Today, back pain is the second most common reason patients seek medical attention. According to the US National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (back pain) is considered an interdisciplinary pathology, because there is a symptom in the clinic of neurological and somatic diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs with diseases of the spine (spinal pain). In other cases, the cause may be pathologies of internal organs, spinal cord, etc. (non-vertebral pain).
Therefore, the vertebrogenic group includes:
- intervertebral hernia;
- sacral- or lumbarization;
- spondylosis;
- osteoporosis;
- tumor processes of the vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
The non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formations (neurinomas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its strength and duration vary depending on the underlying pathology.
- Intervertebral hernia.A hernial bulge appears between the vertebrae with the development of osteochondrosis. In this case, the pain can be sharp or painful and local in nature (depending on the level of the affected disc). The pain often spreads to the extremities, accompanied by numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), alterations of the sensory and motor spheres of the arms or legs may appear. In rare cases, there are violations 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 vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum separates and becomes an additional lumbar vertebra. In general, the pathologies are asymptomatic, but the symptoms are caused by excessive physical activity or by lifting heavy objects. In such cases, there is a low back pain in the sacrum region, which increases with movement and spreads to the lower extremities. The pathology is also characterized by the fact that it occurs at an early age (usually between 20 and 25 years old).
- Spondylosis.Spondylosis (unlike the previous ailment) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear and tear". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous with injuries to the neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only in movement, but also at rest, which causes insomnia. With uncontrolled disease, there are frequent cases of immobilization of the vertebral joints, as well as pinching of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis.Osteoporosis is a metabolic disorder, during which the processes of bone destruction prevail over bone formation. The clinical picture of the disease is scarce: the pathological process is usually asymptomatic and is detected by chance (with X-rays). However, in the later stages of the disease, dull pains appear, as well as curvature of posture.
- Tumor processes of the vertebrae.Spinal tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower spine), which can spread to the thighs and lower legs. Sooner or later, tumor growth leads to compression of the nerve roots, which is manifested by neurological disorders - loss of sensation and movement in the extremities.
- Injuries.A common cause of acute pain, limited mobility, and neurological symptoms are spinal injuries: fractures, bruises, dislocations / subluxations, as well as "slippage" of the vertebrae due to damage to the ligamentous apparatus: spondylolisthesis. Typically, patients notice a sharp, diffuse pain in the back, the presence of bleeding ("bruising"), local swelling, and restriction of movement.
- Psychogenic pain.A similar view occurs in the context of full health after an emotional outburst or stressful situation. Pain is described by patients in different ways, which is only limited by the patient's imagination. Sometimes there is a call. "Painful behavior" when people, maintaining mobility, tend to use auxiliary supports: crutches, canes and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is extremely similar to psychogenic pain. At the same time, pain is also caused by stress, weather, and emotional overload. However, an important difference is that pain should be observed for more than three months, accompanied by local tenderness at characteristic points (the place of insertion of the occipital muscles, the middle part of the trapezius muscles, etc. ). In addition, the diagnosis requires the complete exclusion of all types of somatic diseases.
- Pathologies of the internal organs.Back pain can often appear with diseases of various organs of the body. So, with a heart attack, the pain syndrome is localized behind the sternum, spreading under the scapula and the left arm, as well as in the spine. With pneumothorax (accumulation of air under the lining of the lungs), there is sharp chest pain that radiates to the spine. A complex of symptoms arises against the background of shortness of breath and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, it arises in the upper abdomen in the form of a "belt", covering the sides and back. Back pain appears along with vomiting and indigestion. A complication of urolithiasis is renal colic, an acute paroxysmal pain syndrome. The pain is usually so severe that it causes patients to bend over for relief. In the context of an attack, the urine turns dirty red due to impurities in the blood.
