back pain

12 October 2021

Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndromes can occur with diseases affecting the spine, kidneys and other organs and systems. Medicine and non-medication in the treatment and prevention of back pain. -Medicine includes both. Untimely provision of medical care can lead to chronicity of the disease with the development of complications.

Back pain is a separate symptom, not a nosological entity. For example, lumbodynia is pain that is localized in the lumbar spine. In addition, concepts such as thoracalgia or cervicitis are distinguished. With the correct strategy of treatment and preventive measures. Precise localization of pathological symptoms is essential for selection.

Definition

Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can result from direct damage to a tissue or organ or as a result of exposure to adverse psychological factors (stress, anxiety, depression).

Back pain is a multidisciplinary practice in medical practice. This is due to the fact that the pain syndrome can occur due to pathologies of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver, and others).

It should be noted that the pain syndrome may be accompanied by a decline in the patient's cognitive abilities - memory disorders may appear, concentration decreases.

In most cases, the appearance of back pain is the body's defense response to the effects of adverse factors. The most common causes of back pain are sciatica, herniated disc or spondylosis.

epidemiology

According to data provided by the World Health Organization (WHO), back pain is a concern for over 40% of the population. In some countries, this figure can be as high as 80%.

This problem can cause initial disability of the patient. In addition, pain syndrome is a common cause of temporary disability in working people. That is why pathology is a problem not only in medicine, but also in the economic sphere of activity.

Most often, people of working age from 30 to 60 years of age turn to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, as a result of whichThere is acute and chronic pain.

In addition, men suffer from this disease more often than women. This is due to the peculiarities of work, physical exertion, as well as other risk factors. According to statistics, pain appears more often in the lumbosacral region.

Therapists explain this fact by the fact that it is on this part of the spine that physical activity exerts the most pressure.

risk

Not only stress and exercise can cause the manifestation of this pathology. The main risk factors are the following:

Working age from 30 years and older;
Male;
Overweight and obesity (with a body mass index greater than 30);
the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
stable physical activity, which does not differ from each other in diversity;
exposed to vibration.

In addition, smoking has been noted as a risk factor by some researchers. It is possible that the acute cough in a smoker is an indirect cause of pain.

classification

A neurologist, after a detailed examination and examination, establishes the nature of the pain. There are several classifications, among which pain syndromes occurring in the back are subdivided according to the location of occurrence of pathology, duration, causes and other characteristics. goes.

In terms of duration, the following types of pain are distinguished:

Spicy,
Micro,
long term.

Patients with acute pain are often treated in an outpatient clinic. Its duration does not exceed 6 weeks. Subtle pain can last from 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or moreIf so, this pain is called chronic.

Acute and subacute pain most often, with proper treatment, is completely cured. Chronic pain syndrome can cause initial disability of the patient. That is why at the first appearance of clinical signs of pathology, you should consult a doctor. Medical help should be sought. To do this, you should undergo a preliminary consultation with a neurologist.

In terms of intensity, the following types of pain are distinguished:

weak
Average,
strong.

By the nature of back pain, there are:

rip up,
Pain,
Shooting,
Pull,
Idiot.

The nature of the pain depends on the pathology that caused the syndrome. So, with osteochondrosis, pain concerns, which differ in radiating to the lower extremities. With sciatica, stabbing pain appears, often unilateral. it happens.

According to the localization of back pain, there are:

local (local),
reflect,
irradiator.

Local pain occurs when the pathological focus is located directly in the back. Pain is caused by irritation, stretching or other effects on receptors located under the skin.

Local pain has its own characteristics. For example, after an injury to the lumbosacral region of the spine, the pain syndrome remains constant. Its character may change with a change in body position due to irritation of the receptors.

Reflective pain occurs with a pathology that affects the internal organs. Associated with the anatomical features of the infection. So, with the reflected type, there is pain in the skin area. The most common cause of back pain is the pancreas, uterus. and deformity of its appendages may occur.

Among the characteristics of the reflected type of pain, the lack of connection with physical activity is distinguished. If, with a change in body position with a local type of pain, there is an increase in the intensity of the symptom, then in this case there is noThere is no relation.

Radiating pains are associated with irritation of the nerve or root. In addition, in addition to the appearance of pain in the back, the patient may complain of a decrease in sensitivity, the presence of goose bumps (paresthesia). Often, upon examination, a neurologist finds pathologicalMay manifest reflexes, which is also associated with impaired transmission of a nerve impulse.

back pain cause

Pain syndrome can manifest itself for several reasons:

pathology of the musculoskeletal system (trauma, sprain, hypothermia and other external causes);
diseases of the spine (osteochondrosis, hernia);
diseases affecting the organs of the retroperitoneal space (pathologies of the gallbladder, pancreas and others);
benign and malignant neoplasms;
Mental disorders (depression, anxiety, stress cause psychological types of pain).

