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Back pain

Back pain in a man

Back pain is one of the most common reasons why patients seek help from medical organizations. Pain syndrome can accompany diseases that affect the spine, kidneys and other organs and systems. Treatment and prevention of back pain includes both medications and non-medications. Premature treatment by a doctor can cause chronic illness 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 lower back. Concepts such as thoracalgia or cervicalgia are also distinguished. The exact localization of the pathological symptom is necessary to choose the correct treatment tactics and choice of preventive measures.

Definition

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

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

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

In most cases, the appearance of back pain is a defensive reaction of the body due to the influence of adverse factors. The most common cause of back pain is sciatica, herniated disc or spondylosis.

Epidemiology

According to statistics from the World Health Organization (WHO), back pain is a concern for more than 40% of the population. In some countries this figure may be as high as 80%.

This problem can cause early disability in the patient. In addition, pain syndrome is a common cause of temporary disability among workers. Therefore, pathology is a problem, not only in the medical field but also in the field of economic activity.

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

In addition, men suffer from the disease more often than women. This is due to peculiarities at work, physical work as well as other risk factors. According to statistics, pain occurs much more often in the lumbosacral area.

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

Risk factors

Not only stress and exercise can cause this pathology to appear. Among the most important risk factors are the following:

  • working age from 30 years and older;
  • he;
  • overweight and obesity (where the body mass index exceeds 30)
  • the presence of other pathologies (for example, frequent migraines or cardiovascular diseases)
  • static physical activity that does not differ in diversity;
  • exposure to vibrations.

In addition, smoking is noted as a risk factor by some researchers. It is possible that an intense cough in a smoker may be an indirect cause of pain.

Classification

A neurologist determines after a detailed examination and examination the nature of the pain. There are several classifications among which the pain syndrome that occurs in the back is divided according to the place of occurrence of pathology, duration, causes and other features.

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

  • sharp,
  • subacute,
  • chronic.

Patients with acute pain are most often treated in the outpatient department. Its duration does not exceed 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, this pain is called chronic.

Acute and subacute pain most often with proper treatment leads to complete recovery. Chronic pain syndrome can cause early disability in the patient. This is why at the first glance of clinical signs of pathology you should seek medical attention. To do this, you need to undergo an initial consultation with a neurologist.

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

  • weak
  • average,
  • strong.

Of the nature of back pain there are:

  • blasting,
  • evil,
  • shooting,
  • pulls,
  • Stupid.

The nature of the pain depends on the pathology that caused the syndrome. So with osteochondrosis, excruciating pain worries, which differs in irradiation to the lower extremities. In sciatica, stabbing pains appear, which are often unilateral.

According to the location of back pain, there are:

  • local (local),
  • reflected,
  • irradiation.

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 area of the spine, the pain syndrome is constant. Its character may change with a change in body position due to irritation of the receptors.

Reflected pain occurs with a pathology that affects the internal organs. Associated with the anatomical features of innervation. So with the reflected type, pain occurs in the area of the dermatomes. The most common cause of back pain can be pathogen in the pancreas, uterus and its appendages.

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

Radiating pain is associated with irritation of a 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 appearance of goosebumps (paresthesia). Often, a neurologist on examination can reveal pathological reflexes, which are also associated with decreased transmission of a nerve impulse.

Cause of back pain

Pain syndrome can manifest itself for several reasons:

  • musculoskeletal pathology (trauma, sprains, hypothermia and other external causes);
  • back diseases (osteochondrosis, hernia);
  • diseases affecting the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others);
  • benign and malignant neoplasms;
  • mental disorders (depression, anxiety, stress causing the psychogenic type of pain).

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

Pain of vertebral origin

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

According to statistics, patients seeking medical attention complain about the appearance of acute pain associated with spinal cord injuries. The cause may be a herniated disc, spondylosis or lumbago.

