Back pain

Lower back pain is often called lumbago or lumbodia. Lumbago or "lumbago" is an attack of acute lower back pain, which is usually associated with hypothermia and exertion. Lumbago occurs in many people and is often the cause of temporary disability. Often the cause of lumbago can be sports injuries or sprains, but sometimes the factor that causes the pain remains unknown. Lumbago is characterized by pain without radiation in the legs. Lower back pain (lumbago) can occur acutely and gradually progress during the day. Stiffness often occurs in the morning and gradually the stiffness turns into a pain syndrome. Curvature of the spine (analgesic scoliosis) is also possible as a result of muscle spasm. The pain itself can be the result of a muscle spasm, which in turn is linked to other causes. These can be overload or sprains, sports injuries, disc herniation, spondyloarthritis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the cause-and-effect relationship of the appearance of fatigue with exertion, hypothermia, but often the pain occurs for no reason. Sometimes back pain can occur even after sneezing, bending over or putting on shoes. This can be alleviated by deforming diseases of the spine, such as scoliosis.

Unlike lumbago, the term lumbodia does not mean acute pain, but subacute or chronic pain. As a rule, the pain in lumbodia occurs gradually over several days. Pain can also occur in the morning and can be reduced by physical activity. Lumbodinia is characterized by increased pain during long-term static loads (sitting, uncomfortable body position). It is also characteristic of lumbodia that the pain is relieved by lying down in a certain position. Patients with lumbodonia have difficulty performing routine activities such as washing or putting on shoes due to muscle cramps. Due to the disease, there is a decrease in the range of motion of the torso (leaning forward or, to a lesser extent, leaning to the side or extension). Because of the pain syndrome, the patient often has to change position when it is necessary to sit or stand. Unlike lumbago, muscle spasm is less pronounced and generally does not cover the entire lower back, and there are often signs of cramp prevalence on one side.

Causes of back pain

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of muscles, bones and intervertebral discs. Sometimesback painthey can be caused by diseases of the abdominal cavity, small pelvis and chest. Such pains are called reflected pains. Abdominal diseases (eg appendicitis), aortic aneurysms, kidney diseases (urolithiasis, kidney infections, bladder infections), pelvic infections, ovaries - all these diseases can manifestback pain. . . Even a normal pregnancy can lead to lower back pain due to sprains in the pelvic area, muscle cramps due to stress and nerve irritation.

Oftenback painit is associated with the following diseases:

• Nerve root compression, which causes symptoms of sciatica, and is most commonly caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is acute, has radiation and impaired sensitivity in the zone of innervation of the nerve root. Disc herniation occurs primarily as a result of disc degeneration. The gelatinous part of the disc bulges out of the central cavity and presses on the nerve roots. Degenerative processes in the intervertebral discs begin at the age of 30 and over. But the mere presence of a hernia does not always lead to an effect on nerve structures.
• Spondylosis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) that can affect nearby nerves, which leads to pain.
• Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience pain in the lower back that spreads to both legs. Lower back pain can occur as a result of standing or walking.
• Horsetail syndrome. This is an emergency medical service. Cauda equina syndrome occurs as a result of compression of the cauda equina (terminal part of the spinal cord) elements. A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atony). This syndrome requires urgent surgery.
• Painful syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and pain at certain points (trigger point), a decrease in the volume of muscle movement in painful areas. The pain syndrome is reduced by relaxing the muscles located in the painful areas. In fibromyalgia, aches and pains are common throughout the body. Fibromyalgia is not characterized by contraction and muscle pain.
• Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
• Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially pronounced in the morning.
• Tumors, most commonly cancer metastases, can be a source of lower back discomfort.
• Inflammation of the nerves and, consequently, manifestations of pain (in the chest or in the lumbar region) can be caused by damage to the nerves themselves (for example, in shingles)
• Given the variety of causes of symptoms, such as acute or subacute low back pain, it is very important to fully assess the patient and perform all necessary diagnostic procedures.

Symptoms

Pain in the lumbosacral region is the main symptom of lumbago, lumbodinia, lumboischalgia.

