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Low back pain: causes and treatment.

Back pain in the lumbar region in a man.

In most cases, low back pain is caused by hypothermia or muscle strain due to uncomfortable movements or lifting heavy objects and may go away on its own. If the pain disrupts the normal rhythm of life, improvement does not occur for too long or there are other suspicious symptoms, then the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.

Depending on how long the pain has bothered the patient, doctors distinguish:

  1. acute pain - less than 4 weeks,
  2. subacute pain: 4 to 12 weeks,
  3. chronic pain: more than 12 weeks.

At the appointment, the doctor clarifies with the patient exactly how his back hurts: it can be sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other unpleasant sensations of varying degrees. . of intensity. Depending on the duration, location and nature of the pain, the doctor assumes its origin.

Pain in the lumbar spine: causes.

Pain in the lower back region can be associated with both spinal problems and other organs and systems in the body. To understand how to heal your lower back, you need to determine what causes the pain.

There are vertebrogenic pains caused by spinal diseases:

  • Osteochondrosis, which is manifested by problems with the intervertebral discs, facets or facet joints. Disorders occur with age in any person: intervertebral discs lose moisture and elasticity, facet joints become denser and less mobile.
  • Overstrain of the muscles and ligaments of the spine.
  • Compression of the roots of the spinal nerves: radiculopathies.
  • Spinal injury.
  • Spinal instability due to weakness of the ligamentous-muscular system.

Non-vertebral causes include:

  1. Neurological disorders

    • Lumbosacral plexopathies are damages to the nerve plexus that gives rise to the peripheral nerves of the lower extremities. It occurs with injuries and metabolic disorders.
    • Dystonia is a violation of the tone of the muscles that support the spine. In this case, the pain may be accompanied by poor posture. The disease can be congenital.

  2. Systemic diseases

    • Infections affecting the vertebrae, discs, spinal cord membranes or the spinal cord itself, for example, osteomyelitis, epidural abscess.
    • Malignant and benign tumors, metastases.
    • Osteoporosis is a decrease in skeletal bone density, plagued by vertebral fractures.
    • Rheumatological diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.

  3. Internal organ pain.It is caused by causes outside the spine and radiates towards the lower back, sometimes in the middle, sometimes to the side, depending on the organ of origin. These include:

    • Diseases of the gastrointestinal tract: most often pancreatitis.
    • Diseases of the urinary system: infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pain in the back and side accompanies renal colic as the stone moves along the ureter.
    • Aortic aneurysm is a rare and dangerous pathology in which the wall of the largest artery in the body forms a bulge. This can cause a throbbing sensation in the abdomen.
    • Diseases of the hip joints: injuries, inflammation, degeneration.

  4. psychogenic pain

    Low back pain may be associated with an anxiety disorder or depression.

Injury to the spinal cord or lower spinal roots, called cauda equina, is a medical emergency. The compression of these structures may be due to:

  • herniated disc,
  • injury,
  • malignant or benign tumor,
  • infection.

Spinal cord compression is accompanied by extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, urinary and fecal incontinence, making it difficult to confuse it with other conditions.

Symptoms

Low back pain is often nonspecific, that is, caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:

  • Aching, pulling, or squeezing pain.
  • The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, for example, hanging curtains, changing light bulbs in a chandelier, bending repeatedly and for a long time. a long time: when washing floors, vacuuming, removing snow.
  • No other symptoms.

The fact that pain may be a symptom of some dangerous condition indicates this"red flags":

  • Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
  • Pain at rest and at night, interfering with sleep. Nonspecific pain usually appears with movement or prolonged static loading, but disappears after resting in a comfortable position.
  • General weakness is also not characteristic of nonspecific pain.
  • Unexplained weight loss in recent months. It may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
  • Increased body temperature, chills. Indicates severe inflammation of various origins.
  • Severe or increasing decreased sensation or weakness in the muscles of the legs.
  • Alteration of the function of the bladder or intestines: involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement combined with acute pain is a sign of compression of a nerve and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord may be lost forever.
  • Lack of treatment effect and transition from acute to chronic pain.
  • Characteristics of the clinical history. For example, if low back pain appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn't matter how long ago the diagnosis was made. Or pain has appeared in a person who has recently had a serious infection, surgery, or has a severely reduced immune system for any reason, for example, has been taking a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, low back pain can indicate various complications.