In addition, everyday problems can cause the appearance of a pathological symptom. So, after waking up with an uncomfortable posture in sleep, the patient may complain of pain in the neck or in the lumbar spine.

vertebral pain

With this type of pain, pathological changes of the degenerative type are observed in the spine. So, the vertebral bodies, intervertebral discs can be damaged. Most often, pain of vertebral origin can be associated with a disease affecting the joints.

According to statistics, patients seeking medical help complain of the presence of acute pain associated with damage to the spinal cord. The cause may be herniated disc, spondylosis or lumbago.

In less than 1% of all cases of visits to the doctor, neoplasms are detected in the spine. Metastasis of malignant tumors are rare, but they can also cause back pain of varying intensity.

Disease	ICD-10 code	peculiarities
osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by the appearancePulling and short-term pain with radiation.Exposure to external factors, such as exercise or coughing, increases the pain.
intervertebral hernia	M51	a disease in which a bulge forms in the spinal canal. It appearsA sharp pain syndrome that occurs during coughing, sneezing and physical exertion.
radiculitis	M54. 1	A disease in which degenerative changes are observed in the roots. Characterized by the appearanceaching pain associated with a change in body position or physical exertion. . . In addition to pain syndrome, sensitivity disorders are added.
discogenic lumbodynia	M54. 4	A pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is shooting and very obvious.
spondylosis	M47	A disease manifested by degenerative changes in the vertebrae. Has a chronic type of course,Pain when radiating to the lower extremities, neck.

It should be noted that each disease has its own distinctive features. Therefore, when making a diagnosis, attention should be paid not only to the histological data, but also to the results of the examinations. To do this, modern diagnostic equipment methods are used. Used, which allows not only to identify the pathological focus, but also to determine its boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.

It is vertebrogenic causes that provoke the appearance of pain in the back. In addition to the diseases listed above, pain may appear during trauma and stretching of the musculoskeletal system. So, with excessive physical exertion or lifting weights, a sudden aching painMay appear.

pain of non-vertebral origin

According to statistics, patients complain of pain of non-vertebral origin in more than 2% of cases. This category includes diseases and somatic conditions that cause back pain.

The most common diseases that provoke the appearance of pain syndrome are pathologies of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. In the first group, the following are distinguished:

clogging of arteries,
extreme angina,
Aortic aneurysm (in the abdominal or thoracic region).

In the second group:

stomach ulcer,
duodenal ulcer,
gallstone disease,
biliary tract dyskinesia,
Inflammatory changes in the pancreas.

Heart diseases often provoke the appearance of pain in the back. So, with angina pectoris, the patient is concerned about pain in the region of the heart, which radiates to the shoulder, arm or back. Therefore during an attack patients feel back pain. complaint may be made.

With angina pectoris, the pain syndrome has its own distinctive features. Firstly, the pain has a crushing character. Secondly, it appears behind the sternum that goes to the back, arm or shoulder. Thirdly, the immediate administration of the drugAfter the pain syndrome disappears. It should be noted that physical activity and stress provoke the appearance of an attack.

An aortic aneurysm is a division of a blood vessel that weakens and then bulges out. In this case, the patient, when seeking medical help, complains of the presence of dull pain in the region of the heart with radiating to the back and lower extremities. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also bother. Back pain with aortic aneurysm can appear both in the thoracic localization of the pathological focus, and with the abdomen.

It should be noted that pain in aneurysms is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are started immediately, including medication andInvolves the use of surgical methods.

Back pain can be caused not only by cardiovascular diseases. In diseases affecting the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarities of the infection - inflammatory and degenerative changes in the region of the backprovoke the appearance of pain.

back pain during pregnancy

Pregnancy is a physiological condition, however, the course may be accompanied by pain and the appearance of other unpleasant symptoms. This is due to changes in the location of the organs, hormonal changes, weight gain in the early and late stages.

During pregnancy, back pain can be caused by physiological and pathological changes.

In the first group are:

natural weight gain during pregnancy, which increases the load on the osteoarticular system;
enlargement of the uterus with the formation of a "baby" space, in which the internal organs are displaced;
Changes in the center of gravity in late pregnancy, when the fundus of the uterus descends.

The immediate cause of back pain during pregnancy can be the early period. It is characterized by the presence of contractions that are irregular. In this case, due to the active work of the pelvic floor muscles, back and lower back pain may appearHowever, due to the production of the female sex hormone, as well as oxytocin, a pregnant woman may not feel these pains.

Nevertheless, the appearance of severe back pain during pregnancy can be an objective reason for consulting a gynecologist. If pathology is suspected, the pregnant woman may be asked to stay in the hospital for further observation.

The appearance of severe back pain during pregnancy can be the cause of some serious illness. This is due to the fact that extragenital diseases can worsen in a woman during this period. The most commonly diagnosed are pyelonephritis and cystitis. In addition, cholecystitisThe formation of stones in the sac or biliary tract can cause pain.

