Back pain: treatment, causes and characteristics.

Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most urgent problems of modern medical care, and the treatment of back pain is not an easy task.

Although the pain syndrome can occur anywhere in the spine, the most common location is the lower back; According to the researchers, the prevalence of low 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 syndrome of pain

Types and manifestations of pain syndrome.

Depending on the affected segment of the back, the pain syndrome is divided into pain in the neck, middle back (chest pain), lower back (low back pain) or coccydynia (pain in the coccyx or sacrum).

According to the findings of a study involving 46 thousand volunteers from various European countries, chronic pain in various parts of the spine is inherent in 24% of the population, in the lumbar region - 18%, and pain in the neck occurs at 8%. of the population.
The duration of the pain is acute, lasting up to 12 weeks, or chronic, longer 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 in the upper and lower extremities is another variant of the accompanying manifestations of back pain. In some patients with spinal pain syndrome, limitation of the range of some movements or increase in pain with a certain position of the body is also observed.

Back pain: why does it happen?

The exam may not always be able to determine the immediate cause of the back pain, in which case the pain is called "nonspecific" or "mechanical. "The cause of such pain is pathological changes in the musculoskeletal system, however, 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 in the context of the underlying disease is about 2% of cases.

Nonspecific back pain has the following characteristics:

• tends to get better or worse depending on body position; for example, the patient may feel better when sitting or lying down;
• the pain is often aggravated by movement;
• an attack may develop suddenly or increase gradually;
• sometimes back pain is the result of poor posture or awkward lifting, but often it appears for no apparent reason;
• it can be caused by a minor injury, such as a sprain of ligaments or muscles;
• it can occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for developing nonspecific back pain:

• heavy physical work;
• frequent bending and bending of the body;
• lifting weights, especially from the wrong position;
• passive lifestyle;
• industrial influences, eg vibration;
• the pregnancy;
• age-related changes in the musculoskeletal system.

Acute pain is of physiological importance, as it indicates the acute influence of an unfavorable factor.

The most common causes of acute back pain are:

• trauma to various structures of the spinal column;
• 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, whereas chronic pain corrects this pathological effect and is reminiscent of a developing disorder.

Conditions that can cause chronic back pain include:

• displacement or prolapse of the intervertebral disc;
• autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
• radiculopathy - inflammation and degeneration of the nerves that go from the spinal cord to the muscles and joints;
• arthritis and arthrosis of the spinal joints of various origins.

Much less often, back pain can be a sign of more serious conditions, such as:

• infectious process (for example, meningitis, tuberculosis);
• diseases of the 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

In order to understand what to do with severe back pain, it is desirable, first of all, to establish its cause. An accurate diagnosis is the key to a well-designed treatment plan.

After a thorough examination of the patient's complaints, history, and nature of symptoms, the doctor may prescribe imaging tests and functional tests to confirm the diagnosis.

• spine x-rayIt is used to detect degenerative diseases and fractures.
• computed tomographyprovides detailed cross-sectional images of the spine, showing even slight changes in the bones.
• magnetic resonance imagingIt shows both tissue and bone structures and is used to detect herniated or slipped discs, pinched nerves, or spinal cord.
• To makemyelogramsa special biological preparation is used - a dye that is injected into the area around the spine for better visualization of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
• Electrodiagnostic testsallows you to assess the electrical activity of the nerves in the upper and lower extremities.
• Positron emission bone scanreveals, first of all, the oncopathology of the bones.
• Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone mineral density.

Ways to deal with back pain

The complex structure of the pain syndrome in the area of 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, involve:

1. explain to the patient the causes of pain and, as a rule, its benign origin;
2. Ensuring a sufficient level of daily physical activity;
3. the appointment of an effective and safe treatment, mainly for pain relief;
4. correction of therapy in case of its ineffectiveness after 1-3 months.

The international clinical recommendations of doctors provide a general algorithm on how to cure chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), nonsurgical treatment, physical therapy, manual therapy, as well as antidepressants and psychotherapy are considered the most effective methods for long-term pain management.

Non-pharmacological treatment for back pain

In most cases, a patient with back pain improves in 2 to 6 weeks. The main objective of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.

The development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of pain syndrome.

Depending on the duration, the non-pharmacological treatment of back pain can be divided into three phases.

I stage- passive physiotherapy during the acute period (6 weeks).

second stage- active exercise during the subacute period (6-12 weeks).

Stage III- Rehabilitation physiotherapeutic influence.

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 control pain, such as:

1. non-specific physical exercise, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physical therapy may also be recommended to strengthen the muscles of the abdomen and spine;
2. therapeutic massage is used for short-term pain relief but does not lead to long-term functional improvement;
3. the use of acupuncture, manual therapy, and spinal traction methods.

Regardless of the method of conservative treatment used, it is important to remember that the patient may not feel immediate relief and that improvement will come in a few weeks or months.

Medical treatment for pain

The most common medical treatments for back pain are:

1. Non-steroidal anti-inflammatory drugs and muscle relaxants.
2. Steroid hormone injections into the joint cavity or epidural space of the spine, which reduces inflammation and pain in the back. However, this type of therapy is not designed for long-term use due to the side effects of the medications.

When is surgery used?

While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may require surgical correction of spinal conditions. Generally, a patient with spinal pain can be operated on if the following criteria are met:

• a structural problem has been diagnosed and confirmed by imaging (such as X-ray or MRI);
• Conservative treatments such as physical therapy or medications have failed to provide adequate pain relief;
• back pain is debilitating: interferes with participation 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;
• there is neurological damage.

Back pain prevention

Maintaining a healthy lifestyle is the key to preventing back pain. Being overweight puts pressure on your back, so it's important to maintain a healthy weight. Regular exercise strengthens the 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 refusing to use tobacco-containing products is another step toward a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.