If you have identified at least one of the listed points, immediately consult a doctor for further examination.

Diagnosis

Pain is a subjective symptom, so examination and examination by a doctor play a very important role in the diagnosis. The doctor prescribes additional tests depending on the diagnosis he suggests. For an accurate diagnosis perform:

  • Lab tests— complete blood count, biochemical blood test, general urine analysis, tests for infections, autoimmune diseases.
  • Electroneuromyography- study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
  • Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spine, the presence of hernias, compression of the roots of the spinal nerves.
  • Ultrasonographykidneys and abdominal cavity: carried out if pathology of the internal organs is suspected.
  • Bone status assessment: densitometry - with suspicion of osteoporosis, bone scan - with malignant lesions.

If the doctor is absolutely sure that the low back pain is non-specific, he can prescribe treatment based solely on the examination, without additional tests.

Often, with lower back pain, a person does not consult a doctor, but only goes to an MRI of the spine at his own expense. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic herniated discs. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person suffers from discomfort for a long time, takes painkillers uncontrollably, and develops complications and side effects.

Which doctor should I contact?

First of all, if you have lower back pain, you can also consult a GP. He will suggest what is causing the pain and, based on this, will refer you to another specialist. You can skip this step and immediately make an appointment with a neurologist.

If a neurologist, after a specialized examination, suspects a pathology outside the spine, he may refer to:

  • rheumatologist,
  • surgeon,
  • urologist,
  • gastroenterologist,
  • endocrinologist,
  • oncologist.

Doctors in all of these specialties periodically encounter the symptom of low back pain, because it has a large number of possible causes.

If a diagnosis of mechanical pain has been established, the patient will be treated by physiotherapists, reflexologists, physiotherapists and massage therapists.

How to cure lower back pain

  • SurgeryThey are mainly used for signs of compression of the spinal cord or spinal nerve roots, when the patient experiences paresis of a limb or urinary disorder. These symptoms may be caused by an intervertebral hernia, tumor, or injury. Additionally, the patient may be recommended to consult a neurosurgeon in case of chronic pain when conservative treatment is not effective within 12 weeks. The decision about surgery is made only after visualization of the spine.

    Studies have shown that uncomplicated herniated discs can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.

  • Conservative treatmentIncludes medicinal and non-medicinal methods.

    Pharmacological treatment is carried out with non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.

    Non-drug treatment includes:

    • Physiotherapy— aims to quickly eliminate pain and inflammation, as well as accelerate tissue restoration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
    • Acupuncture- insertion of special sterile needles into biologically active points to reduce pain and relax muscles.
    • Massage— improves the mobility of the spine and joints, promotes proper distribution of the load on the back muscles.
    • Physical therapy- allows you to relax and strengthen your back muscles. The exercises are effective for both acute and chronic back pain.

    If the patient has pain for more than 12 weeks, we speak of chronic pain. In its treatment, antidepressants with an analgesic effect are added to all the previous methods, as well as cognitive-behavioral psychotherapy.

Bed rest does not provide benefits in the treatment of mechanical low back pain and is not an alternative to the previous methods. Additionally, it should be avoided as much as possible for the patient. Prolonged bed rest causes joint stiffness, muscle tension and significantly slows recovery.

Consequences

Acute nonspecific low back pain has a favorable prognosis. Of those who seek treatment immediately, between 70% and 90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with an analgesic effect. If the pain is caused by compression of the spinal nerve roots by a hernia, it may be accompanied by numbness in the extremities, as well as problems urinating and defecating.

Prevention

Help prevent lower back pain:

  • Moderate exercise for 150 minutes per week: walking, swimming, exercises for the core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
  • Keep a healthy weight.
  • Warm up every 40-60 minutes with a prolonged static position.
  • Thigh muscle stretching exercises.
  • Correct body position when lifting weights: you need to squat, not lean forward.
  • Prevention of decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis through densitometry. This is especially important for older people and postmenopausal women.
  • Maintain general somatic and psychological health.