Back pain

Back pain is one of the most common reasons patients seek help from medical organizations. Pain syndrome can be accompanied by diseases affecting the spine, kidneys, and other organs and systems. Treatment and prevention of back pain includes both drug and non-drug treatment. Timely medical care can cause the chronicity of the disease with the development of complications.

Back pain is a separate symptom, not a nosological unit. For example, lumbodynia is a pain that is localized in the lumbar spine. In addition, they distinguish between concepts such as thoracalgia or cervicalgia. Accurate localization of the pathological symptom is necessary to select the right treatment tactics and preventive measures.

Definition

Pain is a pathophysiological condition that responds to irritation of pain receptors. It can occur as a direct damage to a tissue or organ or as a result of adverse psychological factors (stress, anxiety, depression).

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

It should be noted that pain syndrome may be accompanied by deterioration of the patient's cognitive abilities - memory disorders may appear, concentration may decrease.

In most cases, the onset of back pain is the body’s defensive reaction due to the effects of adverse factors. The most common causes of back pain are sciatica, disc herniation, or spondylosis.

Epidemiology

According to statistics from the World Health Organization (WHO), back pain is a concern for more than 40% of the population. In some countries, this figure can be as high as 80%.

This problem can cause the patient to be prematurely disabled. In addition, pain syndrome is a common cause of temporary disability among working people. Therefore, pathology is a problem not only in the medical field but also in the field of economic activity.

Most often, able-bodied people between the ages of 30 and 60 turn to the clinic for help. This is due to the fact that with advancing age, degenerative pathological changes appear in the spine, resulting in acute and chronic pain.

In addition, men suffer from the disease more often than women. This is due to work, specifics of physical work, and other risk factors. According to statistics, pain occurs much more frequently in the lumbosacral region.

Clinicians explain this by saying that this part of the spine is the greatest burden of physical activity.

Risk factors

It is not just stress and exercise that can cause this pathology. The main risk factors are:

• Working age 30 and older;
• man;
• overweight and obesity (in which the body mass index exceeds 30);
• the presence of other pathologies (such as common migraines or cardiovascular diseases);
• static physical activity that does not differ in diversity;
• exposure to vibration.

In addition, some researchers consider smoking to be a risk factor. It is possible that the intense cough of smokers may be an indirect cause of the pain.

Classification

The neurologist will determine the nature of the pain after a detailed examination and examination. There are several classifications, among which spinal pain syndrome is divided according to the location, duration, causes, and other characteristics of the pathology.

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

• sharp,
• subacute,
• chronic.

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

Acute and subacute pain most often, with proper treatment, leads to complete recovery. Chronic pain syndrome can cause early disability in a patient. Therefore, a physician should be consulted at the first appearance of clinical signs of pathology. To do this, you must first consult a neurologist.

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

• weak
• average,
• strong.

Due to the nature of back pain, these include:

• crack,
• sore,
• shot,
• drag,
• stupid.

The nature of the pain depends on the pathology that causes the syndrome. Thus, in osteochondrosis, the pull of pain is a concern that differs in radiation from the lower extremities. In sciatica, there is a stinging pain that is often one-sided.

According to the localization of the back pain, the following are:

• local (local),
• is reflected
• irradiator.

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

Local pain has its own characteristics. For example, after injury in the lumbosacral region of the spine, the pain syndrome is constant. Your character may change as your body position changes due to receptor irritation.

Reflected pain occurs with pathology affecting the internal organs. It is related to the anatomical features of innervation. So in the reflected type, there is pain in the area of the dermatomes. The most common cause of back pain may be pathology of the pancreas, uterus, and appendages.

Among the characteristics of the reflected type of pain, a lack of relationship with physical activity can be distinguished. If the intensity of the symptom increased with a change in body position with local type of pain, then there is no relationship in this case.

Radiating pain is accompanied by nerve or root irritation. In addition to the appearance of back pain, the patient may complain of a decrease in sensitivity, the appearance of goosebumps (paraesthesia). Often, during the examination, a neurologist may reveal abnormal reflexes that are also associated with impaired transmission of nerve impulses.

The cause of back pain

Pain syndrome can manifest itself for several reasons:

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

In addition, everyday problems can cause pathological symptoms. Thus, when sleeping in an uncomfortable position after waking up, the patient may complain of neck or lumbar spine pain.

