Back pain

Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndrome can accompany illnesses that affect the spine, kidneys, and other organs and systems. The treatment and prevention of back pain includes medications and non-medications. Out-of-date medical care can cause the disease to become chronic with the development of complications.

Back pain is a separate symptom, not a nosological entity. For example, lumbodynia is pain located in the lumbar spine. In addition, concepts such as chest pain or neck pain are differentiated. The exact location of the pathological symptom is necessary to choose the correct treatment tactics and the choice of preventive measures.

Definition

Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of direct damage to a tissue or organ or when exposed to unfavorable psychological factors (stress, anxiety, depression).

Back pain is a multidisciplinary practice in medical practice. This is due to the fact that the painful syndrome can occur due to the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver, among others).

It should be noted that the pain syndrome may be accompanied by a deterioration in the patient's cognitive abilities - memory disturbances may appear, concentration decreases.

In most cases, the appearance of back pain is a defense reaction of the body due to the influence of unfavorable factors. The most common cause of back pain is sciatica, herniated disc or spondylosis.

Epidemiology

According to statistics from the World Health Organization (WHO), back pain concerns more than 40% of the population. In some countries, this number can reach 80%.

This problem can cause early incapacity of the patient. Furthermore, pain syndrome is a common cause of temporary disability among workers. That is why pathology is a problem not only in the sphere of medical activity, but also in economic terms.

Most of the time, people of working age between 30 and 60 years old seek help in the clinic. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, resulting in the onset of acute and chronic pain.

Furthermore, men suffer from the disease more often than women. This is due to the peculiarities of work, physical work, among other risk factors. According to statistics, pain appears much more frequently in the lumbosacral region.

Doctors explain this fact by the fact that this part of the spine is where physical activity exerts the most pressure.

Risk factors

Not only stress and exercise can make this pathology appear. Among the main risk factors are the following:

• working age from 30 years old;
• male;
• overweight and obesity (where the body mass index exceeds 30);
• the presence of other conditions (eg, frequent migraines or heart and blood vessel disease);
• static physical activity, which does not differ in diversity;
• exposure to vibration.

In addition, smoking is pointed out as a risk factor by some researchers. It is possible that a heavy cough in a smoker is an indirect cause of pain.

Classification

A neurologist, after a detailed examination and examination, establishes the nature of the pain. There are several classifications, among which the painful syndrome that occurs in the back is subdivided according to the place of occurrence of the pathology, duration, reasons and other characteristics.

In terms of duration, the following types of pain are differentiated:

• sharp,
• sub-high,
• chronic.

Patients with acute pain are most often treated as an outpatient. Its duration does not exceed 6 weeks. Subacute pain can last from 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, this pain is called chronic.

Acute and subacute pain most of the time, with proper treatment, lead to complete recovery. Chronic pain syndrome can cause early patient disability. Therefore, at the first appearance of clinical signs of pathology, you should seek medical help from a physician. To do this, you must undergo an initial consultation with a neurologist.

In terms of intensity, the following types of pain are distinguished:

• weak
• average,
• Strong.

Due to the nature of back pain, there are:

• bursting,
• sore,
• shooting,
• pull,
• Stupid.

The nature of the pain depends on the pathology that caused the syndrome. Thus, with osteochondrosis, pulling the pain worries, which differs in irradiation to the lower extremities. In sciatica, there is a sharp pain, which is usually unilateral.

According to the location of the back pain, there are:

• place (place),
• reflected,
• radiating.

Local pain occurs when the pathological focus is located directly on the back. Pain is caused by irritation, stretching, or other effects on receptors located under the skin.

Local pain has its own characteristics. For example, after an injury to the lumbosacral region of the spine, the pain syndrome is constant. Its character can change with a change in body position due to irritation of the receptors.

Reflected pain occurs with a pathology that affects the internal organs. Associated with the anatomical characteristics of the innervation. Thus, with the reflected type, pain occurs in the area of the dermatomes. The most common cause of back pain can be pathology of the pancreas, uterus and its adnexa.

Among the characteristics of the type of pain reflected, the lack of link with physical activity stands out. If, with a change in body position with a type of local pain, the intensity of the symptom has increased, then in this case there is no connection.

Radiating pain is associated with irritation of a nerve or root. In addition, in addition to the appearance of back pain, the patient may complain of decreased sensitivity, the appearance of chills (paresthesia). Often, on examination, a neurologist can reveal pathological reflexes, which are also associated with impaired transmission of a nerve impulse.

cause of back pain

Pain syndrome can manifest for several reasons:

• pathology of the musculoskeletal system (trauma, sprains, hypothermia and other external causes);
• spine diseases (osteochondrosis, hernia);
• diseases that affect the organs of the retroperitoneal space (pathology of the gallbladder, pancreas and others);
• benign and malignant neoplasms;
• mental disorders (depression, anxiety, stress cause the psychogenic type of pain).

Furthermore, everyday problems can become the cause of the appearance of a pathological symptom. Thus, with an uncomfortable posture during sleep when waking up, the patient may complain of pain in the neck or lumbar spine.

