Back pain (synonymous with back pain) is one of the most common reasons for seeing a doctor - the second after acute respiratory illness1. Most often, these complaints are addressed to a neurologist, therapist or general practitioner. According to international studies, 19-43% of the adult population that was surveyed recently noted back pain in the past month, 27-65% - in the past year. Those who have experienced this at least once in their life, there are 59-84% 1. Almost one in five adult inhabitants of our planet may experience severe back pain at this time. Their most common location is the lower back and lower back.
Why does back pain occur?
Among the main reasons for the development of back pain are:
Spinal causes - associated with pathology of the spine:
pathology of intervertebral discs, including hernias;
narrowing of the spinal canal;
joint diseases;
the consequences of injuries;
birth defects and developmental abnormalities;
Metabolic disorders;
spondylitis - inflammatory processes in the intervertebral joints.
Non-vertebrogenic - not associated with pathology of the spine:
sprains of ligaments and muscles associated with heavy loads;
myofascial syndrome - chronic muscle pain;
inflammation of muscle tissue - myositis;
diseases of internal organs;
pathology of large vessels, for example, aneurysm (sudden expansion) of the abdominal aorta;
osteoarthritis of the hip joint - an inflammatory-dystrophic disease;
mental disorders, etc.
Depending on the origin, the following types of pain are distinguished:
Specific- is associated with a specific disease which can be detected by standard examination methods. This type takes up to 3% 1 of all cases. These can be compression fractures of the spine, tumors, infectious processes, diseases of the pelvic organs (especially with back pain in women).
At the same time, there are a number of symptoms, called "red flags", which speak of serious illnesses and require careful consideration. These include:
rapid and unreasonable loss of body weight and / or indication of a history of oncopathology (tumors);
weakness of the lower limbs, impaired sensitivity and function of the pelvic organs (cauda equina syndrome);
the use of antibiotic therapy, an increase in body temperature (infectious process);
previous trauma or previous diagnosis of osteoporosis, age over 55 (vertebral fracture);
young age - up to 20 years;
long-term preservation of painful sensations and their intensity, despite treatment;
associated with general weakness or trouble walking, worse at night, does not change with a change in body position.
Root- following in frequency (up to 27%). It develops as a result of pinching and / or inflammation of the root of the spinal cord, which exits through openings in the spine. This type may be indicated by increased pain during coughing, sneezing, exertion, and other types of activity.
Not specific- more often acute, it is difficult to immediately determine the specific cause of its development, usually these are the consequences of dystrophic changes in the bone, cartilage tissue of the spine, as well as the muscles and ligaments that make up theback support device. In the International Classification of Diseases (ICD-10) there is a special section for the definition of these syndromes - dorsopathies.
Such back pain accounts for up to 85% 1 of all cases and is mainly associated with a disruption of the normal functioning of individual structures of the spine, each of which can become a source of painful impulses. Pain can be compressive (from compression of nerve roots) and reflex - from all other tissues, including spastic muscles.
Another type of pain syndrome is described, which is not associated with any organic damage to the spine and paravertebral tissues. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.
The location distinguishes:
What is the name of
Where does it hurt
neck pain
neck pain
cervicocranilagia
neck + head
cervicobrachialgia
neck and hand
thoracalgia
pain in chest back and chest, pain under the shoulder blades of the back
lumbodynia
lower back and lumbosacral region
sciatica
lower back + leg
sacralgia
sacrum
coccygodynia
coccyx
In addition to the reasons, it is possible to identify factors that can provoke the development of pain syndrome:
severe physical overload, leading to excessive stretching of muscles and ligaments;
uncomfortable or static postures that a person takes for a long time;
untrained muscles and their overload, inactivity;
trauma and microtrauma;
hypothermia;
prolonged immobility, such as bed rest;
alcohol abuse;
diseases of internal organs;
joint pathology;
Overweight;
individual characteristics: curvature of the spine, curvature;
poor nutrition, diseases of the digestive system, which may be accompanied by impaired absorption of vitamins, mineral metabolism, a large intake of salts affecting the joints;
occupational hazards: thermal effects, temperature variations, vibrations, work with weights, etc.
The mechanism of development of back pain is associated with blockage of the intervertebral joints, which can be caused by loads, both static and dynamic, microtrauma and non-physiological postures. As a result, in one place the muscles contract and stretch too much, and at another they stretch too much. All this leads to the development of muscle pain, changes in pain sensitivity and the formation of pathological pain impulses.
Also, muscle spasms can be a reflex reaction to pathology of the spine or diseases of internal organs. In this case, it is considered a defensive reaction, but at the same time it starts a new circle of pain. In addition, with prolonged preservation of spasms, the transmission of nerve impulses to muscle fibers is disturbed, they become more excitable, calcium deficiency may occur, and circulatory disorders further aggravate the situation.