• The pain may radiate down the front, side, or back of the leg (lumbar ischalgia), or it may be localized only in the lumbar region (lumbago, lumbodia).
• The feeling of lower back pain may intensify after exertion.
• Sometimes the pain can get worse at night or when sitting for a long time, for example during a long car trip.
• Perhaps the presence of numbness and weakness in the part of the leg, which is located in the zone of innervation of the compressed nerve.

For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:

• Recent history of injuries, such as falling from a height, car accident or similar incidents.
• The presence of minor injuries in patients older than 50 years (for example, a fall from a low height as a result of slipping and landing on the buttocks).
• History of long-term use of steroids (for example, these are patients with bronchial asthma or rheumatic diseases).
• Every patient with osteoporosis (mostly older women).
• Any patient older than 70 years: at this age there is a high risk of cancer, infections and diseases of the abdominal organs, which can cause lower back pain.
• History of oncology
• The presence of infectious diseases in the recent past
• Temperature over 100F (37. 7 C)
• Drug use: Drug use increases the risk of infectious diseases.
• Lower back pain worsens at rest: as a rule, this nature of pain is associated with oncology or infection, and such pain can also be in ankylosing spondylitis (ankylosing spondylitis).
• Significant weight loss (for no apparent reason).
• The presence of any acute nerve dysfunction is a signal for emergency medical care. For example, this is a violation of walking, foot dysfunction, as a rule, the symptoms are acute nerve injury or compression. Under certain circumstances, such symptoms may require urgent neurosurgery.
• Bowel or bladder dysfunction (incontinence and urinary retention) may be a sign of emergency medical care.
• Failure of recommended treatment or increased pain may also require seeking medical attention.

The presence of any of the listed factors (symptoms) is a signal to seek medical help within 24 hours.

Diagnosis

Anamnesis is important for making an accurate diagnosis, because different conditions can cause lower back pain. The time of onset of pain, the relationship with physical exertion, the presence of other symptoms such as cough, fever, bladder or bowel dysfunction, the presence of seizures, etc. Physical examination is performed: identification of painful points, presence of muscle spasm, study of neurological status. If there is a suspicion of diseases of the abdominal cavity or pelvic organs, then an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, blood urine analysis).

If somatic genesis of lower back pain is ruled out, then instrumental research methods such as radiography, CT, or MRI may be prescribed.

X-ray is the initial method of examination and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.

CT allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).

MRI is the most informative research method that allows the diagnosis of morphological changes in different tissues.

Densitometry is necessary when osteoporosis is suspected (usually in women over 50)

EMG (ENMG) is used to determine conduction violations along nerve fibers.

Laboratory tests (blood tests, urine tests, blood biochemistry) are prescribed mainly to rule out inflammatory processes in the body.

Pain treatment

After the diagnosis and confirmation of vertebral genesis in lumbago and lumbodia, a certain treatment is prescribed for lower back pain.

In case of acute pain, it is necessary to rest for 1-2 days. Rest in bed can reduce muscle tension and muscle spasm. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome decreases within a few days without the use of medication, only due to rest.

Medications. NSAIDs are used for pain syndrome. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also carries certain risks. Since all drugs from this group have a lot of side effects, taking drugs from this group should be short-term and under the obligatory supervision of a doctor.

Muscle relaxants can be used to relieve cramps. But the use of these drugs is effective only in the presence of cramps.

Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of pronounced side effects, the use of steroids should be selective and short-lived.

Manual therapy. This technique can be very effective in the presence of muscle blocks or subluxation of facet joints. Mobilizing motor segments can reduce muscle spasm and lower back pain.

Physiotherapy. There are many modern physiotherapy procedures that can also reduce pain and inflammation, improve microcirculation (for example, electrophoresis, cryotherapy, laser therapy, etc. ).

Exercise therapy. Exercise is not recommended for acute lower back pain. Linking exercise therapy is possible after the pain syndrome has decreased. In the presence of chronic pain, exercise can be very effective in strengthening the muscular corset and improving the biomechanics of the spine. Exercise should be selected only with a physician for exercise therapy, as often stand-alone exercise can lead to increased manifestations of pain. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can preserve the functionality of the spine and significantly reduce the risk of painful syndromes.