lower back pain

Pain in the lower back is probably familiar to almost every modern person. Employment can be affected by many reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not pay attention to it, becauseBack pain can reach not only incredible strength, making life unbearable for a person, but also become a symptom of the most dangerous diseases.

Pain in the lower back can be different: acute or dull, aching or burning, local (appearing in one place) or spreading to the whole back. Unpleasant sensations also manifest in different ways: sometimes-Sometimes suddenly, suddenly, and sometimes gradually, intensifying every day.

The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms and other factors. But in no case can you leave the disease on its own. Timely treatment can avoid dangerous consequences. will help.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computed or magnetic resonance imaging. About 80% of modern residents of European countries have attacks of pain, lumbosacral, during life. appear to.

Acute or chronic back pain in the lumbar region is a consequence of a variety of neurological, degenerative-dystrophic diseases of women and men. In some cases, lower back pain is a consequence of diseases of internal organs, obesity, stress, mental disordersIs.

Pain syndrome - primary and secondary

Understanding why low back pain occurs, we must not forget that there are dozens of reasons for such pain, and a non-professional will never be able to determine the true source of the problems. In general, Medical classification differentiates primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is he who is the cause of most cases of back pain in the lumbar region. Among the most important causes are degenerative-dystrophic changes occurring in different parts of the spine:

• Osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic character. With it, the intervertebral discs and adjacent vertebrae are affected, spondylosis begins to develop.
• Spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or the synovial joints.

Pain in secondary pain syndrome has many different causes:

• Scoliosis, which is a curvature of the spine, as well as some other developmental diseases;
• various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc . ;
• a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, whether primary or due to metastases;
• Fracture of one or more dorsal vertebrae. This is probably one of the most serious causes of back pain;
• various infectious diseases that damage the vertebral and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• Stroke condition in which there is a severe violation of the blood supply to the spinal cord. In this case, it may also be felt that the lower back hurts;
• diseases of the gastrointestinal tract. eg, acute appendicitis with atypical course, intestinal obstruction;
• Often back pains are of a reflective nature. Similar problems can occur with some diseases of organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all thesediseases cause referred back pain).

acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain due to various diseases of nerve endings or spinal cord. So-called displaced lower back pain is also often observed: in this case, located more deeply of the bodyThere is a translation of pain sensations from internal organs and structures; In other words, what may seem to the patient to be low back pain, but in fact a completely different part of the body is affected.

Most often, back pain occurs in the lumbar region when pain is projected from tumors located behind the pelvic organs, kidney, pancreas, colon, or peritoneum in this region. Many patients do not realize that ifWhat to do if they have pain in the lower back. But there is a clear recommendation what exactly should not be done: to self-medicate. The causes of pain are so diverse that only a qualified specialist can make the correct diagnosis.

Possible causes of acute lower back pain include:

• The pain is accompanied by an acute stretching of the muscles. In this case, the pain signals are localized in the back, they are supplied by the spasmodic long muscles. The pain does not move to the groin or leg area. Human mobility is limited.
• One of the most common and serious causes of severe back pain is a spinal fracture (including vertebral fractures, compression ones). As a rule, this occurs with an unsuccessful fall, bending of the back and other injuries; But in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the vertebral region or there are other lesions of the skeletal system, vertebral fractures literally "blue color". out of". , and even without determination by the patient's sensations at the time of the fracture.
• An equally unpleasant condition in which there is a sharp pain in the lower back is the displacement of the intervertebral discs that occurred in the vertebral region. According to the frequency of lesions, zones are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and above are rare cases.

Symptoms include severe lower back pain, forced posture, limited mobility. Involvement in the pathological process of nerve roots is represented by:

1. Radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increased or decreased sensitivity levels);
3. lack or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. Decreased intensity or absence of knee jerk (represents damage to the L3–L4 region).

The general tendency is for a bulging intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With defeat of the cauda equina (horsetail), the bladder and rectumThe functions of the spinal cord are disturbed. Also, a similar condition can occur with strong protrusion of the spinal disc.