Vertebral pain

In this type of pain, degenerative type abnormalities are observed in the spine. So the vertebral body, the intervertebral discs can be damaged. Most often, vertebral pain can be associated with joint disease.

According to statistics, patients seeking medical help complain of the onset of acute pain associated with spinal damage. This can be caused by a disc herniation, spondylosis or lumbago.

Tumors of the spine are detected in less than 1% of all cases of a doctor's visit. Metastases of malignant tumors are rare, but can cause back pain of varying intensity.

Disease	ICD-10 code	Peculiarities
Osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. It is characterized by appearancepulling and short-term pains with irradiation. Exposure to external factors exacerbates pain in the form of exercise or coughing.
Intervertebral hernia	M51	A disease in which a bulge develops in the spinal cord. Seemsacute pain syndrome that occurs during coughing, sneezing, and physical exertion.
Radiculitis	M54. 1	A disease in which degenerative changes are observed in the roots. It is characterized by appearanceaching pain associated with a change in body position or physical exertion. . . In addition to pain syndrome, sensitivity disorders are also added.
Discogenic lumbodynia	M54. 4	The pathology is characterized by sudden severe pain in the lumbar region of the spine.The pain is shooting and very pronounced.
Spondylosis	M47	The disease manifests itself in degenerative changes in the vertebrae. Of course he has a chronic type, pain while hurting the lower limbs by irradiating the neck.

It should be noted that each disease has its own characteristics. Therefore, the diagnosis should focus not only on the data of the anamnesis, but also on the results of the examinations. To this end, state-of-the-art diagnostic instrumental methods are used, which allow not only the identification of the abnormal focus, but also the extent of its boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.

Vertebrogenic causes provoke the appearance of back pain. In addition to the diseases listed above, there may be pain during trauma and stretching of the musculoskeletal system. So with excessive physical exertion or weight lifting, you can experience sudden painful pain.

Non-vertebral pain

According to statistics, in up to 2% of cases, patients complain of non-vertebral pain. This category includes diseases and somatic conditions in which there is back pain.

The most common diseases that cause the onset of pain syndrome are cardiovascular pathology and diseases of the gastrointestinal tract, pancreas and bile ducts. From the first group we distinguish the following:

• occlusion of the arteries,
• angina with load,
• aortic aneurysm (in the abdominal or chest region).

In the second group:

• peptic ulcer,
• duodenal ulcer,
• cholelithiasis,
• biliary dyskinesia,
• inflammatory lesions in the pancreas.

Cardiovascular disease often provokes the appearance of back pain. Thus, in angina pectoris, the patient is concerned about pain in the area of the heart that radiates to the shoulder, arm, or back. Therefore, during a seizure, patients may complain of painful back pain.

In angina pectoris, pain syndrome has its own characteristics. First, the pain has a crushing nature. Second, it appears behind the sternum, which radiates to the back, arms, or shoulders. Third, the pain syndrome disappears immediately after drug administration. It should be noted that physical activity and stress provoke the onset of an attack.

An aortic aneurysm is a rupture of a blood vessel that weakens and then bulges. In this case, the patient, when seeking medical help, complains of the appearance of dull pain in the area of the heart, with irradiation of the back and lower extremities. Symptoms such as dizziness, weakness, a sharp drop in blood pressure also interfere. Back pain associated with an aortic aneurysm may appear with both chest localization of abnormal focus and abdominal.

It should be noted that aneurysm pain is not related to physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment is started immediately, including medication and surgical techniques.

Back pain can be caused by more than just cardiovascular disease. In diseases affecting 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 back pain.

Back pain during pregnancy

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

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

In the first group are:

• natural weight gain during pregnancy, which increases the load on the osteoarticular system;
• enlargement of the uterus with the formation of a "child" place in which the internal organs move;
• a change in center of gravity at the end of pregnancy when the buttocks of the uterus lower.

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

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

The onset of severe back pain during pregnancy can be a cause of serious illness. This is due to the fact that a woman’s extragenital disease may worsen during this period. The most commonly diagnosed pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or bile ducts can cause pain.