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

Disease

ICD-10 code

Peculiarities

Osteochondrosis

M42

A disease in which intervertebral discs and vertebrae are destroyed. Characterized by appearancepulling and short-term pain with irradiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain.

Intervertebral hernia

M51

A disease in which a bulge forms in the spinal canal. It seems toa sharp pain syndrome that occurs with coughing, sneezing and physical exertion.

Radiculitis

M54. 1

A disease in which degenerative changes are observed in the roots. Characterized by appearancepain associated with a change in posture or physical exertion. . . In addition to the pain syndrome, sensitivity disorders are added.

Discogenic lumbodynia

M54, 4

A pathology characterized by the sudden onset of severe pain in the lower back of the spine.The pain shoots and is very pronounced.

Spondylosis

M47

A disease manifested by degenerative changes in the vertebrae. Of course, have a chronic type, pain by pain with irradiation to the lower extremities, neck.

It should be noted that each disease has its own characteristic features. Therefore, attention at diagnosis should be focused not only on anamnestic data but also on the results of examinations. For this, modern diagnostic instrumental methods are used, which not only make it possible to identify the pathological focus, but also to determine its limits and the degree of inflammation or destruction of the anatomical structures of the spine.

It is the vertebral causes that cause the appearance of back pain. In addition to the above diseases, pain can occur during trauma and stretching of the musculoskeletal system. So with excessive physical exertion or lifting weights, acute pain can suddenly occur.

Pain of non-vertebral origin

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

The most common diseases that cause pain syndrome are the pathology of the cardiovascular system as well as diseases of the gastrointestinal tract, pancreas and bile duct. The first group distinguishes the following:

  • occlusion of arteries,
  • exertional angina,
  • aortic aneurysm (in the abdominal or thoracic region).

Among the second group:

  • ulcer,
  • duodenal ulcer,
  • cholelithiasis,
  • dyskinesia of the bile duct,
  • inflammatory changes in the pancreas.

Cardiovascular disease often causes the appearance of back pain. So with angina pectoris, the patient is worried about pain in the heart area, which radiates to the shoulder, arm or back. Therefore, patients during an attack may complain of back pain.

With angina pectoris, pain syndrome has its own characteristic features. First, the pain has a crushing character. Second, it appears behind the sternum and radiates out to the back, arms or shoulder. Third, the pain syndrome disappears after immediate administration of the drug. It should be noted that physical activity and stress provoke an attack.

An aortic aneurysm is a division of a blood vessel that weakens and then bends out. In this case, when seeking medical attention, the patient complains of the appearance of dull pain in the heart area with radiation to the back and lower extremities. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also interfere. Back pain with aortic aneurysm can occur both with the thoracic localization of the pathological focus and with the abdominal.

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

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

Back pain during pregnancy

Pregnancy is a physiological condition, but the course can be accompanied by pain and 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 due to physiological and pathological changes.

Among the first group are:

  • natural weight gain during pregnancy, increasing the load on the osteoarticular system;
  • enlargement of the uterus with the formation of a "child" site where the internal organs are displaced;
  • a change in the center of gravity late in pregnancy when the uterine fundus falls down.

The immediate cause of back pain during pregnancy may be the initial period. It is characterized by the appearance of irregular contractions. Due to the active work of the pelvic floor muscles, pain in the back and lower back may occur in this case. However, due to the production of female sex hormones 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 to seek advice from a gynecologist. If a pathology is suspected, a 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 a serious illness. This is due to the fact that extragenital diseases in a woman during this period can worsen. The most commonly diagnosed are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile duct can cause pain.

A worsening of pyelonephritis or cystitis is not only associated with the penetration of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy aggravates the symptoms.

Back pain with coronavirus

Coronavirus infection can also cause severe back pain. COVID-19 causes specific symptoms, including a sudden rise in temperature, an unproductive cough, chest pain, and weakness and fatigue. However, some patients also complain of back pain that appeared along with the onset of coronavirus infection.

