Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, it is one of the most pressing problems of modern healthcare, and treating back pain is a difficult task.
Although pain can occur in any part of the spine, the most common place is the lower back - according to researchers, the occurrence of lumbar 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% experience a relapse of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected segment of the back, the pain syndrome is divided into cervical, central (chest pain), lumbar pain (lumbar pain) or coccydynia (coccyx or sacrum pain).
According to the results of a study involving 46,000 volunteers from several European countries, chronic pain in various parts of the spine is typical for 24% of the population, in the lumbar region for 18%, and neck pain for 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 and tingling sensation.Depending on the spinal involvement, the symptoms of some diseases also extend to the arms and hands, legs or feet.Numbness or weakness in the upper and lower limbs is another possible symptom of back pain.Some patients with spinal pain syndrome may experience limitation of certain movements or increased pain in certain postures.
Back pain: why does it happen?
During the examination, it is not always possible to determine the direct cause of back pain, in which case 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 specific diseases of the spine are not observed - this subtype of the pain syndrome occurs in 98% of patients.Pain secondary to the underlying disease accounts for about 2% of cases.
Non-specific back pain has the following characteristics:
- tends to get better or worse depending on body position - for example, the patient feels better sitting or lying down;
- pain often worsens with movement;
- the attack may develop suddenly or gradually increase;
- Sometimes back pain is the result of bad posture or awkward lifting, but often it occurs for no apparent reason;
- it can be caused by a minor injury, such as a ligament or muscle strain;
- it can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for the development of non-specific back pain:
- heavy physical work;
- frequent bending and bending of the body;
- lifting heavy objects, especially from an improper position;
- sedentary lifestyle;
- industrial effects such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute effect of an adverse factor.
The most common causes of acute back pain are:
- damage to various structures of the spine;
- spondylolisthesis - relative displacement of the vertebrae;
- sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body) which runs 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 roots of the intercostal nerves;
It is important to note that acute pain marks the onset of a disorder, whereas chronic pain records this pathological effect and is reminiscent of an emerging disorder.
Conditions that cause chronic back pain include:
- intervertebral disc displacement or prolapse;
- autoimmune joint diseases, such as ankylosing spondylitis (swelling of the joints of the spine);
- radiculopathy - inflammation and degeneration of nerves leading from the spinal cord to muscles and joints;
- arthritis and arthrosis of spine joints of various origins.
- infectious processes (for example, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain syndrome
In order to understand what to do with severe back pain, it is first of all advisable to determine its cause.An accurate diagnosis is the key to a well-developed treatment plan.
After a thorough examination of the patient's complaints, anamnesis and the nature of the symptoms, the doctor may prescribe imaging tests and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- Computed tomographyprovides detailed cross-sectional images of the spine, even showing subtle changes in the bones.
- Magnetic resonance imagingIt shows both tissue and bone structure and is used to identify slipped or herniated discs, pinched nerves or the spinal cord.
- When drivingmyelogramsThey use a special biological dye that is 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 testingallows the evaluation of the electrical activity of the nerves of the upper and lower limbs.
- Positron emission examination of bonesabove all, it explores bone oncopathology.
- Densitometry - determination of bone density - can be seendiseases and conditions leading to a decrease in bone mineral density.
Ways to fight back pain
The complex structure of pain in different parts of the back and the stages of pathological changes require a combination of drug and non-drug treatment.
The principles of therapy for patients with chronic back pain are based on evidence-based medicine:
- explains to the patient the causes of pain and its generally benign origin;
- ensuring an adequate level of daily physical activity;
- prescription of effective and safe treatment, primarily for pain relief;
- correction of the therapy if ineffective after 1-3 months.
Non-pharmacological treatment of back pain
In most cases, a patient with back pain will 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.
The development of correct motor stereotypy and physical therapy are important areas of non-pharmacological correction of pain.
Based on the duration, the non-pharmacological treatment of back pain can be divided into three phases.
Section I- passive physiotherapy during the acute period (6 weeks).
section II– active exercises in the subacute period (6-12 weeks).
section III- rehabilitation physiotherapy effects.
Bed rest can only be prescribed for a limited time in case of acute back pain.
Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:
- non-specific physical exercises such as daily walking, cycling, swimming.In case of uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy can 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 stretching methods.
Drug treatment of pain
The most common methods of drug treatment for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injection of steroid hormones into the synovial cavity or epidural space of the spine, which reduces inflammation and back pain.However, this type of therapy is not suitable for long-term use due to the side effects of the drugs.
When is surgical treatment used?
While the vast 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, a patient with spinal pain has undergone surgery if the following criteria are met:- the structural problem has been diagnosed and confirmed by imaging (e.g. X-ray or MRI);
- Conservative treatments such as physical therapy or medications did not 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 reasons to believe that spine surgery will be beneficial, confirmed by objective diagnostic methods;
- neurological damage occurs.
Prevention of back pain
Maintaining a healthy lifestyle is the key to preventing back pain.Excess weight puts strain on the back, so it is important to maintain a healthy weight.Regular exercise strengthens the abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues of the body, thus 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.