Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most urgent problems of modern health care, 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 low back pain is as high as 76% in 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 return 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, in the middle of the back (chest pain), in the lower part of the 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.The 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 possibility for the accompanying manifestations of back pain.In some patients with spinal pain syndrome, there is also a limitation in the range of certain movements or an increase in pain in certain positions of the body.
Back pain: why does it happen?
During the examination, it is not always possible to determine the direct cause of the back pain, in which case the pain is called "non-specific" 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.
Non-specific back pain has the following characteristics:
- tends to get better or worse 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 bad posture or lifting something difficult, but often it appears for no apparent reason;
- it can be caused by a minor injury, such as a ligament or muscle sprain;
- it can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for the development of non-specific back pain:
- hard physical work;
- frequent bending and bending of the body;
- lifting heavy objects, especially from a wrong position;
- sedentary lifestyle;
- industrial impacts such as vibrations;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute impact of an adverse factor.
The most common causes of acute back pain are:
- damage to various structures in the back;
- spondylolisthesis - displacement of the vertebrae in relation 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 nerves;
It is important to remember that acute pain signals the onset of a disorder, while chronic pain registers this pathological effect and is reminiscent 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 that go 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 (aneurysm of the abdominal aorta 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 determine 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 the symptoms, the doctor can 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 spine, showing even subtle changes in the bones.
- Magnetic resonance imagingshows tissue and bone structures and is used to identify slipped or herniated discs, pinched nerves or the spinal cord.
- During the executionmyelogramsA special biological dye is used that is injected into the area around the spine 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 the nerves in the upper and lower extremities.
- Positron emission bone scandetects, first of all, bone oncopathology.
- Densitometry - determination of bone density - is indicatedfor diseases and conditions that lead to decreased bone mineral density.
Methods to fight back pain
The complex structure of pain in different 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, mean:
- explaining to the patient the causes of pain and, as a rule, its benign origin;
- ensuring sufficient levels of daily physical activity;
- prescribing an effective and safe treatment, mainly 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 gets better within 2-6 weeks.The main goal of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical fitness cannot prevent all painful episodes, it facilitates the resolution of these episodes.
Development of the correct motor stereotype and physical therapy are important areas of non-pharmacological pain correction.
Based on the duration, non-drug treatment for back pain can be divided into three stages.
Phase I- passive physiotherapy during the acute period (6 weeks).
Phase II– active exercise during the subacute period (6–12 weeks).
Phase III- rehabilitative 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 light stretching are recommended to improve long-term results.Physical therapy may also be recommended to strengthen the abdominal and spine 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 drug treatment methods 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 nonsurgical treatment, some patients may need surgical correction of spinal disorders.In general, a patient with spine pain can undergo surgery if the following criteria are met:- the structural problem is 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 useful;
- neurological damage occurs.
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 strengthens 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 stopping the use of tobacco products is another step towards a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.