxious or static postures that a person suffers for a long time;
- untrained muscles and their overload, inactivity;
- trauma and microtrauma;
- hypothermia;
- prolonged inactivity as bed rest;
- alcohol abuse;
- diseases of the internal organs;
- joint pathology;
- overweight;
- individual characteristics: lumbar curvature, bending;
- malnutrition, diseases of the digestive system, which may be accompanied by the absorption of vitamins, mineral metabolism, significant intake of salts that affect the joints;
- occupational hazards: thermal effects, temperature fluctuations, vibration, work with weights, etc.
The mechanism of dorsal development is associated with a block of intervertebral joints that can cause both static and dynamic, microtrauma and non-physiological postures. As a result, in one place the muscles spasm and stretch excessively, in another place they stretch excessively. All this leads to the development of muscle pain, changes in pain sensitivity and the formation of pathological pain impulses.
In addition, muscle spasm can be a reflex reaction to spinal pathology or internal organ disease. In this case, it is seen as a defensive reaction, and at the same time begins a new circle of pain. In addition, long-term protection of spasms disrupts the transmission of nerve impulses to muscle fibers, exacerbates them, may lead to calcium deficiency, and circulatory disorders exacerbate the condition.
Depending on the duration of dorsalgia, the following may occur:
- acute - lasts up to 6 weeks;
- subacute - between 6 and 12 weeks;
- chronic - last 12 weeks or longer.
Symptoms
Dorsal symptoms depend on the cause, the mechanism of development and the presence of co-morbidities.
The following symptoms are characteristic of non-specific pain:
- painful or painful, sometimes painful;
- increasing with loads or movements in the lumbar or lumbar positions can be reduced after resting in a relaxed position while kneading or rubbing the muscles;
- possible pain in the sides or back of the waist;
- probing, compression, changes in contours, tension are determined, but the sensitivity in the painful area is not disturbed, there is a decrease in muscle strength, reflexes do not change.
When the nerve root is compressed (radiculopathy), the pain varies in intensity, there may be fever, it often spreads to the legs, and the pain in the lower back may be stronger. During the examination, there are signs of damage to a certain nerve root - muscle weakness, impaired sensitivity in a certain area.
Diagnostics
The diagnostic algorithm for acute and chronic dorsalgia is slightly different.
Acute pain
To determine the tactics of treatment, the doctor should, if possible, determine the cause of the pain syndrome: compressed nerves or their roots, trauma, tumor, inflammation, infection, osteoporosis, diseases of the internal organs, etc. As a rule, these types of pain are very vivid and have specific clinical manifestations. After examination and palpation, patients are referred to appropriate specialists or for additional examination, for example:
- X-ray examination;
- MRI and CT of the spine;
- scintigraphy - a method of visualization with the application of a contrast agent;
- densitometry - determination of bone density;
- laboratory tests for tumor markers, rheumatic tests, biochemical blood tests, etc.
Patients with non-specific acute pain generally do not require additional research.
Chronic pain
Because the mechanisms of development have not yet been adequately studied, it can be difficult to identify the source, especially if it is a non-functional species that reflects pathology of other organs. It can be a manifestation of irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and other diseases. In any case, a thorough interview and examination of the patient is carried out to decide on further treatment tactics.
For pain syndrome, which occurs against the background of dystrophic changes in the joints, it is possible to use magnetic resonance imaging to monitor the dynamics of the spinal condition after any mechanical stress or under the influence of other factors.
How to deal with acute back pain
Physicians who follow the principles of evidence-based medicine use the following tactics to manage patients with acute dorsalgia:
- to inform the patient about the causes of pain syndrome;
- exclude bed rest and recommend the continuation of normal activities;
- prescribe effective drug and non-drug treatment;
- monitor the dynamics and adjust therapy.
When choosing a drug, attention is paid to the analgesic effect, speed and safety. First of all, non-specific anti-inflammatory drugs (NSAIDs) are prescribed because their effectiveness has been proven for back pain. One such drug is naproxen.
Naproxen is available as an oral tablet and as a gel for external use. The drug is indicated as a painkiller for trauma, overload, inflammation-related low back pain. It also has anti-inflammatory and antipyretic effects, the duration of action can last up to 12 hours. If you do not have the opportunity to see a doctor soon and the pain is a serious concern, you can take naproxen as follows: 2 tablets as a starting dose and then 2 tablets every 12 hours or 1 tablet every 8 hours. The duration of admission without consulting a doctor is not more than 5 days.
While maintaining the intensity of pain, it is possible to prescribe other analgesic and sedative (sedative) groups.
Non-drug treatments include:
- warming;
- manual treatment;
- physiotherapy;
- massage;
- physiotherapy;
- acupuncture and other alternative methods.
Treatment of chronic low back pain
If the localization of pain and the source of pain impulses can be identified, local therapy is used - blockades, intradiscal effects and other procedures. For the rest of the patients, such a treatment is not used for back and back pain, so a different treatment regimen is used. The main goal is to reduce the intensity of pain and maintain quality of life.
In addition, as in acute pain, drugs from the group of NSAIDs, including naproxen, other analgesics, muscle relaxants and vitamin B3, are prescribed. Antidepressants are recommended when needed. Manual therapy should be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic treatments are used.
Prophylaxis
For the prevention of dorsalgia, it is necessary to identify all possible risk factors and work to eliminate them.
The following will be helpful for each type of pain:
- adequate physical activity, including the spine, and muscle strengthening;
- timely treatment of chronic diseases of internal organs;
- protection of physiological posture at work;
- quit smoking and alcohol;
- regular preventive examinations;
- adequate treatment and prevention of infections;
- balanced diet;
- wear comfortable shoes and clothes;
- proper organization of the workplace and life to protect the back;
- prevention of stress and emotional overload.
Comprehensive treatment and full rehabilitation of patients with low back pain helps to maintain quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.