Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most pressing problems of modern healthcare, and the treatment of back pain is a difficult task.
Although pain can occur in any part of the spine, the most common location is the lower back - according to researchers, the prevalence 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% of them 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 pain in the neck, mid-back (thoracic pain), lower back (lumbar pain) or coccydynia (pain in the tailbone or sacrum).
According to the findings of a study involving 46 thousand volunteers from several European countries, chronic pain in various parts of the spine is characteristic of 24% of the population, in the lumbar region - 18%, and neck pain occurs in 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.Symptoms of some diseases also extend to the arms and hands, legs, or feet, depending on the level of spinal involvement.Numbness or weakness in the upper and lower extremities is another option for accompanying manifestations of back pain.Restriction in the range of certain movements or increased pain in certain body positions is also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
When examining, it is not always possible to determine the direct cause of back pain, in which case the pain is called “nonspecific” 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 pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease accounts for about 2% of cases.
Nonspecific back pain has the following characteristics:
- tends to improve or worsen depending on body position - for example, the patient may feel better when sitting or lying down;
- pain often worsens with movement;
- the attack may develop suddenly or gradually increase;
- Sometimes back pain is the result of poor posture or awkward lifting of something, but often appears for no apparent reason;
- may be caused by a minor injury, such as a sprained ligament or muscle;
- may occur after stress or overwork and usually begins to get better within a few weeks.
Risk factors for developing nonspecific back pain:
- hard physical labor;
- frequent bending and bending of the body;
- lifting heavy objects, especially from an incorrect position;
- sedentary lifestyle;
- industrial impacts such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute influence of an unfavorable factor.
The most common causes of acute back pain are:
- injury to various structures in the spine;
- spondylolisthesis - displacement of the vertebrae relative to each other;
- sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body), running from the lower back to the feet
- 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 remember that acute pain signals the onset of a disorder, while chronic pain records this pathological effect and reminds of a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of an intervertebral disc;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints of the spine);
- radiculopathy - inflammation and degeneration of the nerves running from the spinal cord to the muscles and joints;
- arthritis and arthrosis of the spinal joints of various origins.
- infectious process (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
To understand what to do with severe back pain, it is advisable, first of all, to establish its cause.An accurate diagnosis is the key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history, and the nature of symptoms, the doctor may prescribe imaging studies 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 spinal column, showing even subtle changes in the bones.
- Magnetic resonance imagingshows both tissue and bone structures and is used to identify slipped or herniated discs, pinched nerves or the spinal cord.
- When conductingmyelogramsA special biological dye is used 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 you to evaluate the electrical activity of nerves in the upper and lower extremities.
- Positron emission scan of bonesreveals, first of all, oncopathology of bones.
- Densitometry - determination of bone density - shownfor diseases and conditions leading to a decrease in bone mineral density.
Methods to combat back pain
The complex structure of pain in various parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.
The principles of therapy for a patient with chronic back pain, based on evidence-based medicine, imply:
- explaining to the patient the causes of pain and, as a rule, its benign origin;
- ensuring sufficient levels of daily physical activity;
- prescribing effective and safe treatment, primarily to relieve pain;
- correction of therapy if it is ineffective after 1–3 months.
Non-drug treatment for back pain
In most cases, a patient with back pain improves within 2-6 weeks.The main goal of nonspecific treatment is to reduce movement restrictions, minimize relapses, and although good physical fitness cannot prevent all painful episodes, it does facilitate resolution of these episodes.
Developing the correct motor stereotype and physical therapy are important areas of non-pharmacological correction of pain.
Based on the duration, non-drug treatment for back pain can be divided into three phases.
Stage I- passive physiotherapy during the acute period (6 weeks).
Stage II– active exercises during the subacute period (6–12 weeks).
Stage III- rehabilitation physiotherapeutic effects.
Bed rest is prescribed for acute back pain only for a limited period of time.
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.For uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy may 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 traction methods.
Drug treatment of pain
The most common methods of drug treatment for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduces inflammation and pain in the back.However, this type of therapy is not intended 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 can undergo surgery if the following criteria are met:- the structural problem has been diagnosed and confirmed by imaging (eg, X-ray or MRI);
- Conservative treatments such as physical therapy or medications have failed to 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 objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- neurological damage occurs.
Preventing back pain
Maintaining a healthy lifestyle is the key to preventing back pain.Excess weight puts stress on your back, so it's 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, including 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.