Spinal pain

With this type of pain, pathological changes of the degenerative type are observed in the spine. So, vertebral bodies, intervertebral discs can be damaged. Most of the time, pain of vertebral origin can be associated with a disease that affects the joints.

According to statistics, patients who seek medical attention complain of the onset of acute pain associated with spinal injuries. The cause could be a herniated disc, spondylosis, or lumbago.

In less than 1% of all cases of medical consultation, neoplasms are detected in the spine. Metastasis from malignant tumors is rare, but it can also cause back pain of variable intensity.

Illness	ICD-10 code	Peculiarities
osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. characterized by appearancepulling and short-term pains with irradiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain.
intervertebral hernia	M51	A disease in which a lump forms in the spinal canal. Looksan acute pain syndrome that occurs when coughing, sneezing, and exerting physical exertion.
radiculitis	M54. 1	Disease in which degenerative changes are seen in the roots. characterized by appearanceacute pain associated with a change in body position or physical exertion. . . In addition to the pain syndrome, sensitivity disorders are added.
Discogenic Lumbodynia	M54. 4	Pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is sharp and very pronounced.
Spondylosis	M47	Disease manifested by degenerative changes in the vertebrae. There's a kind of chronic course, pain while it hurts with radiation to the lower extremities, neck.

It should be noted that each disease has its own characteristics. Therefore, in diagnosis, attention must be focused not only on the anamnestic data, but also on the results of the exams. For this, modern instrumental diagnostic methods are used, which allow not only to identify the pathological focus, but also to determine its limits and the degree of inflammation or destruction of the anatomical structures of the spine.

They are vertebrogenic causes that cause the appearance of back pain. In addition to the diseases listed above, pain may appear during trauma and stretching of the musculoskeletal system. Therefore, with excessive physical exertion or heavy lifting, a sharp, painful pain may appear suddenly.

Non-vertebral pain

According to statistics, patients complain of pain of non-vertebral origin in no more than 2% of cases. This category includes diseases and somatic conditions where there is back pain.

The most common diseases that cause the onset of the painful syndrome are pathologies of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. Among the first group, the following are distinguished:

• artery occlusion,
• exertion angina,
• aortic aneurysm (in the abdominal or thoracic region).

Enter the second group:

• stomach ulcer,
• duodenal ulcer,
• cholelithiasis,
• dyskinesia of the biliary tract,
• inflammatory changes in the pancreas.

Cardiovascular diseases often cause back pain. Thus, with angina pectoris, the patient is concerned about pain in the heart region, which radiates to the shoulder, arm, or back. This is why, during an attack, patients may complain of back pain.

With angina pectoris, the pain syndrome has its own characteristics. First, pain has an overwhelming character. Second, it appears behind the sternum, radiating to the back, arms, or shoulder. Thirdly, the pain syndrome disappears after immediate drug administration. It should be noted that physical activity and stress trigger an attack.

An aortic aneurysm is the division of a blood vessel that weakens and then expands. In this case, the patient, when seeking medical care, complains of the onset of dull pain in the heart region, radiating to the back and lower limbs. Symptoms such as dizziness, weakness, and a sharp drop in blood pressure can also cause disturbances. Back pain with aortic aneurysm can arise both with the thoracic location of the pathological focus, as with the abdominal.

It should be noted that aneurysm pain is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are initiated immediately, including the use of medications and surgical methods.

Back pain cannot be caused by cardiovascular disease alone. In diseases that affect the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarities of innervation - inflammatory and degenerative changes in this area cause the appearance of back pain.

Back Pain During Pregnancy

Pregnancy is a physiological condition, however, the course may be accompanied by the onset of pain and other unpleasant symptoms. This is due to changes in the location of organs, hormonal changes, weight gain in the early and late phases.

During pregnancy, back pain can be caused by physiological and pathological changes.

Among the first group are:

• natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• enlargement of the uterus with formation of a "child" site, in which the internal organs are displaced;
• a shift in the center of gravity towards the end of pregnancy, when the fundus of the uterus descends.

The immediate cause of back pain during pregnancy may be the preliminary period. It is characterized by the appearance of irregular contractions. In this case, due to the active work of the pelvic floor muscles, back and lower back pain may arise. However, due to the production of female sex hormones as well as oxytocin, a pregnant woman may not experience these pains.

However, the appearance of severe back pain during pregnancy may be an objective reason to seek advice from a gynecologist. If a condition is suspected, a pregnant woman may be asked to stay in hospital for further observation.

The appearance of severe back pain during pregnancy can be the cause of serious illness. This is due to the fact that, during this period, extragenital diseases in women can get worse. The most commonly diagnosed ones are pyelonephritis and cystitis. Also, stone formation in the gallbladder or biliary tract can cause pain.

An exacerbation of pyelonephritis or cystitis is associated not only with the entry of microbial flora into sterile organs. Most of the time, extragenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy makes symptoms worse.