Exacerbation of pyelonephritis or cystitis is not limited to the entry of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the walls of the organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy exacerbates symptoms.

Back pain due to coronavirus

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

The main reasons include:

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

Intoxication syndrome is often accompanied by diseases of the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches and pains. As with other respiratory diseases, the coronavirus may present with non-specific back pain. This is a manifestation of intoxication syndrome. With effective medication, the intensity of the pain decreases after a few days.

The body’s active fight against infection can cause exacerbation of chronic diseases. In addition, previously hidden pathologies may occur in the background of respiratory diseases. Therefore, patients may be concerned about back pain.

Among the main causes, the appearance of viral radiculopathy is also distinguished. This is not only related to the development of the intervertebral hernia. Radiculopathy is a concern when a viral agent causes inflammation or irritation in the roots of the spinal cord.

Diagnostic measures

If you have back pain, seek medical attention immediately. To diagnose the disease, you should visit a neurologist in this area.

The specialist working at the reception should perform a neurological examination of the patient after a detailed collection of medical history data. The following aspects are taken into account during the information gathering phase:

• first appearance of back pain;
• the relationship between pain and physical activity;
• presence of concomitant diseases;
• localization of pain syndrome;
• duration of pain;
• appearance of other symptoms.

After collecting the medical history, the neurologist will continue the examination. At this stage, the practitioner monitors the gait of the pathological patient, the position of the spine, and 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 as well as perform some tests. If the patient is unable to transfer the support to his leg while walking, he makes unnecessary movements - this is one of the clear signs of neurological disease.

In addition, the position of the spine should be assessed. The neurologist monitors for the presence or absence of kyphosis, lordosis, and scoliosis. The practitioner uses tests to evaluate the patient's response to reflex irritation.

If back pain occurs, the disease may be accompanied by a change in sensitivity. Therefore, the neurologist evaluates the state of tactile, temperature, and other sensitivities. In addition, one skilled in the art will monitor for the appearance of abnormal sensations, such as a creeping or tingling sensation in the back.

After the test, the neurologist may prescribe a number of additional tests. Instrumental examination is required if the exact localization of the abnormal focus is to be determined. Modern methods allow for a safe and painless examination, the results of which the patient receives in a few days.

To diagnose the causes of back pain, the neurologist may refer the patient for the following diagnostic procedures:

• magnetic resonance imaging (MRI);
• computed tomography (CT);
• X-ray of the abdominal organs.

In some cases, no further testing is needed to make a diagnosis. After receiving the results of the instrumental diagnosis, the neurologist selects the optimal treatment tactic.

Back pain treatment

Treatment of acute or chronic back pain should be mandatory under medical supervision. Independent use of drugs can lead not only to ineffective treatment but also to the appearance of complications of the disease. It is therefore recommended that you seek medical attention for back pain. After completion of diagnostic tests, the patient is prescribed treatment based on clinical characteristics, pathogenetic mechanisms, and disease course.

A few years ago, in medicine, when back pain appeared, it was recommended to adhere to strict bed rest. It is no longer necessary to restrict the patient's movement. It is also recommended to wear special bandages, crutches or stilts while walking.

Modern treatment of back pain is based on evidence-based medicine. Not only medications are used, but also non-pharmacological treatments.

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

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

The groups of drugs listed can be used in both monotherapy and combination to achieve a therapeutic effect. Manual therapy with back pain medications is recommended.

In case the patient’s pain syndrome is very pronounced, daily activity should be limited as well as the recommendations of other doctors should be followed, but in general, the level of previous physical activity should be maintained.

In the case of chronic back pain, in addition to the listed treatment methods, the methods of physiotherapy exercises (training therapy) can also be used. In addition, the neurologist may recommend a massage. Particular attention is paid to cognitive-behavioral therapy along with the administration of antidepressants.

The duration of treatment is determined by a neurologist. In case the treatment was not effective, you will need to change the group of medicines as well as carry out further research.

Forecast

If you diagnose it in time and choose the right treatment tactics, your back pain can be relieved in a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the treating physician are followed.

Prophylaxis

To prevent the onset of back pain, you need to stick to a healthy lifestyle and distribute physical activity appropriately so as not to cause overload in different parts of the spine. In addition, concomitant diseases should be diagnosed and treated in a timely manner.