Back pain is the second most common cause today for patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people experiences pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (dorsalgia) is considered an interdisciplinary pathology because in the clinic there is a symptom of both neurological and somatic diseases.
What is the cause of back pain?
90% of back pain occurs during diseases of the spine (back pain). In other cases, the cause may be internal organs, spinal cord, etc. Sh. Pathologies (non-eating pain in the spine).
Thus, the vertebrogenic group includes:
- Maltese intervertebral hernia;
- sacra- or lumbarization;
- spondylosis;
- osteoporosis;
- vertebral tumor processes;
- Trauma (spinal fractures, spondylolisthesis).
non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- Tumors (neuromas) and metastases;
- epidural abscess;
- is syringomyelia.
Symptoms
The nature of back pain, its severity and duration vary from the underlying pathology.
- Intervertebral hernia.With the development of osteochondrosis, a herniated discharge appears between the vertebrae of the spine. In this case, the pain may be sharp or excruciating and be local in nature (depending on the level of the affected disc). The pain often extends to the extremities, accompanied by numbness and tingling. In advanced cases (when the hernia sac suffocates the nerve roots), disorders of the sensitive and motor areas of the hands or feet may occur. Rarely occurs disorders of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacra or lumbarization.Sacralization is a congenital anomaly associated with the fusion of the last lumbar spine to the spine. In this case, the reverse defect is lumbarization, when the first vertebra of the uterus separates and becomes the extra lumbar spine. Pathologies are usually asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, low back pain in the groin area, which increases with movement, extends to the lower extremities. The pathology is also characterized by the fact that it occurs at a young age (usually at the age of 20-25 years).
- spondylosis.Spondylosis (unlike previous disease) is mainly found in the elderly. The disease develops as a result of senile changes in the spinal column - its "wear". The pathology is accompanied by an increase in bone tissue in the form of osteophytes, which can lead to complete fusion of the spine. The latter is dangerous with damage to the neurovascular bundle, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens at the end of the day. Sometimes pain syndrome manifests itself not only in movement but also in the rest of the condition, leading to insomnia. In uncontrolled disease, the development of neurological disorders characteristic of immobilization of the spinal joints, as well as nerve fibrillation is common.
- Osteoporosis. Osteoporosis is a metabolic disorder in which the processes of bone destruction predominate over bone formation. The clinical picture of the disease is scarce: usually, the pathological process is asymptomatic and is detected by chance (radiography). However, in the later stages of the disease there are dull pains as well as a posture curve.
- Spinal tumor processes. Spinal tumors often go on asymptomatically until they are large enough to compress the nerve fibers. In such cases, chronic back pain (usually in the lower back) occurs, which can spread to the thighs and lower legs. Sooner or later, the growth of the tumor causes compression of the nerve roots, which is manifested by neurological disorders: loss of sensation and movement of the limbs.
- Injuries.Common causes of severe pain, limited mobility, and neurological symptoms include spinal cord injuries: fractures, bruises, dislocations / subluxations, and spinal displacement due to damage to the yoga apparatus - spondylolisthesis. Typically, patients report sharp diffuse pain in the back, the presence of hemorrhages ("bruises"), local swelling, and limited movement.
- Psychogenic pain.A similar view occurs in the context of complete health after an emotional outburst or stressful situation. Patients describe pain in different ways, which is limited only by the patient's imagination. Sometimes there is e. წ. "Painful behavior" when people, when maintaining mobility, use an auxiliary support: crutches, sticks and even wheelchairs.
- Fibromyalgia.Pain syndrome in fibromyalgia is very similar to pain in psychogenic pain. At the same time, pain is caused by stress, climate, and emotional overload. The important difference, however, is that the pain should be observed for more than three months, accompanied by local tenderness at characteristic points (site of attachment of the occipital muscles, middle of the trapezius muscles, etc. ). Also, diagnosis requires the complete exclusion of all somatic diseases.
- Pathologies of internal organs.Back pain can often be manifested by diseases of various organs of the body. So with a heart attack, the pain syndrome is localized to the back of the bump, extending under the bone and into the left arm, as well as into the spine. With pneumothorax (accumulation of air under the lining of the lungs) severe chest pain occurs, radiating to the spinal column. A complex of symptoms arises on the background of shortness of breath and facial cyanosis. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, arising in the upper abdomen in the form of a "belt" that covers the sides and back. Back pain occurs with vomiting and digestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Typically, the pain is so severe that it causes patients to bend in search of relief. Against the background of the attack, the urine becomes dirty due to bloody impurities.