With Facial syndrome there is a sharp pain in the back in the lumbar region: in this case, the disc remains unaffected, and the pain appears as a result of compression of the root at the outlet of the spinal canal. unilateral type in the region of the root L5The most commonly seen aspect of the syndrome; Arises on the basis of an increase in the facets of the intervertebral joint (upper and lower), and, consequently, a contraction of the intervertebral foramen.

In addition, severe lower back pain accompanies an epidural abscess, a serious disease that requires immediate diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; The pain becomes especially strong from mechanical effects on the area of the pathology (pressure, tapping).

If there are signs of spinal cord compression, any highly effective medical measures, including surgery, are recommended. Another cause of low back pain can be diseases of the hip joint - primarily coxarthrosis. In this case, pain is characteristic, radiating from the lower back, buttocks and legs to the knees as well.

Diseases characterized by chronic back pain:

• Deformed spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligamentous apparatus and further bone development; Bone growth presses on the roots and narrows the spinal canal. In the case when low back pain is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent stiffness syndrome is considered, which may be due to narrowing of the spinal canal. An examination is necessary, the results of which establish the final diagnosis.
• Ankylosing spondylarthrosis (or Bechteru's disease). In the early stages, it is characterized by limited mobility, especially in the morning, by decreased chest movements during breathing. Pain in the lower back; Raises forward and protrudes the curvature of the spine in the thoracic region. An X-ray examination corrects anomalies of the sacroiliac joints: destruction, changes in the structure, "bamboo" spine. Thorough examination and finding out the cause thatWhy does the lower back hurt, because similar symptoms and limited mobility of the lower spine can also cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; Multiple myeloma (multiple myeloma). An exception is made by the method of X-ray examination and myelography.
• Osteomyelitis also causes prolonged pain in the lower back. If this disease is suspected, an X-ray of bone tissue is performed, a skin test with tuberculin and tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body. ) an ESR determination is performed to determine the presence / absence of bacteria, usually staphylococci - the causative agents of osteomyelitis.
• Various types of spinal cord tumors (intradural tumours). Diseases such as lipoma, neurofibroma, meningioma can initially provoke persistent back pain without any neurological symptoms.

Causes of back pain of an intermittent nature. Many diseases of internal organs provoke periodic, sharp or pulling pains in the lower back. At the same time, patients do not have a feeling of stiffness in the back region, no obvious location of paindoes not occur, and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back pain does not occur constantly, but from time to time, the answer is simple: "Be likeShouldn't wait until the pain occurs, but consult a doctor.

The pathology of one or another organ has a pronounced effect on a certain part of the spine. So, from the pelvic organs, the pain spreads to the sacrum, in diseases of the organs located in the lower part of the abdominal cavity, it is the lower back (section L3-L5), and in the upper part - the segments radiate to the upper part of the lumbar region or in the lower part of the chest region.

Diseases - Causes of pain in the lower back, and the area of pain distribution:

• If the pelvic organs are affected with endometriosis, ovarian or uterine carcinoma, there is pain in the lower back. In men, such intermittent pain may be due to the development of chronic prostatitis or prostate carcinoma.
• Various kidney diseases provoke pain at the junctions of the ribs and spine.
• tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - pain spreads to the region of the spinal segment T10-L2;
• With ulcerative colitis, diverticulitis, or colon tumors, lower back pain occurs;
• If back pain occurs in the thoracic/lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis of lower back pain

For low back pain and lumbago, a computer (shows the condition of the spinal cord tissue) and magnetic resonance (allows you to assess the condition of the soft tissues) from tomography and ultrasound scans of the internal organsIt is recommended to pass. ,

One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a wide variety of disorders, from bone fractures to kidney stones. may require additional studies. In addition, some radiological changes may be concomitant findings that are not a cause of pain.

It all begins with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological status is assessed, as well as identification of possible violations in the biomechanics of the spine. Mandatory evaluation of the condition of the muscles of the back and gluteal regionAlready at this stage of study, a patient with osteochondrosis of the spine and back and lower back pain can be diagnosed and treated.

