Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and one of the most pressing problems of modern healthcare, and treatment of back pain is a difficult task.
Although pain can occur in any part of the spine, the most common location is the lower back: according to researchers, the prevalence of lower back pain reaches 76% among the adult population.
According to statistics, within 1 year, about 80% of people complain of at least one attack of pain in the lower back, and in the next 12 months, 75% of them experience a relapse of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected back segment, the pain syndrome is divided into pain in the nape of the neck, in the middle of the back (chest pain), in the lower back (lumbar pain) or coccydynia (pain in the coccyx or sacrum).
According to the results of a study involving 46 thousand volunteers from different European countries, chronic pain in various parts of the spine is characteristic of 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8% of the population.
The duration of pain is acute - lasts up to 12 weeks, or chronic - more than 12 weeks.
The pain can be dull or stabbing, sometimes there is a burning and tingling sensation.Symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the level of spinal involvement.Numbness or weakness of the upper and lower extremities is another option to accompany the manifestations of back pain.In some patients with spinal pain syndrome, a limitation in the range of certain movements or increased pain in certain body positions is also observed.
Back pain: why does it happen?
During the examination it is not always possible to determine the direct cause of back pain, in which case the pain is called "nonspecific" or "mechanical".The cause of this pain is pathological changes in the musculoskeletal system, but damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observed: this subtype of pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease accounts for approximately 2% of cases.
Nonspecific back pain has the following characteristics:
- tends to get better or worse depending on the position of the body - for example the patient may feel better while sitting or lying down;
- pain often worsens with movement;
- the attack may develop suddenly or increase gradually;
- Sometimes back pain is the result of poor posture or lifting something awkwardly, but often it appears for no apparent reason;
- may be caused by a minor injury, such as a ligament or muscle sprain;
- it can occur after stress or overwork and usually begins to improve within a few weeks.
Risk factors for developing nonspecific back pain:
- hard physical work;
- frequent bending and bending of the body;
- lift heavy objects, especially from an incorrect position;
- sedentary lifestyle;
- industrial impacts such as vibrations;
- pregnancy;
- Age-related changes in the musculoskeletal system.
Acute pain has a physiological meaning, since it indicates the acute influence of an unfavorable factor.
The most common causes of acute back pain are:
- injuries to various structures of the spine;
- spondylolisthesis: displacement of the vertebrae relative to each other;
- sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the lower back to the feet
- cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
- intercostal neuralgia - caused by compression or irritation of the nerve roots of the intercostal nerves;
It is important to remember that acute pain signals the onset of a disorder, while chronic pain records this pathological effect and resembles a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of an intervertebral disc;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints of the spine);
- radiculopathy: inflammation and degeneration of the nerves that run from the spinal cord to the muscles and joints;
- arthritis and arthrosis of the spinal joints of various origins.
- infectious process (for example, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
- metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.
Diagnosis of back pain syndrome
To understand what to do in case of severe back pain, it is advisable to first establish the cause.An accurate diagnosis is the key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history and the nature of the symptoms, the doctor may prescribe imaging studies and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and fractures.
- Computed tomographyprovides detailed cross-sectional images of the spine, showing even the most subtle changes in the bones.
- Magnetic resonance imagingshows both tissue and bone structures and is used to identify herniated or herniated disc, pinched nerves, or spinal cord.
- While drivingmyelogramsA special biological dye is used and injected into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the state of the nerve fibers in and around the spine.
- Electrodiagnostic testsallows you to evaluate the electrical activity of the nerves of the upper and lower limbs.
- Bone scan with positron emissionreveals, first of all, the oncopathology of the bones.
- Densitometry - determination of bone density - shownfor diseases and conditions that lead to a decrease in bone mineral density.
Methods to combat back pain
The complex structure of pain in various parts of the back and the stages of pathological changes impose the need for a combination of pharmacological and non-pharmacological treatments.
The principles of therapy for a patient with chronic back pain, based on evidence-based medicine, involve:
- explain to the patient the causes of pain and, as a rule, its benign origin;
- ensure sufficient levels of daily physical activity;
- prescribe effective and safe treatments, mainly to relieve pain;
- correction of therapy if it is ineffective after 1-3 months.
Non-drug treatment for back pain
In most cases, a patient with back pain improves within 2 to 6 weeks.The main goal of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical shape cannot prevent all painful episodes, it facilitates the resolution of these episodes.
The development of the correct motor stereotype and physical therapy are important areas of non-pharmacological pain correction.
Based on the duration, non-pharmacological treatment of back pain can be divided into three phases.
Phase I- passive physiotherapy in the acute period (6 weeks).
Phase II– active exercises during the subacute period (6–12 weeks).
Phase III- physiotherapeutic rehabilitative effects.
Bed rest is prescribed for acute back pain only for a limited period of time.
Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:
- non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy to strengthen abdominal and spinal muscles may also be recommended;
- therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
- the use of acupuncture, manual therapy and spinal traction methods.
Pharmacological treatment of pain
The most common methods of drug treatment for back pain are:- Non-steroidal anti-inflammatory drugs and muscle relaxants.
- Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduce inflammation and back pain.However, this type of therapy is not intended for long-term use due to the side effects of the drugs.
When is surgical treatment used?
While the vast majority of people with back or neck pain heal over time without medications or nonsurgical treatments, some patients may require surgical correction of spinal disorders.In general, a patient with spinal pain can undergo surgery if the following criteria are met:- the structural problem has been diagnosed and confirmed by imaging (for example, X-ray or MRI);
- Conservative treatments such as physical therapy or medications have failed to provide adequate pain relief;
- back pain is debilitating and prevents you from participating in daily activities or physical activity;
- symptoms negatively affect physical or emotional health;
- there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
- neurological damage occurs.
Prevent back pain
Maintaining a healthy lifestyle is key to preventing back pain.Excess weight puts stress on your back, so it's important to maintain a healthy weight.Regular exercise strengthens your abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues in the body, also contributing to the aging of the spine, so stopping using products containing tobacco is another step towards a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.