Back pain is the second most common reason people seek medical care today. According to the US National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (back pain) is considered an interdisciplinary pathology, since in the clinic there is a symptom of neurological and somatic diseases.
What Causes Back Pain?
Pain in the back in 90% of cases occurs with diseases of the spine (spinal pain). In other cases, the cause may be pathologies of the internal organs, spinal cord, etc. (non-vertebral pain).
Thus, the vertebrogenic group includes:
- intervertebral hernia;
- sacra- or lombarisation;
- spondylosis; osteoporosis
- ;
- tumor processes of the vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
The non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formations (neuromas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its strength and duration vary depending on the underlying pathology.
- Intervertebral hernia.A hernial protrusion appears between the vertebrae with the development of osteochondrosis. In this case, the pain may be sharp or aching and be local in nature (depending on the level of the affected disc). The pain often spreads to the limbs, accompanied by 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 there are violations of urination, defecation and sexual function (with lesions of the pelvic spine).
- Sacra or lumbarization.Sacralization is a congenital anomaly associated with the fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum is separated and becomes an additional lumbar vertebra. The pathologies are usually asymptomatic, but the clinic is provoked by excessive physical activity or by heavy lifting. In such cases, there is low back pain in the sacral region, which increases with movement and spreads to the lower extremities. The pathology is also characterized by the fact that it occurs at a young age (usually between 20 and 25 years).
- Spondylosis.Spondylosis (unlike the previous disease) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear and tear". 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 with damage to neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only in movement, but also at rest, leading to insomnia. With uncontrolled disease, there are frequent cases of immobilization of the spinal joints, as well as pinching of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis.Osteoporosis is a metabolic disorder in which the processes of bone destruction take precedence over bone formation. The clinical picture of the disease is rare: the pathological process is usually asymptomatic and is detected by chance (with X-ray). However, in the later stages of the disease, dull pains appear, as well as a curvature of the posture.
- Tumor processes of the vertebrae.Spinal 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. Sooner or later, tumor growth leads to compression of the nerve roots, which manifests itself in neurological disorders: loss of feeling and movement of the limbs.
- Injuries.Spine injuries are a common cause of acute pain, limited mobility and neurological symptoms: fractures, bruises, dislocations / subluxations, as well as "slipping" of the vertebrae due to damage to the ligament apparatus- spondylolisthesis. Typically, patients note acute diffuse pain in the back, the presence of hemorrhages ("bruises"), local swelling and restriction of movement.
- Psychogenic pain.A similar point of view occurs in the context of full health after an emotional outburst or a stressful situation. Patients describe pain in different ways, which is limited only by the imagination of the patient. Sometimes there is a so called. “Painful behavior” when people, while maintaining their mobility, tend to use auxiliary aids: crutches, sticks and even wheelchairs.
- Fibromyalgia.The pain syndrome of fibromyalgia is extremely similar to that of psychogenic pain. At the same time, pain is also caused by stress, weather and emotional overload. However, an important difference is that the pain should be observed for more than three months, accompanied by local tenderness at the characteristic points (place of attachment of the occipital muscles, middle of the trapezius muscles, etc. ). In addition, the diagnosis requires the complete exclusion of all kinds of somatic diseases.
- Pathologies of internal organs.Back pain can often appear with diseases of various organs of the body. So, during a heart attack, the pain syndrome is localized behind the breastbone, spreading under the scapula and left arm, as well as into the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, radiating to the spine. A symptom complex appears against the background of difficulty breathing and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, appears in the upper abdomen in a "girdle" type, covering the sides and back. Back pain appears with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Usually, the pain is so severe that it causes patients to bend down in search of relief. Against the background of an attack, the urine turns dirty red due to blood impurities.
- Tumor processes.A neuroma 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 feeling and motor activity below the level of the lesion. It should also be noted that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases from breast, prostate, lung, kidney, etc. cancer.
- Epidural abscess.An epidural abscess is a buildup of pus under the hard wall of the spinal cord. The disease is accompanied by an acute pain syndrome, which is supplemented by neurological disorders: paresis (decrease in muscle strength), loss of sensitivity, pelvic disorders, etc. a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, compression of the brain, etc. cause disease. . In the initial stages, there is a slight pain in the spine, which does not bring discomfort. Then there is weight loss, muscle weakness, loss of pain sensitivity, there is no sweating, and the bones become brittle. Often there are injuries to the joints, bone skeleton (burns, fractures, cuts), however, due to the lack of sensitivity to pain, they pass imperceptibly.
Diagnostics
As a diagnosis, a qualitative investigation and physical examination of the patient is required by palpation (sensation), percussion (percussion) and auscultation (listening). For some pathologies, it is necessary to perform laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or magnetic resonance imaging. While x-rays and computed tomography are used for direct examination of the skeleton.
In some cases less common techniques may be necessary: bone scintigraphy, electromyography, etc.
Back pain treatment
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), exclude physical activity, immobilizing the spine if possible. If the pain is unbearable, pain relievers may be taken. However, it should be remembered that anesthetics "lubricate" the clinic of the disease. Subsequently, this can complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
Herniated disc
The main drug treatment is the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and analgesics (Ketorolac). In some cases, surgical removal of the intervertebral hernia, as well as intervertebral disc stents, may be required.
Sacra or lombarisation
In case of pain, blockages with anesthetics are prescribed, as well as physiotherapy (paraffin applications, electrophoresis, etc. ). With the ineffectiveness of conservative treatment, reconstruction operations are indicated.
Spondylosis
Anti-inflammatory drugs (meloxicam, indomethacin), as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a diet rich in calcium and vitamin D. 
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogen, calcitonin, and parathyroid hormones is used.
Tumor processes
Treatment for tumor diseases includes chemotherapy and surgery. In this case, the amount of assistance depends on the specific clinical case.
Injury
In case of minor injuries, a gentle diet and warm-up are prescribed. In some situations, skeletal reduction or traction is necessary. When neurological symptoms appear, operations with fixation of bone fragments are performed.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy, as well as taking antidepressants (fluoxetine, sertraline).
Fibromyalgia
Since the causes of the disease are still unknown, symptomatic treatment is prescribed: antidepressants (paroxetine, amitriptyline), anticonvulsants (pregabalin), hypnotics (zopiclone) or tranquilizers (diazepam). Self-attunement for positive thinking, avoiding stressful situations, and being in a hot, dry climate are also important.
Pathologies of internal organs
Each of the possible internal pathologies requires individual treatment tactics. Emergency care for a heart attack takes nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in the case of an open wound of the lung; with renal colic - antispasmodics (drotaverine, sodium metamizole) and warming.
Epidural abscess
Treatment consists of urgent surgery to normalize the pressure in the spinal canal and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports the surgery.
Syringomyelia
Usually, patients are advised to protect their skin from cuts and burns (the latter often occur because patients lose sensitivity and do not experience trauma). Pain relievers, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is possible to revise the formed cavities of the spinal cord.
Back prevention
For the prevention of back pain, it is necessary to prevent the occurrence of each of the pathologies noted above. To do this you need:
- Normalize lifestyle: reduce body weight to normal; constitute a correct diet rich in trace elements and vitamins; ensure adequate physical activity without excessive effort.
- Give up bad habits: smoking and drinking alcohol.
- Correct postural curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, clubfoot, etc. ).
- Timely diagnose and treat concomitant diseases of the musculoskeletal system or internal organs.
- Prevent or properly treat injuries to the spine.
- Avoid emotional outbursts and stressful situations.
It should be remembered that back pain is not an isolated pathology, but a symptom of an illness. The main illness can be extremely serious and, if left untreated, lead to disability and even death of the patient!