Exacerbation of pyelonephritis or cystitis is associated not only with the penetration of microbial flora into sterile organs. Often, extragenital diseases occur due to irritation of the walls of organs, hormonal changes during pregnancy. Often the stress that accompanies pregnancy exacerbates the symptoms. Increases.

back pain with coronavirus

Corona virus infection can also cause severe back pain. COVID-19 causes typical symptoms, including a sudden rise in temperature, unproductive cough, chest pain, and weakness and fatigue. However, some patients experience back pain. There is also a complaint of syphilis, which appeared with the onset of corona virus infection.

Among the main reasons are:

exposure to toxins on the body;
exacerbation of chronic diseases of the musculoskeletal system;
the emergence of new, not previously diagnosed pathology of the spine;
Viral radiculopathy.

Intoxication syndrome often accompanies diseases affecting the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains. With coronavirus, as with other respiratory diseases, non-specific back pain may appear. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the intensity of pain subsides after a few days.

The body's active fight against infections can exacerbate chronic diseases. In addition, against the background of a respiratory disease, previously hidden pathologies may appear. Therefore patients may worry about back pain.

Among the main causes, the presence of viral radiculopathy is also distinguished. It may be associated not only with the formation of an intervertebral hernia. Radiculopathy is of concern when a viral agent causes inflammation or irritation of the spinal cord roots.

diagnostic measures

If you have back pain, you should immediately seek help from a medical organization. To diagnose a disease in this area, you should visit a neurologist.

The specialist at the reception, after a detailed collection of anamneistic data, should conduct a neurological examination of the patient. At the information gathering stage, the following aspects are noted:

the first appearance of back pain;
relationship of pain with physical activity;
the presence of concomitant diseases;
localization of pain syndrome;
duration of pain;
Presence of other symptoms.

After collecting the history, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the walking of the patient with pathology, checking the position of the spinal column, the presence or absence of reflexes.

To study the patient's gait, the neurologist asks the patient to walk a few meters into the office, as well as perform some tests. If, while walking, the patient cannot move the support to his leg, performs unnecessary movements. It is one of the clear signs of a neurological disease.

In addition, the condition of the spine should be assessed. A neurologist notes the presence or absence of kyphosis, lordosis and scoliosis. The specialist evaluates with the help of tests the response of the patient to irritation of reflexes.

When back pain occurs, the disease may be accompanied by a change in sensitivity. That is why a neurologist evaluates the state of touch, temperature and other types of sensitivity. In addition, the specialist notes the presence of pathological sensations. Have, for example, a crawling or tingling feeling in the back.

After the examination, the neurologist may prescribe a number of additional studies. Instrumental examination is necessary if necessary to establish the exact localization of the pathological focus. Modern methods allow a safe and painless examination, the result of which is delivered to the patient within a few days. are received later.

To diagnose the cause of back pain, a neurologist may refer the patient to undergo the following diagnostic measures:

Magnetic resonance imaging (MRI);
computed tomography (CT);
X-ray of abdominal organs.

In some cases, to make a diagnosis may not require additional tests. After receiving the results of the instrumental diagnosis, the neurologist chooses the optimal treatment strategy.

back pain treatment

Treatment of acute or chronic back pain under the supervision of a physician should be mandatory. Independent use of drugs can lead not only to ineffective treatment, but also to the emergence of complications of the disease. That is why in case of back pain, seek medical help from a specialist. It is advisable to take. After passing the diagnostic tests, the patient will be prescribed treatment depending on the characteristics of the clinic, the pathogenetic mechanism and the course of the disease.

A few years ago, in medicine, when back pain occurred, strict bed rest was recommended. There is no longer a need to limit the patient's movement. Also, wearing special bandages and crutches or stilts while walkingIt is also recommended to use

Modern treatments for back pain are based on evidence-based medicine. They use not only drugs, but also non-drug methods of treatment.

The following groups of drugs are used as drug therapy in medical practice for back pain:

nonsteroidal anti-inflammatory drugs;
muscle relaxants to reduce muscle tone;
Painkillers.

The listed groups of drugs can be used both as monotherapy and in combination to obtain a pharmacological effect. With medication for back pain, manual therapy is recommended.

In the case when the patient's pain syndrome is very pronounced, it will be necessary to limit daily activity, as well as follow other doctor's recommendations, but in general, the level of previous physical activity should be maintained.

For chronic back pain, in addition to the listed methods of treatment, methods of physiotherapy exercises (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Cognitive as well as the intake of antidepressantsSpecial attention is paid to behavioral therapy.

The duration of treatment is determined by a neurologist. In the case when the treatment was ineffective, you should change the group of drugs, as well as conduct additional research.

Forecast

With timely diagnosis and correctly chosen treatment strategy, back pain may subside after a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.

prophylaxis

To prevent the appearance of back pain, you should adhere to a healthy lifestyle and properly distribute physical activity so as not to create overload on different parts of the spine. In addition, concomitant diseases are diagnosed and treated in a timely manner. should go.