Today, back pain is the second most common reason for patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people suffer from pain.
At the same time, the incidence of the disease increases only with age. In medical practice, dorsalgia is considered an interdisciplinary pathology because it has a symptom in the clinic of neurological and somatic diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs with diseases of the spine (vertebral pain). In other cases, the cause may be pathology of internal organs, spinal cord, etc. (non-vertebral pain).
Thus, the vertebrogenic group includes:
- intervertebral hernia;
- sacra- or lumbarization;
- spondylosis;
- osteoporosis;
- vertebral tumor processes;
- trauma (vertebral fracture, spondylolisthesis).
The non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formations (neurinomas) 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 extension between the vertebrae appears with the development of osteochondrosis. In this case, the pain may be sharp or painful and have a local nature (depending on the level of the affected disc). The pain often extends to the limbs, accompanied by numbness and tingling sensation. In advanced cases (when the hernial sac compresses the nerve roots), disorders of the sensitive and motor spheres of the arms or legs may occur. Rarely, there are violations of urination, defecation and sexual function (with pelvic spine injury).
- Sacra or lumbarization.Sacralization is a congenital anomaly associated with the union of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first sacrum vertebra separates and becomes an additional lumbar vertebra. Usually the pathologies are asymptomatic, but the clinic is provoked by excessive physical activity or lifting heavy weights. In such cases, there is a lumbar pain in the sacrum region, which increases with movement, spreading to the lower extremities. The pathology is also characterized by the fact that it occurs at a young age (usually at the age of 20-25 years).
- Spondylosis.Spondylosis (unlike previous illness) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear". The pathology is associated with 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 at the end of the day. Sometimes pain syndrome manifests itself not only in movement but also at rest, leading to insomnia. With an uncontrolled disease, there are frequent cases of immobilization of the vertebral joints, as well as pinchings of 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 poor: usually the pathological process is asymptomatic and is detected accidentally (X-ray). However, in the later stages of the disease, dull pain appears as well as curvature of the posture.
- Tumor processes of the vertebrae.Vertebral tumors are often asymptomatic until they are large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower back), which can spread to the thighs and lower legs. Sooner or later, tumor growth leads to compression of nerve roots, which is manifested by neurological disorders: loss of sensation and movement in the limbs.
- Injuries.A common cause of acute pain, limited mobility and neurological symptoms are spinal cord injuries: fractures, bruises, dislocations / subluxations, and vertebral "slippage" due to damage to the ligament apparatus - spondylolisthesis. Typically, patients report a sharp diffuse back pain, the presence of hemorrhages ("bruising"), local swelling, and limited movement.
- Psychogenic pain.A similar view occurs in the background 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 a so-called. "Painful behavior" when people, while maintaining movement, tend to use assistive support: crutches, sticks and even wheelchairs.
- Fibromyalgia.Pain syndrome in fibromyalgia is extremely similar to that in psychogenic pain. At the same time, grief is also provoked by stress, climate and emotional overload. An important difference, however, is that the pain should be observed for more than three months, accompanied by local tenderness at characteristic points (site of occipital muscle attachment, mid-trapezius muscle, etc. ). Also, the diagnosis requires the complete exclusion of all types of somatic diseases.
- Pathologies of the internal organs.Back pain can often present with diseases of various organs of the body. So with a heart attack, the pain syndrome is localized behind the sternum, spreading under the shoulder and left arm, as well as in the back. With pneumothorax (accumulation of air under the lung lining), acute chest pain occurs, radiating to the spine. A complex of symptoms arises against the background of difficulty breathing and facial cyanosis. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, arising in the upper abdomen in a "belt" type, covering the sides and back. Back pain appears along with vomiting and indigestion. A complication of urolithiasis is abdominal pain in the kidneys - an acute paroxysmal pain syndrome. Typically, the pain is so severe that it causes patients to bend over in search of relief. Against the background of an attack, urine becomes contaminated red due to blood impurities.