- Tumor processes.A neurinoma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, back pain often occurs, as well as loss of sensation and motor activity below the level of injury. It is also worth noting that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases from breast, prostate, lung, kidney cancer, etc.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, which is complemented by neurological disorders: paresis (decreased muscle strength), loss of sensation, pelvic disorders, etc. often appear. A purulent process occurs against the background of infections, wounds, immunodeficiency, or as a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, compression of the brain, etc. provoke the disease. In the initial stages, there is a slight pain in the spine, which does not bring discomfort. Then there is weight loss, muscle weakness, sensitivity to pain is lost, there is no sweating, and the bones become brittle. Often there are injuries to the joints, the bone skeleton (burns, fractures, cuts), however, due to a lack of sensitivity to pain, they pass imperceptibly.
Diagnosis
Diagnosis requires a qualitative survey and physical examination of the patient by palpation (feeling), percussion (percussion), and auscultation (listening). For some pathologies, it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or MRI. While radiography and computed tomography are used for direct examination of the skeleton.
In some cases, less common techniques may be necessary: bone scan, electromyography, etc.
Treatment of back pain
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), exclude physical activity, immobilizing the spine if possible. If the pain is unbearable, pain relievers can be taken. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. This can later complicate the diagnosis of the disease. Only the attending physician can prescribe medications.
Herniated disc
The main pharmacological treatment is based on the use of anti-inflammatories (Diclofenac, Ibuprofen) and analgesics (Ketorolac). In some cases, surgical removal of the intervertebral hernia may be necessary, as well as stenting of the intervertebral disc.
Sacra or lumbarization
When pain occurs, anesthetic blocks are prescribed, as well as physiotherapy (paraffin applications, electrophoresis, etc. ). With the ineffectiveness of conservative treatment, reconstructive operations are indicated.
Spondylosis
Anti-inflammatory drugs (meloxicam, indomethacin), as well as physical therapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
The treatment of osteoporosis begins with a diet rich in calcium and vitamin D. 
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogens, calcitonin, and parathyroid hormones is used.
Tumor processes
Treatment of tumor diseases consists of chemotherapy and surgery. In this case, the amount of assistance depends on the specific clinical case.
Injury
In case of minor injuries, a gentle regimen and warm-up is prescribed. In some situations, skeletal reduction or traction is required. When neurological symptoms appear, operations are performed with fixation of bone fragments.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy, in addition to taking antidepressants (fluoxetine, sertraline).
Fibromyalgia
Since the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (paroxetine, amitriptyline), anticonvulsants (pregabalin), hypnotics (zopiclone) or tranquilizers (diazepam). Self-tuning for positive thinking, avoiding stressful situations, and being in hot, dry weather are also important.
Pathologies of internal organs
Each of the possible internal pathologies requires individual treatment tactics. Emergency care for a heart attack is taking nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in the case of an open wound of the lung; with renal colic: antispasmodics (drotaverine, metamizole sodium) and warming.
Epidural abscess
Treatment consists of urgent surgery to normalize pressure in the spinal canal and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgical intervention.
Syringomyelia
In general, patients are advised to protect their skin from cuts and burns (the latter often occur because patients lose sensation and do not feel the trauma). Pain relievers, antidepressants (fluoxetine), and antipsychotics (chlorpromazine) are also prescribed. In some cases, a surgical intervention is possible to check the formed cavities of the spinal cord.
Back prevention
For the prevention of back pain, it is necessary to prevent the appearance of each of the pathologies mentioned above. To do this, you need:
- Normalize lifestyle: reduce body weight to normal; carry out a correct diet rich in trace elements and vitamins; Ensure adequate physical activity without overexertion.
- Give up bad habits: smoking and drinking alcohol.
- Correct curvature posture (scoliosis, lordosis) and orthopedic pathologies (flat foot, club foot, etc. ).
- Timely diagnose and treat concomitant diseases of the musculoskeletal system or internal organs.
- Prevent or properly treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The main ailment can be extremely serious and, if left untreated, lead to disability and even death of the patient.