Back pain: treatment, causes and characteristics

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

Although the pain syndrome can occur in any part of the spine, the most common localization is the lower back - according to researchers, the prevalence of low back pain in the adult population reaches 76%.

According to statistics, approximately 80% of people complain of at least one attack of pain in the lower back within 1 year, and 75% of them experience a recurrence of the pain syndrome in the next 12 months.

Types and manifestations of pain syndrome

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

According to the results of the study, which involved 46 thousand volunteers from several European countries, 24% of the population have chronic pain in different parts of the spine, 18% in the lumbar region, and 8% have neck pain. of the population.
Duration of pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.

The pain can be dull or shooting, 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. Another possible symptom of back pain is numbness or weakness in the upper and lower limbs. Some patients with spinal pain syndrome also experience limitation of some range of motion or increased pain with certain body positions.

Back Pain: Why Does It Happen?

Examination will not always be able to determine the immediate cause of back pain, in which case the pain is referred to as "non-specific" 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 on the background of the main disease accounts for about 2% of cases.

Non-specific 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 when he is sitting or lying down;
• Pain is often aggravated by movement;
• The attack may develop suddenly or gradually increase;
• Sometimes back pain is the result of bad posture or awkward lifting, but often it appears for no apparent reason;
• May be caused by a minor injury, such as a sprained ligament or muscle;
• May occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for the development of non-specific back pain:

• hard physical work;
• frequent bending and bending of the body;
• lifting weights, especially from the wrong position;
• passive lifestyle;
• Industrial impact, for example, vibration;
• pregnancy;
• Age-related changes in the musculoskeletal system.

Acute pain has physiological significance because it indicates the acute impact of an unfavorable factor.

The most common causes of acute back pain are:

• trauma of various structures of the spine;
• spondylolisthesis - displacement of vertebrae relative to each other;
• Sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the back to the legs.
• cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
• Intercostal neuralgia - caused by compression or irritation of nerve roots of intercostal nerves;

It is important to remember that acute pain indicates the onset of a disorder, while chronic pain captures this pathological effect and suggests a developing disorder.

Conditions that can cause chronic back pain include:

• intervertebral disc displacement or prolapse;
• Autoimmune diseases of the joints, 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 spinal joints of various origins.

Less commonly, back pain can be a sign of more serious conditions, such as:

• 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

In order to understand what to do with severe back pain, it is desirable, first of all, to determine 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 physician may order imaging tests and functional tests to confirm the diagnosis.

• X-ray of the spineIt is used to detect degenerative diseases and fractures.
• CT scanProvides detailed cross-sectional images of the vertebral column that show even minor changes in the bones.
• Magnetic resonance imagingShows both tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves, or the spinal cord.
• while conductingmyelogramsA special biological drug is used - dye, which is injected into the area of the spinal column, for better visualization of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers inside and around the spine.
• Electrodiagnostic testingAllows you to evaluate the electrical activity of the nerves in the upper and lower limbs.
• Positron emission bone scanIt reveals, first of all, bone oncopathology.
• Densitometry - determination of bone density - is indicatedIn diseases and conditions that cause a decrease in bone mineral density.

Ways to deal with back pain

The complex structure of the pain syndrome in different 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 patients with chronic back pain, based on evidence-based medicine, include:

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. prescribing effective and safe treatment, primarily for pain relief;
4. Correction of therapy in case of its ineffectiveness after 1-3 months.

International clinical recommendations of doctors provide a general algorithm on how to treat chronic low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical treatment, physical therapy, manual therapy, as well as antidepressants and psychotherapy are considered the most effective methods for treating chronic pain.

Non-narcotic treatment of back pain

In most cases, a patient with back pain will improve within 2-6 weeks. The main goal of non-specific treatment is to reduce movement restrictions, minimize recurrences, and although good physical condition cannot prevent all painful episodes, it helps to resolve these episodes.

Development of correct motor stereotypes and exercise therapy are important areas of non-pharmacological correction of pain syndrome.

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

I stand- Passive physiotherapy during the acute period (6 weeks).

II stage- Active training in the subacute period (6-12 weeks).

III stage- Rehabilitation physiotherapeutic effect.

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 manage pain, such as:

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

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

Pain treatment

The most common medical treatments for back pain are:

1. Nonsteroidal anti-inflammatory drugs and muscle relaxants.
2. Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduce inflammation and pain in the back. However, this type of therapy is not intended for long-term use due to the side effects of the drugs.

When is surgery used?

Although 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. In general, a patient with spinal pain can undergo surgery if the following criteria are met:

• A structural problem has been identified and confirmed by imaging (such as an X-ray or MRI);
• Conservative treatments such as physical therapy or medications have not provided adequate pain relief;
• Back pain is debilitating - prevents participation in daily activities or physical activity;
• Symptoms negatively affect physical or emotional health;
• With objective, proven diagnostic methods, there are reasons to believe that spine surgery will be beneficial;
• There is neurological damage.

Prevention of back pain

Maintaining a healthy lifestyle is the key to preventing back pain. Being overweight puts strain 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 the aging of the spine, so quitting tobacco products is another step towards a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective means of preventing back pain.