Pain in the lower back

Low back pain is probably familiar to almost all modern people. Employability can be affected for a wide variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be aware of this, because back pain can not only reach incredible strength, making a person's life unbearable, but also become a symptom of the most dangerous diseases.

Low back pain can be varied: sharp or dull, aching or burning, local (appears in one place) or spreading across the entire back region. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly, and sometimes gradually, intensifying each day.

The response to pain and the ability to tolerate it depend on many factors: age, mental characteristics, concomitant symptoms, and other factors. But in any case, you cannot leave the disease to chance. Timely treatment will help to avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray, MRI or CT scan. Pain attacks, lumbosacral, appear during life, in about 80% of modern residents of European countries.

Acute or chronic low back pain in the lower back is a consequence of a variety of neurological, degenerative-dystrophic diseases in women and men. In some cases, low back pain is a consequence of diseases of Organs internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional will never be able to determine the true source of the problems. In general, the medical classification separates the primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is he who is the cause of the vast majority of cases of back pain in the lumbar region. The most significant of the causes are the degenerative-dystrophic changes that occur in various parts of the spine:

• osteochondrosis, which is a lesion of bone and cartilaginous tissues, this disease has a dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
• Spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, responsible for the mobility of the spine, or synovial joints.

Secondary pain syndrome has much more diverse causes of pain:

• scoliosis, which is a curvature of the spine, as well as some other growth disorders;
• various inflammations of a non-infectious nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
• a tumor located in the vertebrae, in the spinal cord itself, or in the retroperitoneal space, whether primary or caused by metastases;
• fracture of one or more dorsal vertebrae. This is perhaps one of the most serious causes of back pain;
• various infectious diseases that lead to damage to the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
• stroke conditions in which there is a severe violation of the blood supply to the spinal cord. In this case, there may also be a feeling of pain in the lower back;
• gastrointestinal tract diseases. For example, acute appendicitis with an atypical course, intestinal obstruction;
• often back pains are reflected in nature. A similar problem can occur with some diseases of the organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis and exitis - all these diseases cause referred back pain).

Acute and chronic low back pain

Low back pain is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. So-called displaced lumbar pain is also often observed: in this case, there is a translation of pain sensations from more deeply located internal organs and body structures; in other words, it appears to the patient that the lower back hurts, but in fact a completely different part of the body is affected.

Most often, the back hurts in the lumbar region, when the pain is projected into this area by Organs pelvic organs, kidneys, pancreas, colon, or tumors located behind the peritoneum. Many patients don't know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done: self-medicate. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.

Possible causes of acute low back pain include:

• The pain is accompanied by an acute stretching of the muscles. In this case, pain signals are located in the back, they are provided by spasmodic long muscles. The pain does not tend to move to the groin or leg area. Human mobility is limited.
• One of the most common and serious causes of severe back pain is a fracture of the spine (fractures of the vertebrae, including compression fractures). As a rule, this happens with an unsuccessful fall, flexion of the back and other injuries; but in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, vertebral fractures can literally occur "out of nowhere", and even without fixation by the patient's sensations at the time of the fracture.
• An equally unpleasant situation in which the lower back hurts a lot is the displacement of the intervertebral discs that has occurred in the vertebral region. According to the frequency of the lesions, the areas are distinguished: LV-SII - most of the time; LIV-LV - second in frequency; LIII-LIV and above are rarer cases.

Symptoms include severe lower back pain, strained posture, limited mobility. Participation in the pathological process of the nerve roots is indicated by:

1. radicular pain, usually unilateral;
2. sensitivity disorders (numbness, increased or decreased level of sensitivity);
3. decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
4. decreased intensity or absence of a knee reflex (indicates damage to the L3-L4 area).

The general tendency is for a protruding intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (ponytail), the functions of the bladder and rectum are disturbed. Also, a similar condition can occur with a strong spinal disc protrusion.

The back hurts a lot in the lumbar region with facet syndrome: in this case, the disc remains unchanged and the pain appears as a result of compression of the root itself at the exit of the spinal canal. The most commonly observed facet syndrome is unilateral type in the L5 root area; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower) and, as a result, narrowing of the intervertebral foramen.

In addition, severe low back pain accompanies an epidural abscess, a serious condition that requires urgent diagnosis and prompt treatment. Most often, the inflammatory process develops in the thoracic region of the spine; pain becomes especially strong with a mechanical effect on the area of pathology (pressure, beat).

If there are signs of spinal cord compression, any highly effective medical measures, including surgery, are recommended. Another reason why the lower back hurts can be diseases of the hip joint - mainly coxarthrosis. In this case, the pain is characteristic, radiating to the lower back, buttocks, and also to the legs to the knees.

Diseases that are characterized by chronic low back pain:

• Spondylosis deformans is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligament apparatus and additional bone growth; bony outgrowths press on the roots and narrow the spinal canal. In the event that lower back pain is accompanied by leg weakness, numbness, and other neurological symptoms, the possibility of intermittent claudication syndrome, which can be caused by narrowing of the spinal canal, should be considered. An examination is required, the results of which establish the final diagnosis.
• Ankylosing spondylarthrosis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, due to a reduction in chest movements during breathing. There are pulling pains in the lower back; the curvature of the spine in the thoracic region still arises and progresses. An X-ray examination corrects anomalies of the sacroiliac joints: destruction, change in structure, "bamboo" spine. A thorough examination and finding out the reason why the lower back hurts is needed, as similar symptoms and limited mobility of the lower back can also cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by the X-ray and myelography examination method.
• Osteomyelitis also causes prolonged, painful pain in the lower back. If this disease is suspected, an X-ray of bone tissue, a tuberculin skin test and an ESR determination are performed to determine the presence/absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causative agents of tuberculosis. osteomyelitis.
• Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without concomitant neurological symptoms.

