Today, back pain is the second most common cause for patients to see a doctor. According to the American National Institute of Health, one in five middle-aged people suffers from pain.
However, the incidence of the disease only increases with age. In medical practice, pain (dorsalgia) is considered an interdisciplinary pathology because the clinic has symptoms of both neurological and somatic diseases.
What causes back pain?
Back pain occurs in 90% of cases of spinal diseases (spinal pain). In other cases, the cause is internal organs, spinal cord, and so on. It may be pathology (not vertebral pain).
So the vertebrogen group includes:
- intervertebral hernia;
- specialization or lumbarization; spondylosis;
- osteoporosis;
- Tumor processes of vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
The non-vertebrate group includes:
- psychogenic pain;
- fibromyalgia; pathology of the internal organs
- (heart attack, pneumothorax, inflammation of the pancreas, urolithiasis, etc. );
- tumor formations (neurinomas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The nature, severity, and duration of back pain vary depending on the underlying pathology.
- Intervertebral hernia.A hernial bulge appears between the vertebrae with the development of osteochondrosis. In this case, the pain may be sharp or painful and local (depending on the level of the affected disc). The pain often extends to the limbs, along with numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), disorders of the sensitive and motor spheres of the arms or legs may appear. Rarely, urinary incontinence, defecation, and sexual dysfunction (with damage to the pelvic spine) occur.
- Sacra or lumbarization.Sacralization is a congenital disorder that involves the fusion of the last lumbar vertebra and the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum separates and becomes a further lumbar vertebra. Pathologies are usually asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, lumbar pain occurs in the sacral region, which increases with movement and spreads to the lower extremities. Pathology is also characterized by the fact that it occurs at a young age (usually at the age of 20-25).
- Spondylosis.Spondylosis (unlike the previous disease) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - "wear and tear". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous for injuries to neurovascular bundles, muscles and surrounding organs. The disease is associated with chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only in movement but also in calmness, leading to insomnia. In uncontrolled disease, immobilization of vertebral joints and tightening of nerve fibers with the development of characteristic neurological disorders often occur.
- Osteoporosis.Osteoporosis is a metabolic disorder in which the processes of bone destruction dominate over bone formation. The clinical picture of the disease is sparse: usually the pathological process is asymptomatic and can be detected accidentally (by X-ray). However, in the later stages of the disease, dull pains appear and the curvature of the posture.
- Tumor processes in the vertebrae.Vertebral tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower spine), which can spread to the thighs and lower legs as well. Sooner or later, tumor growth leads to compression of the nerve roots, which is indicated by neurological disorders: loss of sensitivity and movement of the limbs.
- Injuries.Acute pain, limited mobility, and nervous system symptoms are common causes of spinal cord injuries: fractures, bruises, dislocations / subluxations, and "slippage" of the vertebrae due to damage to the ligament apparatus - spondylolisthesis. Typically, patients experience sharp diffuse pain in the back, the presence of bleeding ("bruises"), local swelling, and restriction of movement.
- Psychogenic pain.A similar view occurs in the background of overall health after an emotional outburst or stressful situation. Patients describe pain in different ways that are limited only by the patient’s imagination. Sometimes there is a so-called. "Painful behavior" when people tend to use additional aids while maintaining mobility: crutches, sticks and even wheelchairs.
- Fibromyalgia.Fibromyalgia pain syndrome is extremely similar to psychogenic pain. However, pain is also provoked by stress, climate, and emotional overload. An important difference, however, is that pain should be observed for more than three months, accompanied by local sensitivity at characteristic points (at the site of occipital muscle attachment, in the middle of the trapezius muscles, etc. ). Diagnosis requires the complete exclusion of all somatic diseases.
- Pathologies of internal organs.Back pain can often occur in diseases of various organs in the body. Thus, in a heart attack, the pain syndrome is localized behind the sternum, spreading under the scapula and left arm, and in the spine. Pneumothorax (an accumulation of air under the lining of the lungs) causes acute chest pain that radiates toward the spine. The complex of symptoms occurs in the background of respiratory difficulties and facial cyanosis. In inflammation of the pancreas (inflammation of the pancreas), the pain syndrome is of a different nature, of the "belt" type in the upper abdomen, covering the sides and back. Back pain appears with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Typically, the pain is so severe that patients are bent down after relief. Against the background of the attack, the urine turned dirty red due to contaminants in the blood.
