Back pain

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. Untimely provision of medical care can cause chronic disease with the development of complications.

Back pain is a special symptom, not a nosological entity. For example, lumbodinia is a pain that is localized in the lumbar spine. Terms such as thoracalgia or cervicalgia are also distinguished. Accurate localization of the pathological symptom is necessary to select the correct treatment tactics and select 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 tissue or organ damage or 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 pathology 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 deterioration in the patient's cognitive abilities - memory disorders may occur, and the concentration may decrease.

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, disc herniation or spondylosis.

Epidemiology

According to World Health Organization (WHO) statistics, back pain worries more than 40% of the population. In some countries this figure can be up to 80%.

This problem can cause early disability in the patient. In addition, pain syndrome is a common cause of temporary disability among working people. That is why pathology is a problem not only in the medical, but also in the economic sphere of 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 appear in the spine, resulting in acute and chronic pain.

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

Clinicians explain this fact by the fact that physical activity exerts the greatest pressure on this part of the spine.

Risk factors

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

• working age 30 years and older;
• male;
• overweight and obesity (in which the body mass index exceeds 30);
• the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
• static physical activity, which does not differ in diversity;
• vibration exposure.

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

Classification

The neurologist, after a detailed examination and examination, determines 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 the pathology, duration, reasons 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 an outpatient setting. Its duration does not exceed 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 or more weeks, this pain is called chronic.

Acute and subacute pain usually, with proper treatment, leads to complete recovery. Chronic pain syndrome can cause early disability of the patient. Therefore, you should seek medical attention at the first appearance of clinical signs of pathology. To do this, you need to go through an initial consultation with a neurologist.

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

• weak
• average,
• as.

By the nature of back pain there are:

• shooting,
• sick,
• shooting,
• withdrawal,
• stupid.

The nature of the pain depends on the pathology that caused the syndrome. Thus, with osteochondrosis, pulling pain worries, which differs in the radiation of the lower extremities. With sciatica, there is a stabbing pain, which is often unilateral.

According to the localization of back pain, there are:

• local (local),
• reflected,
• radiation.

Local pain occurs when the pathological focus is 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 is constant. Its character can be changed by changing body position due to receptor irritation.

Reflected pain occurs with pathology affecting the internal organs. Related to the anatomical characteristics of innervation. Thus, with the reflected type, pain occurs in the area of the dermatome. The most common cause of back pain can be pathology of the pancreas, uterus and its appendages.

Among the features of the reflected type of pain is the lack of association with physical activity. If with the change of body position with the local type of pain the intensity of symptoms has increased, then in this case it has nothing to do.

Irradiation pain is associated with nerve or root irritation. Moreover, in addition to the appearance of back pain, the patient may also complain of decreased sensitivity, the appearance of thicker skin (paresthesia). Often, after examination, a neurologist can detect pathological reflexes, which are also associated with impaired nerve impulse transmission.

Cause of back pain

Pain syndrome can manifest for several reasons:

• pathology of the musculoskeletal system (trauma, sprains, hypothermia and other external causes);
• diseases of the spine (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 cause psychogenic type of pain).

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

Pain of vertebral origin

With this type of pain, pathological changes of the degenerative type are observed in the spine. Thus, the bodies of the vertebrae, the intervertebral discs can be damaged. Most commonly, back pain can be associated with a disease that affects the joints.

According to statistics, patients seeking medical help complain of the appearance of acute pain associated with spinal cord injury. The cause can be a herniated disc, spondylosis or lumbago.

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

Disease	ICD-10 code	Features
Osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. It is characterized by appearancewithdrawal and short-term pain with radiation.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 seemsacute pain syndrome that occurs with coughing, sneezing, and physical exertion.
Radiculitis	M54. 1	A disease in which degenerative changes in the root are observed. It is characterized by appearanceexcruciating pain associated with a change in body position or physical exertion. . . In addition to the pain syndrome, sensitivity disorders are added.
Discogenic lumbodinia	M54. 4	Pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is shooting and very pronounced.
Spondylosis	M47	A disease manifested by degenerative changes in the vertebrae. Of course he has a chronic type, pain on pain with irradiation of the lower extremities, neck.

It should be noted that each disease has its own characteristics. Therefore, when diagnosing, attention should be focused not only on the anamnestic data, but also on the results of the examination. For this, modern diagnostic instrumental methods are used that allow not only the identification of the pathological focus, but also the determination of its limits and the degree of inflammation or destruction of the anatomical structures of the spine.

Vertebrogenic causes cause back pain. In addition to the above diseases, pain can occur during trauma and stretching of the musculoskeletal system. Thus, with excessive physical exertion or lifting weights, acute excruciating pain may suddenly appear.

Pain of non-vertebral origin

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

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

• clogged arteries,
• angina effort,
• aortic aneurysm (in the abdominal or thoracic region).

Among the second group:

• stomach ulcer,
• duodenal ulcer,
• cholelithiasis,
• biliary tract dyskinesia,
• inflammatory changes in the pancreas.