- Tumor processes. A neurinoma 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. cancers.
- Epidural abscess.Epidural abscess is a collection of pus under the strong lining of the spinal cord. The disease is associated with acute pain syndrome, which is complemented by neurological disorders: often appear paresis (reduced muscle strength), loss of sensation, pelvic disorders, etc. A purulent process occurs against the background of infections, wounds, lack of immunity or as a complication of lumbar puncture (or epidural anesthesia).
- Siringomelia.Syringomyelia is a pathology of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, compression of the brain, etc. provoke the disease. In the initial stages, there is a slight back pain, which does not cause discomfort. Then there is weight loss, muscle weakness, pain sensitivity is lost, there is no sweating and the bones become brittle. There are often injuries to the joints, bone skeleton (burns, fractures, cuts), however, due to the lack of pain sensitivity, they pass invisibly.
Diagnosis
As a diagnosis, a qualitative study and physical examination of the patient by palpation (feeling), stroke (stroke) and auscultation (hearing) is required. For some pathologies, it is necessary to perform laboratory tests of blood (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or magnetic resonance. 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), exclude physical activity, and immobilize your spine if possible. If the pain is unbearable, pain relievers can be taken. However, it is worth remembering that anesthetics "lubricate" the disease clinic. Subsequently, this can complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
Disc hernium
The main treatment of medicines is based on the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and painkillers (Ketorolac). In some cases, surgical removal of the intervertebral hernia may be required, as well as endoprosthesis of the intervertebral disc.
Sacra or lumbarization
When pain occurs, blockades with anesthetics are prescribed, as well as physiotherapy (paraffin applications, electrophoresis, etc. ). With the ineffectiveness of conservative treatment, reconstructive surgeries 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 medicines. In some cases, hormone therapy with estrogen, calcitonin and parathyroid hormones is used.
Tumor processes
Treatment for tumor diseases consists of chemotherapy and surgery. In this case, the amount of help depends on the specific clinical case.
Injury
In case of minor injuries, a gentle warm-up regimen is prescribed. In some situations, skeletal reduction or retraction is required. When neurological symptoms appear, operations are performed with fixation of bone fragments.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy as well as taking antidepressants (fluoxetine, Sertraline).
Fibromyalgia
Given that the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), hypnotics (Zopiclone) or sedatives (Diazepam). Self-adaptation to positive thinking, avoiding stressful situations and being in a hot and dry climate are also important.
Pathologies of the internal organs
Each of the possible internal pathologies requires individual treatment tactics. Urgent care for a heart attack is taking Nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a closed (occlusive) dressing in the case of an open lung wound; with renal colic - antispasmodic (Drotaverine, Metamizole sodium) and fever.
Epidural abscess
Treatment consists of an urgent operation to normalize the pressure in the spinal canal and drain the meninges. Antibiotic therapy (Amoxicillin, Cefotaxime) supports surgical intervention.
Syringomyelia
Usually, patients are advised to protect their skin from cuts and burns (the latter often occur because patients lose sensitivity and do not feel trauma). Pain relievers, antidepressants (Fluoxetine) and antipsychotics (Chlorpromazine) are also prescribed. In some cases, surgical intervention is possible in order to review the formed cavities of the spinal cord.
Return Prevention
To prevent back pain, it is necessary to prevent the occurrence of any of the pathologies mentioned above. To do this, you need:
- Normalize your lifestyle: reduce your body weight to normal; constitute a correct diet rich in trace elements and vitamins; ensure proper physical activity without overload.
- Give up bad habits: smoking and alcohol consumption.
- Correct posture curvature (scoliosis, lordosis) and orthopedic pathologies (flat feet, cane feet, etc. ).
- Diagnosis and timely treatment of diseases associated with the musculoskeletal system or internal organs.
- Prevent or properly treat spinal cord injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The underlying disease can be extremely serious and, if left untreated, leads to disability and even death of the patient!