Sometimes, according to the results of an examination by the orthopedist of a patient with symptoms of pain against the background of osteochondrosis of the spine, the following additional diagnostic procedures can be prescribed:

• Radiography of the lumbosacral spine with functional tests;
• CT scan of the lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by an annulus fibrosus consisting of fibrous cartilage and connective tissue. You can read more about this in the article about the anatomy of the human spine and spinal cord. can.

The thickness of the discs decreases, the vertebral bodies move closer to each other, reducing the intervertebral foramina and endangering the nerves and vessels located in them (osteochondrosis).

The protrusion of the disc (protrusion of the intervertebral disc) with their protrusion into the lumen of the spinal canal (herniated disc) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain whichradiates to, arms, back of the head, neck, intercostal spaces depending on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.

Often, a protrusion or herniation of the intervertebral disc is accompanied by muscle pain along the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal cord may also be impaired. With spinal instability, the vertebrae move forward (enterolisthesis) or backward (retrolisthesis). With functional tests, to clarify the diagnosisX-rays of the lumbosacral spine may be required.

Often, the nerve bundles that make up the sciatic nerve, due to their anatomical location, suffer from compression of the hernia or protrusion of the intervertebral disc. The sciatic nerve contains fibers L5, S1, S2, S3 - the spinal nerves.

The focus of chronic inflammation in the lumen of the spinal canal can cause its narrowing (stenosis of the spinal canal) and compression of the nerves passing through it and the spinal cord. That is why in the case of spinal canal stenosis, different treatmentsIt is always necessary to conduct a full course of treatment using the entire arsenal of methods and, in case of ineffectiveness, surgical treatment.

Which doctor should I contact?

In case of spinal pain, the first thing to do is to consult a neurologist in the district clinic or call an ambulance if the patient's condition is stable. Lower back pain is a symptom of gynecological, urological, surgical, gastroenterological problems. Could be one of.

Pain in the lower back is combined with various infections, injuries of the limbs. Pain in the lower back with diseases of the heart and lungs is not excluded. It is established by a thorough examination. Diagnosis of the patientAfter, she is given commonly prescribed medications that reduce back pain, normalize blood circulation and help restore nerve tissue. These can be pills, gels, ointments or injections that reduce swelling and inflammation. Gives relief from cramps.

Surgical intervention is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis.

If you sleep on a hard mattress with a small pillow under your knees, it is best to relax the spine and paravertebral muscles. , which will only exacerbate the problem. Even with severe pain, you should try to maintain as little physical activity as possible.

how to get rid of back pain

The occurrence of a pain symptom is often caused by muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

So, with a strong, unpredictable pain in the lower back, it is advisable to take a muscle relaxant pill, rub the back with a warming anesthetic gel. When using the funds, you must strictly follow its instructionsNeeded.

In cases where an unpleasant symptom is caused by the presence of inflammatory diseases of internal organs, it is recommended not to delay contacting a doctor, if at a particular moment it is impossible to visit a specialist, and pain occurs. very intense, then you can take Pentalgin or No-shpu. The painful area should not be heated with a heating pad, as the heat contributes to the spread of the inflammatory process, and, as a result, the strengthening of the accompanying symptomsto do.

ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have a pronounced anti-inflammatory, mild analgesic and antipyretic effect.

The course of treatment is prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, on the substance ketoprofen with a powerful analgesic effect. Rubbing the lower back with based ointments is indicated.

The main advantage of local preparations lies not because of their effect on the whole body, but on a specific area that needs treatment. Painkiller and anti-inflammatory ointments have fewer contraindications and side effects than similar drugs in the form of tablets.

exercise for back pain

Gymnastics is considered an additional method of treatment of diseases of the lower spine. The exercises shown to the patients are quite simple and are not accompanied by special loads on the body. For example, the spine from hanging normally on the crossbar of the horizontal barHas a beneficial effect on the condition, helps to relax muscles and eliminate lumbago - pain caused by pinching of its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower back, exercisesAre included:

• raising the legs (so that the knee touches the chin);
• "Bicycle", performed lying on your back;
• walk on your knees.

Every day it is recommended to give exercises no more than 10-15 minutes, with pronounced pain - to refuse to do them.