Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and is one of the most urgent 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 lower back pain in the adult population reaches 76%.
According to statistics, within 1 year, about 80% of people complain of pain in the lower back at least once, and in the next 12 months, 75% of them experience a recurrence 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, middle back (chest pain), low back (back pain) or coccydynia (pain in the tailbone or sacrum).
According to the results of a study involving 46,000 volunteers from several European countries, chronic pain in various areas of the spine occurs in 24% of the population, in the lumbar region in 18%, and neck pain 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 burning, sometimes there is a burning and tingling sensation.The symptoms of some diseases also spread to the arms and hands, legs or feet, depending on the level of involvement of the spine.Numbness or weakness in the upper and lower extremities is another option for the accompanying manifestations of back pain.Some patients with low back pain syndrome also experience limitation of certain range of motion or increased pain in certain body positions.
Back pain: why does it happen?
During the examination, it is not always possible to determine the direct cause of 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 neck, chest, lumbar and sacral nerve roots and specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients.Pain secondary to the underlying disease accounts for about 2% of cases.
Non-specific 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 increase gradually;
- Sometimes back pain is the result of bad posture or awkward lifting, but often appears for no apparent reason;
- can be caused by a minor injury such as a ligament or muscle;
- 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:
- heavy physical labor;
- frequent bending and bending of the body;
- lifting heavy objects, especially from the wrong position;
- sedentary lifestyle;
- industrial effects such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute effect of an unfavorable factor.
The most common causes of acute back pain are:
- damage to various structures of the spine;
- spondylolisthesis - displacement of vertebrae relative to each other;
- sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the human body) that runs from the waist 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 should be remembered that acute pain indicates the beginning of a disorder, while chronic pain marks this pathological effect and reminds the developing disorder.
Conditions that can cause chronic back pain include:
- intervertebral disc displacement or prolapse;
- 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 spinal joints of various origins.
- infectious process (for example, meningitis, tuberculosis);
- diseases of internal organs (aneurysm of the abdominal aorta or gynecological pathology);
- certain types of cancer, such as metastases or 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 to first determine its cause.An accurate diagnosis is the key to a well-designed 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 both tissue and bone structures and is used to identify slipped or herniated discs, compressed nerves, or the spinal cord.
- While drivingmyelogramsA special biological dye 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 spinal column.
- Electrodiagnostic testallows to evaluate the electrical activity of the nerves in the upper and lower limbs.
- Positron emission scan of bonesprimarily reveals bone oncopathology.
- Densitometry - determination of bone density - is indicatedfor diseases and conditions that cause a decrease in bone mineral density.
Ways to deal with 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 evidence-based medicine-based therapy for a patient with chronic low back pain include:
- explaining to the patient the causes of pain and, as a rule, its benign origin;
- ensure a sufficient level of daily physical activity;
- prescribing an effective and safe treatment to relieve pain in the first place;
- Correction of therapy if ineffective after 1-3 months.
Drug-free treatment of 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, to minimize relapses, and although good physical training cannot prevent all painful episodes, it facilitates the resolution of these episodes.
The development of correct motor stereotypes and physical therapy are important areas of non-pharmacological correction of pain.
Depending on the duration, non-drug treatment for back pain can be divided into three stages.
Stage I- passive physiotherapy in the acute period (6 weeks).
Stage II- active exercises in the subacute period (6-12 weeks).
III stage- rehabilitation physiotherapeutic effects.
Bed rest is only prescribed for a limited period of time for acute back pain.
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 low back pain, regular physical activity and gentle stretching are recommended to improve long-term outcomes.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 techniques.
Drug treatment of pain
The most common drug treatments 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 reduce inflammation and lower back pain.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?
Although 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 their spinal problems.In general, a patient with back pain may be eligible for surgery if they meet the following criteria:- diagnosis of a structural problem and confirmation by imaging (eg, X-ray or MRI);
- Conservative treatments such as physical therapy or medications failed to provide adequate pain relief;
- back pain is debilitating and prevents participation in daily activities or physical activity;
- symptoms adversely affect physical or emotional health;
- there are objective reasons to believe that spinal surgery will be useful, confirmed by diagnostic methods;
- neurological damage occurs.
Prevention of back pain
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 tissues of the body, including contributing to the aging of the spine, so stopping the use of tobacco products is another step towards a healthy back.Correct posture, ergonomics at work and avoiding a sedentary lifestyle are effective ways to prevent back pain.