Causes of back pain of an intermittent nature. Many diseases of Organs internal organs cause periodic, sharp, or pulling pains in the lower back. At the same time, patients do not have a feeling of stiffness in the back region, there is no clear location of pain, and the pain does not increase with the maximum possible range of motion. To the question of what to do if your lower back hurts not constantly, but from time to time, the answer is simple: don't wait until it hurts "as it should", but see a doctor.

There is a clear influence of the pathology of one or another organ on a given section of the spine. So, from Organs pelvic organs, pain radiates to the sacrum, in diseases of the organs situated in the lower part of the abdominal cavity, it radiates to the lower back (segments L3-L5), and in the upper part - to the segments of the upper part of the lumbar area or the lower part of the thoracic area.

Diseases - the causes of low back pain and the area of pain distribution:

• If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, this intermittent pain can be caused by chronic prostatitis or the development of prostate cancer.
• Several kidney diseases cause pain at the joints of the ribs and spine.
• Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease has spread beyond the peritoneum) - pain spreads to the region of the T10-L2 spinal segments;
• With ulcerative colitis, diverticulitis, or colon tumors, the lower back hurts;
• If the back hurts in the thoracic/lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis for low back pain

For lower back pain and lumbago, it is recommended to do a CT scan (shows the condition of the bone tissues of the spine) and MRI (allows you to assess the condition of the soft tissues) and an ultrasound of Organs internal organs .

One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a range of disorders, from bone fractures to kidney stones. Many of the changes detected only suggest the correct diagnosis, and further studies may be needed to confirm this. In addition, some radiological changes may be concomitant findings that are not the cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological status is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the back muscles and the gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.

Sometimes, according to the results of an examination by an orthopedist of a patient with a symptom of pain against the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:

• radiography of the lumbosacral spine with functional tests;
• computed tomography of the lumbosacral spine;
• MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrous ring, consisting of fibrous cartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.

The thickness of the discs decreases, the vertebral bodies get closer, reducing the intervertebral foramina and putting at risk the nerves and vessels located in them (osteochondrosis).

The protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (herniated disc) often leads to compression of the nerve roots, causing pain along the pinched nerve (pain that radiates to the leg, arm, back of the head, neck, intercostal spaces depending on the level of nerve compression) with a weakening of muscle strength in the areas of its innervation and a violation of sensitivity.

Often, a protrusion or hernia of the intervertebral disc is accompanied by muscle pain along the path of the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, spinal segment stability can also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, a lumbosacral spine radiograph with functional tests may be necessary.

Most of the time, the nerve bundles that form the sciatic nerve due to its anatomical location suffer compression from a hernia or protrusion of the intervertebral disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (spinal canal stenosis) and compression of the nerves and spinal cord that pass through it. Therefore, in case of spinal canal stenosis, it is always necessary to carry out a complete treatment with a whole arsenal of different treatment methods and, in case of ineffectiveness, surgical treatment.

Which doctor should I contact?

With back pain, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Low back pain is combined with various infections, limb injuries. Pain in the lower back with diseases of the heart and lungs is not excluded. This is established by in-depth examination. Once the patient is diagnosed, medications are usually prescribed that reduce back pain, normalize blood circulation, and help restore nerve tissue. These can be pills, gels, ointments or injections that relieve inflammation and spasms.

Surgical intervention is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. The hernia compressing the nerve root is removed, repaired, and the pain passes over time.

It is best to relax your spine and paraspinal muscles if you sleep on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last long, because this is fraught with weakening of the paraspinal muscles, which will only exacerbate the problem. Even with severe pain, you should try to maintain at least mild physical activity.

How to relieve back pain

The occurrence of a pain symptom is usually due to muscle spasm, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

Therefore, with a strong and unexpected pain in the lower back, it is recommended to take a muscle relaxant pill, rub the back with a warm anesthetic gel. When using funds, you must strictly follow their instructions.

In cases where an unpleasant symptom is due to the presence of inflammatory diseases of Organs internal organs, it is recommended not to delay contacting a doctor, if at a certain time it is impossible to visit a specialist and the pain is very intense, you can take Pentalgin or No-shpu. The sore spot should not be heated with a heating pad, as heat contributes to the spread of the inflammatory process and, accordingly, to the strengthening of the accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the spine. These medications include medications that have pronounced anti-inflammatory, analgesic, and antipyretic effects.

The course of treatment is prescribed taking into account the severity of the pain symptom. Ointment for back pain is used as a main or auxiliary treatment. With pronounced symptoms of osteochondrosis, it is indicated to rub the lumbar region with ointments based on ketoprofen, a substance with a powerful analgesic effect.

The main advantage of local preparations is due to their effect not on the whole body as a whole, but on a specific area that needs treatment. Pain relievers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar medications in pill form.

Back pain exercises

Gymnastics is considered an additional method of treating diseases of the spine. The exercises shown to patients are quite simple and are not accompanied by a special load on the body. For example, the custom hanging on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, it helps to relax the muscles and eliminate lumbago - pain caused by the compression of your nerve roots. Therapeutic exercises for back ailments, accompanied by pain in your lower back, include exercises:

• lift the legs (so that the knee touches the chin);
• "bicycle", performed lying on the back;
• walking on your knees.

Every day it is recommended to give exercises no more than 10-15 minutes, with pronounced pain - refuse to perform them.