Cardiovascular diseases often cause back pain. Thus, with angina pectoris, the patient is concerned about pain in the area of the heart, which radiates to the shoulder, arm, or back. Therefore, during an attack, patients may complain of back pain.

With angina pectoris, the pain syndrome has its own characteristic features. First, the pain is deadly. Second, it appears behind the sternum radiating toward the back, arms, or shoulders. Third, the pain syndrome disappears after immediate administration of the drug. It should be noted that physical activity and stress cause seizures.

An aortic aneurysm is a rupture of a blood vessel that weakens and then bulges. In this case, the patient, when seeking medical help, complains of dull pain in the heart area with irradiation to the back and lower extremities. Symptoms such as dizziness, weakness, a sudden drop in blood pressure will also be disturbed. Back pain with an aortic aneurysm can occur with both thoracic localization of the pathological focus and abdominal.

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

Back pain can be caused not only by cardiovascular diseases. In diseases that affect the organs of the retroperitoneal space, patients can also complain of pain syndrome. This is due to the 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, however, the course may be accompanied by the appearance of pain and other unpleasant symptoms. This is due to changes in the position 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.

Among the first group are:

• natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• enlargement of the uterus by creating a "baby" place where internal organs are displaced;
• change in center of gravity in late pregnancy, when the uterine fundus descends.

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

However, the appearance of severe back pain during pregnancy can be an objective reason to seek advice from a gynecologist. If pathology is suspected, the pregnant woman may be asked to remain 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 women may worsen during this period. Pyelonephritis and cystitis are most commonly diagnosed. In addition, the formation of stones in the gallbladder or biliary tract can cause pain.

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

Back pain due to coronavirus

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

Among the main reasons are:

• exposure to toxins in the body;
• exacerbation of chronic diseases of the musculoskeletal system;
• the appearance of new, previously diagnosed pathologies 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, nonspecific back pain may occur. This is one of the manifestations of the intoxication syndrome. With effective drug therapy, the intensity of pain decreases after a few days.

The body’s active fight against infection can cause exacerbation of chronic diseases. In addition, previously hidden pathologies may appear in the background of respiratory disease. That's why patients may be worried about back pain.

Among the main reasons, the appearance of viral radiculopathy stands out. It can be associated not only with the formation of an intervertebral hernia. Radiculopathy is a concern when the viral causative agent causes inflammation or irritation of the spinal cord roots.

Diagnostic measures

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

The specialist at the reception, after a detailed collection of anamnestic data, should perform a neurological examination of the patient. In the information gathering phase, attention is paid to the following aspects:

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

After collecting the anamnesis, the neurologist continues with the examination. At this stage, the specialist pays attention to the walking of the patient with pathology, the position of the spine, checks 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 to perform some tests. If during walking the patient is unable to transfer support to the leg, perform unnecessary movements - this is one of the clear signs of neurological disease.

In addition, the position of the spine must be assessed. The neurologist pays attention to the presence or absence of kyphosis, lordosis and scoliosis. The specialist assesses the patient's reaction to reflex irritation with the help of tests.

When back pain occurs, the disease may be accompanied by a change in sensitivity. Therefore, the neurologist assesses the state of tactile, temperature and other types of sensitivity. Also, the expert pays attention to the appearance of pathological sensations, for example, a feeling of crawling or tingling in the back.

After the examination, the neurologist may prescribe a series of additional studies. Instrumental examination is necessary when it is necessary to determine the exact localization of the pathological focus. Modern methods allow a safe and painless examination, the results of which the patient receives after a few days.

To diagnose the causes of back pain, a neurologist may refer the patient for the following diagnostic measures:

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

In some cases, additional tests may not be needed to make a diagnosis. After receiving the results of instrumental diagnostics, the neurologist selects 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 lead not only to ineffective treatment, but also to the occurrence of complications of the disease. Therefore, in case of back pain, it is recommended to seek medical help from a specialist. After passing the diagnostic tests, the patient will be prescribed treatment based on the characteristics of the clinic, pathogenetic mechanisms and the course of the disease.

A few years ago, in medicine, when back pain appeared, it was recommended to adhere to a strict bed. Now there is no need to restrict the patient's movement. In addition, it is recommended to wear special bandages and use crutches or stools while walking.

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

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

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

These groups of drugs can be used both in monotherapy and in combination to achieve a therapeutic effect. In addition to medications for back pain, manual therapy is also recommended.

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

In chronic back pain, in addition to the above methods of treatment, methods of physiotherapeutic exercises (therapy exercises) can also be used. In addition, a neurologist may recommend massages. Special attention is paid to cognitive-behavioral therapy with the intake of antidepressants.

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

Forecast

With timely diagnosis and properly chosen treatment tactics, back pain can subside after a few weeks. In the chronic course, long-term remission can be achieved if the doctor's recommendations are followed.

Prophylaxis

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