Back pain with coronavirus

Coronavirus infection can also cause severe back pain. COVID-19 causes specific symptoms, including a sudden rise in temperature, unproductive cough, chest pain, weakness and fatigue. However, some patients also complain of back pain, which appears along with the onset of coronavirus infection.

Among the main reasons are:

• exposure to toxins in the body;
• exacerbation of chronic diseases of the musculoskeletal system;
• the emergence of new previously undiagnosed spinal pathologies;
• viral radiculopathy.

Intoxication syndrome often accompanies diseases that affect the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, pain and pain. With coronavirus, as with other respiratory diseases, nonspecific back pain may appear. This is one of the manifestations of the intoxication syndrome. With effective drug therapy, pain intensity decreases after a few days.

The body's active fight against infection can lead to an exacerbation of chronic illnesses. Furthermore, in the context of a respiratory disease, previously hidden pathologies may arise. That's why patients may be concerned about back pain.

Among the main reasons, there is also the onset of viral radiculopathy. It may be associated not only with the formation of an intervertebral hernia. Radiculopathy is of concern when a viral agent causes inflammation or irritation of the spinal cord roots.

diagnostic measures

If you have back pain, you should immediately seek help from a medical organization. To diagnose a disease in this area, you must visit a neurologist.

The reception specialist, after meticulous collection of anamnestic data, must carry out the neurological examination of the patient. In the information gathering phase, attention is paid to the following aspects:

• the first appearance of back pain;
• the connection of pain with physical activity;
• the presence of concomitant diseases;
• pain syndrome location;
• the duration of pain;
• the appearance of other symptoms.

After collecting the anamnesis, the neurologist proceeds with the examination. At this stage, the specialist pays attention to the ambulation of the patient with the pathology, in the position of the spine, checks for the presence or absence of reflexes.

To study the patient's gait, the neurologist asks the patient to walk a few meters in the office, in addition to performing some tests. If, when walking, the patient cannot transfer support to the leg, he/she performs unnecessary movements - this is one of the clear signs of a neurological disease.

Also, the column position must be evaluated. A neurologist pays attention to the presence or absence of kyphosis, lordosis, and scoliosis. The specialist assesses with the help of tests the patient's response to the irritation of the reflexes.

When back pain occurs, the condition may be accompanied by a change in sensitivity. That's why a neurologist assesses the state of touch, temperature, and other types of sensitivity. In addition, the specialist pays attention to the appearance of pathological sensations, for example, a crawling or tingling sensation in the back.

After the examination, the neurologist may prescribe a series of additional studies. Instrumental examination is necessary when it is necessary to establish the exact location of the pathological focus. Modern methods allow for a safe and painless examination, the results of which the patient receives after a few days.

To diagnose the causes of back pain, a neurologist can send a patient to undergo the following diagnostic measures:

• magnetic resonance imaging (MRI);
• computed tomography (CT);
• Radiography of abdominal organs.

In some cases, additional testing may not be necessary to make a diagnosis. After receiving the results of the instrumental diagnosis, the neurologist chooses the optimal treatment tactics.

Back Pain Treatment

Treatment of acute or chronic back pain should be mandatory under the supervision of a physician. The independent use of medications can lead not only to ineffective treatment, but also to the emergence of complications of the disease. Therefore, it is recommended to seek medical help from a specialist in case of back pain. After passing diagnostic tests, the patient will receive treatment based on clinical characteristics, pathogenic mechanisms, and disease progression.

A few years ago, in medicine, when back pain arose, absolute bed rest was recommended. Now there is no need to restrict patient movement. In addition, the use of special bandages and the use of crutches or stilts when walking is also recommended.

Modern treatments for back pain are based on evidence-based medicine. They use not only drugs but also non-drug treatment methods.

The following groups of medications are used as drug therapy in medical practice for back pain:

• nonsteroidal anti-inflammatory drugs;
• muscle relaxants to reduce muscle tone;
• analgesics.

The drug groups listed can be used in monotherapy and in combination to obtain a medicinal effect. Along with medications for back pain, manual therapy is recommended.

In the event that the patient's pain syndrome is very pronounced, it will be necessary to limit daily activities as well as follow other medical recommendations, but in general, the previous level of physical activity should be maintained.

For chronic back pain, in addition to the treatment methods listed, physical therapy exercise methods (exercise therapy) can also be used. Also, a neurologist can recommend massage sessions. Special attention is given to cognitive-behavioral therapy, along with taking antidepressants.

Duration of treatment is determined by a neurologist. If the treatment is ineffective, the drug group must be changed, as well as further research.

Forecast

With timely diagnosis and correctly chosen treatment tactics, back pain may subside after a few weeks. In a chronic course, long-term remission can be achieved if the attending physician's recommendations are followed.

Prophylaxis

To prevent the onset of back pain, you should adhere to a healthy lifestyle and properly distribute physical activity so as not to overload the various parts of the spine. Furthermore, concomitant illnesses must be diagnosed and treated in a timely manner.