Today, back pain is the second most common reason for patients seeking medical help. According to the American National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease increases only with age. In medical practice, pain (rash) is considered an interdisciplinary pathology, because there is a symptom in the clinic of both neurological and physical diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs with diseases of the spine (spine pain). In other cases, the cause may be pathologies of internal organs, spinal cord, etc. (non-vertebral pain).
Thus, the vertebrate group includes:
- intervertebral hernia?
- sacred or pain?
- spondylosis?
- osteoporosis?
- tumor processes of the vertebrae.
- trauma (vertebral fractures, slippage).
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 endurance and duration vary depending on the underlying pathology.
- Intervertebral hernia.A hernia protrusion occurs between the vertebrae with the development of osteochondrosis. In this case, the pain may be acute or aching and local in nature (depending on the level of the disc affected). The pain often extends to the extremities, accompanied by numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), disturbances of the sensitive and motor sphere of the arms or legs may occur. Rarely, there are violations of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacra or back pain.Ierism is a congenital anomaly associated with the fusion of the last lumbar vertebra to the sacrum. In this case, the opposite defect is back pain, when the first vertebra of the sacrum separates and becomes an additional lumbar vertebra. Usually the pathologies are asymptomatic, but the clinic is caused by excessive physical activity or heavy lifting. In such cases, there is lumbar pain in the sanctuary area, which increases with movement, spreading to the lower extremities. The pathology is also characterized by the fact that it appears at a young age (usually 20-25 years).
- Spondylosis.Spondylosis (unlike previous illness) occurs mainly in the elderly. The disease develops as a result of aging changes in the spine - its "wear". The pathology is accompanied by the development of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous with injuries of neurovascular ligaments, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens at the end of the day. Sometimes the pain syndrome manifests itself not only in movement, but also in calm, leading to insomnia. With an uncontrollable disease, there are frequent cases of immobilization of the spinal joints, as well as stinging of the nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis. Osteoporosis is a metabolic disorder in which the processes of bone destruction predominate over bone formation. The clinical picture of the disease is scarce: usually the pathological process is asymptomatic and is detected randomly (by radiography). However, in the later stages of the disease, dull pains appear, as well as posture curvature.
- Spinal tumor processes.Spinal tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic back pain (usually in the lower spine) occurs, which can spread to the thighs and lower legs. Sooner or later, the growth of the tumor leads to compression of the nerve roots, which is manifested by neurological disorders: loss of sensitivity and movement in the extremities.
- Injuries.A common cause of acute pain, limited mobility and neurological symptoms are spinal injuries: fractures, bruises, dislocations / flares, as well as "slipping" of the vertebrae due to damage to the device-vertebral ligament. Usually, patients experience severe diffuse back pain, the presence of bleeding ("bruises"), local swelling, and restricted movement.
- Psychogenic pain. A similar view appears in the context of complete health after an emotional outburst or stressful situation. Patients describe pain in different ways, which is limited only by the patient's imagination. Sometimes there is the so-called. "Painful behavior" when people, while maintaining mobility, tend to use supportive support: crutches, sticks and even wheelchairs.
- Fibromyalgia.Fibromyalgia pain syndrome is extremely similar to psychogenic pain. At the same time, pain is also caused by stress, climate and emotional overload. However, an important difference is that the pain should be observed for more than three months, accompanied by local tenderness in characteristic points (the site of attachment of the occipital muscles, the waist of the banks, etc. ). Also, the diagnosis requires the complete exclusion of all kinds of physical diseases.
- Pathologies of internal organs.Back pain can often occur with diseases of various organs of the body. Thus, with a heart attack, the pain syndrome is located behind the sternum, spreads below the shoulder and left arm, as well as in the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, which is transmitted to the spine. A complex of symptoms occurs in the context of difficulty breathing and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, it appears in the upper abdomen with a type of "belt", which covers the sides and back. Back pain occurs along with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Usually, the pain is so severe that it forces patients to bend over in search of relief. As part of an attack, the urine becomes red dirty due to blood impurities.
- Tumor processes.A neuroma is a tumor of the nerve sheath. When the spinal cord roots are affected, back pain usually occurs, as well as loss of sensation 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 can be caused by metastases of breast, prostate, lung, kidney, etc.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, which is complemented by neurological disorders: often there is paralysis (reduced muscle strength), loss of sensitivity, pelvic disorders, etc. A purulent process occurs in the context of infections, wounds, immunodeficiency 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 the disease. In the early stages, there is a slight pain in the spine, which does not cause discomfort. Then there is weight loss, muscle weakness, loss of sensitivity to pain, there is no sweating and the bones become brittle. There are often injuries to the joints, bone skeleton (burns, fractures, cuts), however, due to lack of sensitivity to pain, they go unnoticed.
Diagnostics
As a diagnosis, a qualitative examination and physical examination of the patient is required by palpation (feeling), percussion (percussion) and hearing (hearing). For some pathologies, it is necessary to perform laboratory blood tests (heart attack, pancreatitis, tumor procedures).
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 needed: bone scintigraphy, electromyography, etc.
Treatment of back pain
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), block physical activity, and immobilize the spine if possible. If the pain is unbearable, analgesics may be taken. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. This can then complicate the diagnosis of the disease. Only the treating physician can prescribe medication.
Disk Code
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 as well as endoprostheses of the intervertebral disc may be required.
Sacra or back pain
When pain occurs, anesthetic exclusions are prescribed, as well as physiotherapy (paraffin applications, electrophoresis, etc. ). With the ineffectiveness of conservative treatment, remedial interventions are indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin) as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate the 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 procedures
Treatment for tumor diseases consists of chemotherapy and surgery. In this case, the amount of assistance depends on the specific clinical case.
Injury
In case of minor injuries, a gentle regimen and warm-up is recommended. In some cases, reduction or skeletal traction is required. When neurological symptoms appear, surgeries are performed to stabilize bone fragments.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy, as well as taking antidepressants (fluoxetine, sertraline).Fibromyalgia
As the causes of the disease remain unknown, symptomatic treatment is prescribed: antidepressants (paroxetine, amitriptyline), antispasmodics (pregabalin), hypnotics (zopiclone) or sedatives (diazepam). Self-coordination is also important for positive thinking, avoiding stressful situations and being in a hot, dry climate.
Pathologies of internal organs
Each of the possible internal pathologies requires individual treatment regimen. The emergency room for heart attack receives nitroglycerin (one tablet every 5 minutes until the ambulance arrives). with pancreatitis - cold, hunger and resting pneumothorax - a sealed (occlusive) bandage in case of open wound of the lung. with renal colic - antispasmodics (Drotaverin, Metamizole sodium) and heating.
Epidural abscess
Treatment consists of emergency surgery to normalize pressure in the spinal canal and drain the meninges. Antibiotic therapy (Amoxicillin, Cefotaxime) supports surgery.
Syringomyelia
Patients are usually advised to protect their skin from cuts and burns (the latter often occurring because patients lose 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 of the spinal cord.
Back Prevention
To prevent back pain, it is necessary to avoid the occurrence of any of the pathologies mentioned above. To do this, you need:
- Lifestyle normalization: weight reduction to normal. Compose a proper diet rich in trace elements and vitamins. ensure proper physical activity without too much effort.
- Stop bad habits: smoking and alcohol consumption.
- Correct posture curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, leg, etc. ).
- Early diagnosis and treatment of concomitant diseases of the musculoskeletal system or internal organs.
- Prevent or treat spinal cord injuries properly.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of an illness. The underlying disease can be extremely serious and, if left untreated, can lead to disability and even death of the patient!