Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most pressing problems in modern healthcare, and treating back pain is a difficult task.
Although pain can occur in any part of the spine, the most common location is the lumbar region – according to researchers, the prevalence of low back pain reaches 76% in the adult population.
According to statistics, within 1 year, around 80% of people complain of at least one attack of pain in the lower back and, in the following 12 months, 75% of them experience a relapse of the pain syndrome.
Types and manifestations of pain syndrome
Depending on the affected segment of the back, the pain syndrome is divided into neck pain, pain in the middle of the back (chest pain), lower back pain (lumbar pain) or coccydynia (pain in the coccyx or sacrum).
According to the results of a study involving 46 thousand volunteers from several European countries, chronic pain in various parts of the spine is characteristic of 24% of the population, in the lower back - 18%, and pain in the neck occurs in 8% of the population.
The duration of pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.
The pain can be dull or sharp, 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 in the upper and lower extremities is another option to accompany manifestations of back pain.Restriction in the range of certain movements or increased pain in certain body positions is also seen in some patients with back pain syndrome.
Back pain: why does it happen?
When examining, 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 improve or worsen depending on body position – for example, the patient may feel better sitting or lying down;
- pain usually worsens with movement;
- the attack may develop suddenly or gradually increase;
- Sometimes back pain is the result of poor posture or lifting something inappropriately, but it often appears for no apparent reason;
- it can be caused by a minor injury, such as a sprained ligament or muscle;
- It can occur after stress or overwork and usually starts to improve within a few weeks.
Risk factors for developing nonspecific back pain:
- heavy physical work;
- frequent bending and bending of the body;
- lifting heavy objects, especially from an incorrect position;
- sedentary lifestyle;
- industrial impacts such as vibration;
- pregnancy;
- age-related changes in the musculoskeletal system.
Acute pain has physiological significance, as it indicates the acute influence of an unfavorable factor.
The most common causes of acute back pain are:
- injury 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:
- intervertebral disc displacement or prolapse;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
- radiculopathy - inflammation and degeneration of the nerves running from the spinal cord to muscles and joints;
- arthritis and arthrosis of the spinal joints of various origins.
- infectious process (e.g. 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 with severe back pain, it is advisable, first of all, to establish its cause.An accurate diagnosis is the key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history and nature of 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 subtle changes in the bones.
- MRIshows tissue and bone structures and is used to identify herniated discs or discs, compressed nerves or spinal cord.
- When drivingmyelogramsA special biological dye is used that is injected into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic Testallows you to evaluate the electrical activity of nerves in the upper and lower extremities.
- Bone Positron Emission Scanreveals, firstly, the oncopathology of bones.
- Densitometry - determination of bone density - shownfor diseases and conditions that lead to decreased 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 dictate the need for a combination of drug and non-drug treatment.
The principles of therapy for a patient with chronic back pain, based on evidence-based medicine, imply:
- 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 treatment, especially to alleviate pain;
- correction of therapy if 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 objective of non-specific treatment is to reduce movement restrictions, minimize relapses and, although good physical conditioning 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 duration, non-drug treatment for back pain can be divided into three phases.
Stage I- passive physiotherapy during the acute period (6 weeks).
Stage II– active exercise during the subacute period (6–12 weeks).
Stage III- physiotherapeutic rehabilitation 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.Physiotherapy may also be recommended to strengthen abdominal and spinal muscles;
- therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
- the use of acupuncture methods, manual therapy and spinal traction.
Drug treatment of pain
The most common methods of drug treatment for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Steroid hormone injections into the joint cavity or epidural space of the spine, which reduces inflammation and back pain.However, this type of therapy is not intended for long-term use due to medication side effects.
When is surgical treatment used?
Although the vast majority of people with back or neck pain recover over time without medication or nonsurgical treatment, some patients may require surgical correction of spinal disorders.In general, a patient with back pain can undergo surgery if the following criteria are met:- the structural problem has been diagnosed and confirmed by imaging tests (e.g. X-rays 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 activities;
- 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.
Preventing 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, including contributing to the aging of the spine, so stopping the use of 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.