- Tumor processes.Neurinoma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, back pain usually occurs, as well as loss of sensitivity and motor activity below the level of the lesion. It is also worth noting that this tumor process is usually benign. However, a similar clinical picture may be caused by breast cancer, prostate, lung, kidney, and so on.
- Epidural abscess.Epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is associated with acute pain syndrome, which is complemented by neurological disorders: paresis (decreased muscle strength), loss of sensitivity, pelvic disorders, etc. often occur. Purulent process occurs as a complication of infections, wounds, immunodeficiency, or other lumbar punching (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system in which cavities appear in the spinal cord. Injuries, tumors, brain compression, etc. They provoke the disease. In the initial stage, there is mild pain in the spine that does not cause discomfort. Then weight loss, muscle weakness, loss of pain sensitivity, no sweating, and bones become brittle. There are often lesions in the joints, the skeleton (burns, fractures, cuts), but they go unnoticed due to a lack of sensitivity to pain.
Diagnostics
Diagnosis requires qualitative assessment and physical examination of the patient by palpation (feeling), punch (punch), and auscultation (listening). For some pathologies, laboratory blood tests should be performed (heart attack, pancreatitis, tumor processes).
Instrumental diagnostic methods will be needed to visualize soft tissues and internal organs: ultrasound or magnetic resonance imaging. While X-rays and computed tomography are used for direct examination of the skeleton.
In some cases, less frequent techniques may be needed: bone scintigraphy, electromyography, etc.
Treating Back Pain
To relieve acute back pain, apply ice (every 4 hours for 20 minutes), exclude physical activity, and fix your spine if possible. If the pain is unbearable, painkillers can be used. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. This can then make it difficult to diagnose the disease. Only your doctor may prescribe medication.
Herniated disc
The main medication is based on the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and painkillers (Ketorolac). In some cases, surgical removal of the intervertebral hernia and endoprosthesis of the intervertebral disc may be required.
Sacra or lumbarization
Anesthesia with anesthetics and physiotherapy (paraffin, electrophoresis, etc. ) are prescribed when pain occurs. In case of ineffectiveness of conservative treatment, reconstructive operations are indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin) and physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a high calcium and vitamin D diet.
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogens, calcitonin, and parathyroid hormones is used.
Tumor processes
The treatment of cancer consists of chemotherapy and surgery. In this case, the amount of help depends on the specific clinical case.
Injury
For minor injuries, a gentle system and warm-up are prescribed. In some situations, reduction or bone removal is required. When neurological symptoms appear, operations are performed to fix bone fragments.
Psychogenic pain
Psychogenic pain relief consists of complex psychotherapy and the use of antidepressants (fluoxetine, Sertraline).
Fibromyalgia
As the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), antispasmodics (Pregabalin), sleeping pills (Zopiclone) or sedatives (Diazepam). It is also important to tune in to positive thinking, avoid stressful situations, and have a warm, dry climate.
Pathologies of the internal organs
Each possible internal pathology requires a unique treatment tactic. Emergency care for a heart attack is taking nitroglycerin (one tablet every 5 minutes until an ambulance arrives); with inflammation of the pancreas - cold, hunger and rest; with pneumothorax - a closed (occlusive) dressing for open wounds of the lungs; renal colic - antispasmodics (Drotaverine, Metamizole sodium) and warming.
Epidural abscess
Treatment consists of urgent surgery to normalize spinal pressure and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgery.
Syringomyelia
It is generally recommended that patients protect their skin from cuts and burns (the latter often occurs because patients lose their sensitivity and do not feel trauma). Analgesics, antidepressants (Fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is possible to review the formed cavities in the spinal cord.
Back Prevention
To prevent back pain, the occurrence of each of the pathologies mentioned above should be prevented. This requires
- Lifestyle normalization: reducing body weight to normal; preparing a diet rich in appropriate trace elements and vitamins; ensures proper physical activity without overload.
- Give up bad habits: smoking and drinking.
- Proper posture curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, goosefoot, etc. ).
- Timely diagnosis and treatment of concomitant disease of the musculoskeletal system or internal organs.
- Prevention or appropriate treatment of spinal cord injuries.
- Avoid emotional outbursts and stressful situations.
It should be borne in mind that back pain is not an isolated pathology but a symptom of a disease. The main disease can be extremely serious and can lead to disability and even death if left untreated!