Back pain: treatment, causes and characteristics

Back pain is a symptom of a large group of diseases and conditions with similar manifestations, is one of the pressing problems of modern medicine, and treating back pain is not an easy task. .

Although pain syndrome can occur in any part of the spine, the most common area is the lower back – according to researchers, prevalence of low back pain reaches 76% in the adult population.

According to statistics, within 1 year, about 80% of people complain of at least one pain in the lower back, and in the next 12 months, 75% of them suffer from recurrent pain syndrome.

Types and manifestations of pain syndrome

Depending on the affected segment of the back, pain syndrome is divided into pain in the neck, mid back (chest pain), lower back (low back pain) or coccydynia (pain in the tailbone or sacrum).

According to the results of a study involving 46 thousand volunteers from several European countries, chronic pain in different parts of the spine is inherent in 24% of the population, in the lumbar region. back - 18% and neck pain occurs in 8%. 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 sharp, sometimes with a burning and tingling sensation. Symptoms in some diseases also extend to the arms and hands, legs or feet, depending on the extent of spinal involvement. Numbness or weakness of the upper and lower extremities is another variant of accompanying back pain symptoms. Limited range of motion or increased pain in certain parts of the body has also been observed in some patients with vertebral pain syndrome.

Back pain: why does it happen?

Examination is not always able to determine the immediate cause of back pain, in which case the pain is referred to as "nonspecific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observedfound - this type of pain syndrome occurs in 98% of patients. Pain secondary to the underlying disease is present in about 2% of cases.

Nonspecific low back pain has the following characteristics:

• tends to get better or worse depending on the position of the body - for example, the patient may feel better when he is sitting or lying down;
• the pain is often worse with movement;
• an attack can develop suddenly or gradually;
• sometimes back pain is the result of poor posture or awkward lifting, but often comes on for no apparent reason;
• may be caused by a minor injury, such as a sprained ligament or muscle;
• can occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for developing nonspecific low back pain:

• hard manual labor;
• frequent bending and inclination of the body;
• lifting weights, especially from the wrong place;
• passive lifestyle;
• industrial influences, for example, vibrations;
• 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:

• trauma 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), 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 nerve;

It is important to remember that acute pain signals the beginning of the disorder, while chronic pain corrects this pathological consequence and reminds of a developing disorder.

Conditions that can cause chronic back pain include:

• deviated or prolapsed disc;
• autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints of the spine);
• radiculopathy - inflammation and degeneration of the nerves that run from the spinal cord to muscles and joints;
• Arthritis and ankylosing spondylitis of the spinal joints of different origin.

Less often, back pain can be a sign of more serious conditions, such as:

• infectious process (eg, 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.

Diagnosing back pain

To understand what to do with severe back pain, it is first necessary to determine its cause. An accurate diagnosis is key to a well-designed treatment plan.

After a thorough examination of the patient's complaints, history, and nature of symptoms, the physician may order imaging and functional tests to confirm the diagnosis.

• X-ray of the spineused to detect degenerative diseases and fractures.
• CT scanprovides detailed cross-sectional images of the spine, showing minor bone changes.
• Magnetic resonance imagingDisplays both tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves or spinal cord.
• When in progressmyelogramA special probiotic is used - a dye is injected into the area around the spine to better visualize the spinal canal and discs, as well as the condition of the nerve fibers inside and aroundSpine.
• Electrodiagnostic testallows you to evaluate the electrical activity of the nerves in the upper and lower extremities.
• Positron emission bone scanrevealed, first of all, the pathology of the bone.
• Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone mineral density.

How to deal with back pain

The complex structure of the pain syndrome in different regions of the back and the stages of pathological changes requires a combination of pharmacological and non-pharmacological treatment.

The principles of treatment for a patient with chronic low back pain, based on evidence-based medicine, imply:

1. explain to the patient the cause of the pain and, as a rule, its benign origin;
2. Ensure an adequate level of daily physical activity;
3. indication of effective and safe treatment, mainly for pain relief;
4. Adjust therapy in case of ineffectiveness after 1-3 months.

The international clinical recommendations of doctors provide a general algorithm for the treatment of chronic low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical treatment, physical therapy, manual therapy, as well as antidepressants and psychotherapy are considered the most effective methods for treating pain. lengthen.

Treatment of back pain without drugs

In most cases, a patient's back pain improves within 2-6 weeks. The primary goals of nonspecific treatment are to reduce limitation of motion, minimize recurrence, and although good physical condition may not prevent all episodes of pain, it does facilitate resolution of these episodes.

The development of precise motor patterning and exercise therapy are important areas of nonpharmacological management of pain syndrome.

Over time, non-drug back pain treatment can be broken down into three phases.

I stage- Passive physiotherapy in the acute phase (6 weeks).

Phase II- active exercise in the subacute period (6-12 weeks).

Phase III- Restorative physiotherapy effects.

Bed rest is prescribed only for cases of acute back pain for a certain period of time.

Various physical activities and forms of complementary and alternative medicine can help control pain, such as:

1. non-specific exercise, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physical therapy may also be recommended to strengthen the abdominal and spine muscles;
2. therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
3. the use of acupuncture, manual therapy, and spinal traction.

Regardless of which conservative treatment is used, it's important to remember that patients may not feel immediate relief and improvement will come after a few weeks or months.

Medical treatment for pain relief

The most common back pain treatments are:

1. Non-steroidal anti-inflammatory drugs and muscle relaxants.
2. Injecting steroid hormones into the joint cavity or epidural space of the spine, which helps to reduce inflammation and back pain. However, this type of therapy is not for long-term use due to the side effects of the drug.

When is surgery used?

While the vast majority of people with back or neck pain recover on their own over time without medication or nonsurgical treatment, some patients may need surgical correction of spinal conditions. In general, patients with spinal pain can be operated on if the following criteria are met:

• a structural problem that has been diagnosed and confirmed by imaging (such as X-ray or MRI);
• conservative treatments such as physical therapy or medication do not provide adequate pain relief;
• debilitating back pain - it interferes with participation in daily activities or physical activity;
• symptoms that adversely affect physical or emotional health;
• there is objective reason, confirmed by diagnostic methods, to believe that spinal surgery would be beneficial;
• nerve damage.

Back pain prevention

Maintaining a healthy lifestyle is key to preventing back pain. Being overweight puts stress on your back, so it's important to maintain a healthy weight. Regular exercise helps strengthen the abdominal and back muscles. Smoking accelerates the aging of blood vessels and many body tissues, including contributing to the aging of the spine, so refusing to use tobacco-containing products is another step. towards a healthy back. Correct posture, doing light work at work, and avoiding a sedentary lifestyle are all effective ways to prevent back pain.