- Tumor processes.A neuroma is a tumor of the nerve membrane. When the roots of the spinal cord are affected, spinal pain usually occurs, as well as loss of sensitivity and motor activity below the level of injury. It should also be noted that this tumor process is usually benign. However, a similar clinical picture can lead to breast, prostate, lung, kidney, etc. cancers. Sh. Metastases.
- Epidural abscess.An epidural abscess is a collection of pus under the solid membrane of the spinal cord. The disease is accompanied by acute pain syndrome, which is accompanied by neurological disorders: paresis (decreased muscle strength), loss of sensation, pelvic disorders, etc. Sh. The purulent process often occurs on the background of infections, wounds, immunodeficiency or complication of lumbar puncture (or epidural anesthesia).
- is syringomyelia.Syringomyelia is a pathology of the nervous system in which cavities appear in the spinal cord. Injuries, tumors, compression of the brain, etc. Sh. Provokes disease. In the initial stages there is a slight pain in the spine, which does not cause discomfort. Then there is weight loss, muscle weakness, pain sensitivity is lost, sweating does not occur and bones become fragile. Injuries to the joints and bones (burns, fractures, cuts) are common, but due to the lack of sensitivity to pain, they go unnoticed.
Diagnostics
As a diagnosis, a qualitative examination of the patient and physical examination by palpation (sensation), percussion (percussion) and auscultation (hearing) are required. For some pathologies it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
For visualization of soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or magnetic resonance imaging. Whereas X-rays and computed tomography are used for direct examination of the skeleton.
In some cases less common techniques may be needed: bone scintigraphy, electromyography, etc. Sh.
Treatment of back pain
Apply ice (every 4 hours for 20 minutes) to relieve severe pain, exclude physical activity, immobilize the spine if possible. If the pain is unbearable, painkillers may be taken. However, it is important to remember that anesthetics are "drunk" at the anti-disease clinic. As a result, it can complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
herniated disc
Basic drug treatment is based on the use of anti-inflammatory drugs (diclofenac, ibuprofen) and analgesics (ketorolac). In some cases, surgical removal of the intervertebral hernia may be necessary, as well as endoprosthesis of the intervertebral disc.
Sacra or Lumbarization
In case of pain, blockade with anesthetics is prescribed, as well as physiotherapy (paraffin use, electrophoresis, etc. ). Reconstructive surgeries have been shown to be ineffective with conservative treatment.
spondylosis
Anti-inflammatory drugs (meloxicam, indomethacin) as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a diet rich in calcium and vitamin D.
It is possible to prescribe these substances as medicines. In some cases, hormone therapy with estrogens, calcitonin, and parathyroid hormones is used.
Tumor processes
Treatment of cancer consists of chemotherapy and surgery. The amount of assistance in this case depends on the specific clinical case.
injury
In case of minor injuries, gentle mode and warm-up are prescribed. In some situations it is necessary to reduce or pull the skeleton. When neurological symptoms are detected, operations are performed to fix the bone fragments.
Psychogenic pain
Psychogenic pain relief includes complex psychotherapy as well as taking antidepressants (fluoxetine, sertraline).
Fibromyalgia
As the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (paroxetine, amitriptyline), anticonvulsants (pregabalin), sleeping pills (zopiclone) or tranquilizers (diazepam). Self-discipline is also important for positive thinking, avoiding stressful situations, and being in a warm, dry climate.
Pathologies of internal organs
Each possible internal pathology requires individual treatment tactics. An emergency aid for a heart attack is to take nitroglycerin (one tablet every 5 minutes until an ambulance arrives); With pancreatitis - cold, hunger and rest; With pneumothorax - sealed (occlusive) bandage in case of open wound of the lung; With renal colic - antispasmodics (drotaverine, metamizole sodium) and warming.
epidural abscess
Treatment involves emergency surgery to normalize pressure in the spinal canal and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgery.
is syringomyelia
Patients are usually advised to protect their skin from cuts and burns (the latter often occurs because patients lose sensitivity and do not feel trauma). Analgesics, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgical intervention is possible to revise the formed cavities of the spinal cord.
Spinal prophylaxis
For the prevention of back pain it is necessary to avoid marking each pathology. To do this, you need:
- Lifestyle normalization: reduction of body weight to normal levels; Compose a proper diet rich in micronutrients and vitamins; Ensure proper physical activity without overloading.
- Give up bad habits: smoking and drinking alcohol.
- Correct posture curve (scoliosis, lordosis) and orthopedic pathologies (flatfoot, toes, etc. ).
- Timely diagnosis and treatment of diseases of the musculoskeletal system or internal organs.
- Prevention or proper treatment of spinal cord injuries.
- Avoid emotional outbursts and stressful situations.
We must remember that back pain is not an isolated pathology but a symptom of a disease. The underlying disease can be extremely serious and, if left untreated, can lead to disability and even death of the patient!