lower back pain

Lower back pain is probably familiar to almost every modern person. Employability can be affected for a wide variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be inattentive to this, because back pain can not only reach incredible strength, making a person's life unbearable, but also become a symptom of the most dangerous diseases.

Low back pain can be varied: sharp or dull, aching or burning, local (appears in one place) or spreads to the entire back. Unpleasant sensations also appear in different ways: sometimes sharply, suddenly, and sometimes gradually, intensifying every day.

The response to pain and the ability to tolerate it depend on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, the disease cannot be left to chance. Timely treatment will help avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray, MRI or CT examination. Lumbosacral pain attacks appear during life, in about 80% of modern residents of European countries.

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, low back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pain number in the dozens, and a non-professional will never be able to determine the real source of the problems. In general, the medical classification separates the primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a consequence of musculoskeletal changes of a morphofunctional nature. It is he who is the cause of the vast majority of cases of back pain in the lumbar region. The most significant of the causes are degenerative-dystrophic changes that occur in various parts of the spine:

• osteochondrosis, which is a lesion of bone and cartilage tissues, this disease has a dystrophic character. With it, the intervertebral disc 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 synovial joints.

Secondary pain syndrome has much more diverse causes of pain:

• scoliosis, which is a curvature of the spine, as well as some other growth disorders;
• various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• a tumor located in the vertebrae, in the spinal cord itself, or in the retroperitoneal space, regardless of whether it is primary or caused by metastasis;
• Fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases that cause damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• stroke conditions in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling of pain in the lower back;
• gastrointestinal tract diseases. For example, acute appendicitis with atypical course, intestinal obstruction;
• often back pains are reflexive in nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred back pain).

Acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine. The so-called displaced low back pain is also often observed: in this case, there is a translation of pain sensations from deeper internal organs and structures of the body; in other words, it seems to the patient that the lower back hurts, but in reality a completely different part of the body is affected.

In most cases, the back hurts in the lumbar region, when pain is projected into this area from the pelvic organs, kidneys, pancreas, colon, or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done: self-medicate. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.

Possible causes of acute low back pain include:

• The pain is accompanied by a sharp stretching of the muscles. In this case, pain signals are localized in the back, they are supplied by long spasmodic muscles. The pain does not tend to 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 fracture of the spine (fractures of the vertebrae, including compression fractures). As a rule, this happens 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 other lesions of the skeletal system, vertebral fractures can literally occur "from the nothing" , and even without fixation by the patient's sensations at the time of the fracture.
• An equally unpleasant situation in which the lower back hurts a lot is the displacement of the intervertebral discs that has occurred in the vertebral region. Depending on the frequency of lesions, the areas are distinguished: LV-SII, more often; LIV-LV - second in frequency; LIII-LIV and higher are rarer cases.

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

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increased or decreased level of sensitivity);
3. decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. decreased intensity or absence of a patellar reflex (indicates damage to the L3-L4 area).

The general trend is for a protruding intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (horse's tail), the functions of the bladder and rectum are disturbed. Also, a similar condition can occur with a strong spinal disc bulge.

The back hurts a lot in the lumbar region with facet syndrome - in this case, the disc is not affected, and the pain appears as a result of compression of the root at the exit of the spinal canal. The most commonly observed facet syndrome is unilateral in the L5 root area; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower) and, as a result, the narrowing of the intervertebral foramen.

Also, severe low back pain accompanies an epidural abscess - a serious disease that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes especially strong with a mechanical effect on the pathology area (pressure, tapping).

If there are signs of spinal cord compression, any highly effective medical measure, including surgery, is recommended. Another reason why the lower back hurts can be diseases of the hip joint, mainly coxarthrosis. In this case, the pain is characteristic and radiates to the lower lower back, buttocks, and also down the legs to the knees.

Diseases that are characterized by chronic low back pain:

• Spondylosis deformans is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of its ligamentous apparatus and increased bone growth; bony growths press on the roots and narrow the spinal canal. In the event that aching low back pain is accompanied by leg weakness, numbness, and other neurological symptoms, the possibility of intermittent claudication syndrome should be considered, which may be caused by narrowing of the spinal canal. . An examination is necessary, the results of which establish the final diagnosis.
• Ankylosing spondyloarthrosis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, due to reduced chest movements during breathing. There are pulling pains in the lower back; in addition, the curvature of the spinal column arises and progresses in the thoracic region. An X-ray examination corrects abnormalities of the sacroiliac joints: destruction, change in structure, "bamboo" spine. A complete examination and finding out the reason why the lower back hurts is necessary, since similar symptoms and limited mobility of the lower spine can also cause other diseases: Reiter's syndrome, psoriatic arthritis, colitis chronicle.
• 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, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made for the method of X-ray examination and myelography.
• Osteomyelitis also causes long-term pain in the lower back. If this disease is suspected, an X-ray of bone tissue, a tuberculin skin test and an ESR determination are performed to determine the presence/absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci. the causative agents of osteomyelitis.
• Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without accompanying neurological symptoms.