Depending on the duration of the back pain, there may be:
acute - can last up to 6 weeks;
subacute - from 6 to 12 weeks;
chronic - last 12 weeks or more.
Symptoms
Symptoms of back pain depend on the cause, mechanism of development and the presence of concomitant diseases.
For non-specific pain, the following signs are characteristic:
aching or drawing pain, sometimes tightness;
increases with the load or movements of the spine, as well as in some positions, may decrease when kneading or rubbing the muscles, as well as after resting in a comfortable position;
possible pain on the sides of the back or pain in the back of the back;
when probing, compaction, changes in contours, tension are determined, but there are no disturbances of sensitivity in the painful area, a decrease in muscle strength, reflexes do not change.
When the nerve root is compressed (radiculopathy), the pain differs in its intensity, can be throbbing, often radiates to the leg and into the limb, it can be stronger than in the back. On examination, symptoms of damage to a specific nerve root are observed - muscle weakness, impaired sensitivity in a certain area.
Diagnostic
The algorithm for diagnosing acute and chronic back pain is somewhat different.
Sharp pain
In order to determine the tactics of treatment, the doctor should, if possible, determine the cause of the pain syndrome: pinched nerves or their roots, trauma, tumor, inflammation, infection, osteoporosis, diseases of internal organs, etc. As a rule, these types of pain have quite vivid and specific clinical manifestations. After examination and palpation, patients are referred to appropriate specialists or for further examination, for example:
x-ray examination;
MRI and CT scan of the spine;
scintigraphy - a method of visualization using the introduction of a contrast agent;
densitometry - determination of bone density;
laboratory tests to determine tumor markers, rheumatic tests, biochemical blood tests, etc.
Patients with acute, nonspecific pain usually do not need further research.
Chronic pain
As the mechanisms of its development have not yet been sufficiently studied, it can be problematic to identify the source, especially if it is a dysfunctional species that reflects the pathology of other organs. It can be a manifestation of such diseases as irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and others. In any case, a thorough interview and examination of the patient is carried out to decide on further treatment tactics.
For the pain syndrome that occurs against the background of dystrophic changes in the joints, after any mechanical stress or under the influence of other factors, it is possible to use magnetic resonance imaging to monitor the dynamics of the condition ofspine.
How to treat acute back pain
Physicians who adhere to the principles of evidence-based medicine use the following tactics to manage patients with acute back pain:
inform the patient about the causes of the pain syndrome;
exclude bed rest and recommend to maintain usual activity;
prescribe effective drug and non-drug therapy;
monitor dynamics and adjust therapy.
When choosing a drug, special attention is paid to its analgesic effect, speed of action and safety. First, non-specific anti-inflammatory drugs (NSAIDs) are prescribed, as they have been shown to be effective for back pain. One of these drugs is naproxen.
Naproxen is available as an oral tablet and gel for external use. The drug is indicated as an analgesic for back pain associated with trauma, overload, inflammation. It also has anti-inflammatory and antipyretic effects, the duration of the effect can last up to 12 hours. If you cannot see a doctor quickly and the pain is very discomforting, you can take naproxen as follows: 2 tablets as the starting dose, then 2 tablets every 12 hours or 1 tablet every 8 hours. . The course of admission without consulting a doctor does not exceed 5 days.
While maintaining the intensity of the pain, it is possible to prescribe other groups of analgesics and sedatives (sedatives).
Non-drug treatments include:
warming up;
manual therapy;
physiotherapy;
massage;
physiotherapy;
acupuncture and other alternative methods.
Treatment of chronic back pain
If the localization of pain and the source of pain impulses can be identified, local therapy is used - blockages, intradiscal influences and other procedures. For the rest of the patients, such treatment for low back pain and back pain is not used, therefore a different treatment regimen is used. Its main objective is to reduce the intensity of pain and preserve the quality of life.
In addition, as with acute pain, drugs from the group of NSAIDs are prescribed, including naproxen, other pain relievers, muscle relaxants and B3 vitamins. Antidepressants are recommended as needed. Manual therapy should be carried out by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic treatment methods are used.
Prophylaxis
For the prevention of back pain, it is necessary to identify all possible risk factors and work to eliminate them.
For all types of pain, the following will be helpful:
adequate physical activity and muscle building, including the back;
timely treatment of chronic diseases of internal organs;
maintain a physiological posture during labor;
quitting smoking and alcohol;
regular preventive examinations;
adequate treatment and prevention of infections;
Balanced diet;
wear comfortable shoes and clothing;
good organization of work and life to protect the back;
prevention of stress and emotional overload.
Comprehensive treatment and full rehabilitation of patients with back pain allows you to preserve the quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.