Among the main reasons are:

  • exposure to toxins on the body;
  • exacerbation of chronic diseases of the musculoskeletal system;
  • the emergence of new, previously undiagnosed pathologies in the spine;
  • viral radiculopathy.

Russian 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, nonspecific back pain can occur. This is one of the manifestations of poisoning syndrome. With effective drug therapy, the pain intensity decreases after a few days.

The body's active fight against infection can cause an exacerbation of chronic diseases. In addition, due to a respiratory disease, previously hidden pathologies may occur. Therefore, patients may be concerned about back pain.

Among the main causes, the appearance of viral radiculopathy is also distinguished. It can not only be associated with the formation of an intervertebral hernia. Radiculopathy is concerned when a viral substance causes inflammation or irritation of the roots of the spinal cord.

Diagnostic measures

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

The specialist at the reception, after a detailed collection of anamnestic data, should conduct a neurological examination of the patient. At the information gathering stage, emphasis is placed on the following aspects:

  • the first appearance of back pain;
  • the connection between pain and physical activity
  • the presence of concomitant diseases;
  • localization of pain syndrome;
  • the duration of the pain
  • the appearance of other symptoms.

After collecting the anamnesis, the neurologist proceeds to the examination. At this stage, the specialist is aware of the patient's gait with pathology, the position of the spine, checking for the presence or absence of reflexes.

To study the patient's gait, the neurologist asks the patient to walk a few meters in the office, as well as perform some tests. If the patient can not transfer support to the leg while walking, perform unnecessary movements - this is one of the clear signs of a neurological disease.

In addition, the position of the spine must be assessed. A neurologist is aware of the presence or absence of kyphosis, lordosis, and scoliosis. The specialist assesses using tests the patient's response to irritation of the reflexes.

When back pain occurs, the disease may be accompanied by a change in sensitivity. Therefore, a neurologist assesses the state of tactile, temperature and other forms of sensitivity. The specialist is also aware of the appearance of pathological sensations, such as a feeling of tingling or tingling in the back.

After the examination, the neurologist may prescribe a number of additional examinations. Instrumental examination is necessary when it is necessary to determine the exact location of the pathological focus. Modern methods allow for a safe and painless examination if results the patient receives after a few days.

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

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

In some cases, no further tests are needed to make a diagnosis. After receiving the results of instrumental diagnostics, the neurologist chooses the optimal treatment tactics.

Treatment of back pain

Treatment of acute or chronic back pain should be mandatory under the supervision of a physician. Independent use of drugs can not only lead to ineffective treatment, but also to the emergence of complications of the disease. Therefore, it is recommended to seek medical attention from a specialist in case of back pain. After passing diagnostic tests, the patient will be prescribed treatment based on the clinic's characteristics, pathogenetic mechanisms and the course of the disease.

A few years ago, in the field of medicine, when back pain appeared, it was recommended to adhere to strict bed rest. Now it is not necessary to restrict the patient's movement. In addition, it is also recommended to wear special bandages and use crutches or stilts when walking.

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

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

  • non-steroidal anti-inflammatory drugs;
  • muscle relaxants to reduce muscle tone;
  • painkillers.

The listed groups of drugs can be used both in monotherapy and in combination to achieve a medicinal effect. Along with medication for back pain, manual therapy is recommended.

In cases where the patient's pain syndrome is very pronounced, it will be necessary to limit daily activity as well as comply with the recommendations of other doctors, but in general the level of the previous physical activity should be maintained.

For chronic back pain, in addition to the listed treatment methods, methods for physiotherapy exercises (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Particular emphasis is placed on cognitive behavioral therapy along with the intake of antidepressants.

The duration of treatment is determined by a neurologist. In case the treatment was ineffective, you should change the group of drugs as well as make further investigations.

Forecast

With timely diagnosis and correctly chosen treatment tactics, back pain can subside after a few weeks. In a chronic course, prolonged 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 an overload on different parts of the spine. In addition, concomitant diseases should be diagnosed and treated in a timely manner.