Causes of intermittent back pain. Many diseases of the internal organs cause periodic, sharp, or drawing pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back area, there is no clear localization of pain, and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back hurts not constantly, but from time to time, the answer is simple: do not wait until it hurts "as it should", but consult a doctor.

There is a clear influence of the pathology of one or another organ on a certain section of the spine. So, from the pelvic organs, the pain radiates to the sacrum, in diseases of the organs that are in the lower part of the abdominal cavity, it radiates to the lower back (L3-L5 segments), and in the upper part, towards the segments. from the upper part of the lumbar area or from the lower part of the thoracic area.

Diseases: the causes of low back pain and the area of distribution of pain:

• If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, this intermittent pain can be caused by chronic prostatitis or the development of prostate carcinoma.
• Several kidney diseases cause pain at the joints of the ribs and the spine.
• Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease extends beyond the peritoneum) - pain extends to the region of the spinal segments T10-L2;
• With ulcerative colitis, diverticulitis or colon tumors, the lower back hurts;
• If the back hurts in the thoracic/lumbar regions, an aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis of low back pain

For low back pain and lumbago, it is recommended to undergo computed tomography (shows the state of the bone tissues of the spine), and magnetic resonance imaging (allows you to assess the state of soft tissues), and ultrasound of internal organs. .

One diagnostic method is radiography, which is relatively inexpensive and can be helpful in detecting a variety of disorders, from bone fractures to kidney stones. Many of the changes detected only suggest the correct diagnosis, and additional studies may be required to confirm it. Also, some radiological changes may be concomitant findings that are not the cause of the pain.

It all starts with a neurological and orthopedic exam by a doctor. During this examination, the patient's neurological status is assessed and possible violations in the biomechanics of the spine are identified with a mandatory assessment of the state of the muscles of the back and the gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.

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

• x-ray of the lumbosacral spine with functional tests;
• computed tomography 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, which consists of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.

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

Protrusion of the discs (intervertebral disc protrusion) with their subsequent prolapse into the lumen of the spinal canal (disc herniation) most often leads to compression of the nerve roots, causing pain along the compressed nerve (radiating pain). to the leg, arm, 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 bulging or herniated intervertebral disc is accompanied by muscle pain along the course of 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 segment may also be affected. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, an x-ray of the lumbosacral spine with functional tests may be required.

Very often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer compression from a hernia or protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

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

Which doctor should I contact?

With pain in the spine, first of all, you need to contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Low back pain is combined with various infections, injuries to the extremities. Pain in the lower back with diseases of the heart and lungs is not excluded. This is established by in-depth examination. After the patient is diagnosed, he is usually prescribed drugs that reduce back pain, normalize blood circulation, help restore nerve tissue. These can be tablets, gels, ointments, or injections that relieve inflammation and spasms.

Surgical intervention is usually required when a herniated disc is diagnosed, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, restored, and the pain passes over time.

It is best to relax your spine and paraspinal muscles if you sleep on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this leads to a weakening of the paravertebral muscles, which will only aggravate the problem. Even with severe pain, you should try to maintain at least weak physical activity.

How to relieve back pain

The appearance of a pain symptom is often due to 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 unexpected strong pain in the lower back, it is recommended to take a muscle relaxant tablet, rub the back with a warming anesthetic gel. When using funds, you must strictly follow their instructions.

In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is recommended not to delay in contacting a doctor, if at a particular time it is impossible to visit a specialist, and the pain is too severe, you you can take Pentalgin or No-shpu. The sore spot should not be heated with a heating pad, since heat contributes to the spread of the inflammatory process and, consequently, to the strengthening of the accompanying symptoms.

back pain ointment

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. Back pain ointment is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, it is indicated to rub the lower back with ointments based on ketoprofen - a substance with a powerful analgesic effect.

The main advantage of local preparations is due to their effect not on the entire body as a whole, but on a specific area that needs treatment. Analgesics and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in tablet form.

exercises for back pain

Gymnastics is considered as an additional method of treatment of diseases of the lower spine. The exercises that are shown to patients are quite simple and are not accompanied by a special load on the body. For example, the usual suspension on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminates lumbago - pain caused by pinching of its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower section, include exercises:

• raise the legs (so that the knee touches the chin);
• "bicycle", performed lying on your back;
• walking on knees

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