Lower back pain

13 March 2022

Low back pain is probably familiar to almost all modern people. Employability can be affected by a variety of reasons. These include back pain, sciatica, osteochondrosis, and other abnormalities of the lumbosacral spine. You should not ignore this because back pain can not only reach incredible strength, making a person’s life unbearable, but can also be a symptom of the most dangerous diseases.

Lumbar pain can be varied: acute or dull, sore or burning, local (occurring in one place) or spreading all over the back. Unpleasant feelings also manifest themselves in different ways: sometimes suddenly, suddenly, and sometimes gradually, intensifying every day.

The response to pain and tolerability depend on many factors: age, mental characteristics, accompanying symptoms, and other factors. But under no circumstances can you leave the disease to chance. Timely treatment will help you avoid dangerous consequences.

Diagnosis of the cause of back pain requires examination of the spine and some additional procedures: X-ray examination, computer or magnetic resonance imaging. About 80% of the modern population in European countries experience lifetime lumbosacral pain attacks.

Acute or chronic back pain in the lumbar region is the result of various neurological, degenerative-dystrophic diseases in women and men. In some cases, lower back pain is the result of diseases of the internal organs, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

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

Primary low back pain syndrome occurs as a result of locomotor lesions of a morphofunctional nature. He is the one who causes the vast majority of back pain in the lumbar region. The most significant causes are degenerative-dystrophic lesions in different parts of the spine:

osteochondrosis, a lesion of bone and cartilage tissue, this disease is dystrophic in nature. With this, the intervertebral disc and adjacent vertebrae are affected, spondylosis develops.
Spondyloarthrosis is a form of osteoarthritis in which the disease affects the intervertebral joints or synovial joints responsible for spinal mobility.

There are many more varied causes of pain in secondary pain syndrome:

scoliosis, which is the curvature of the spine, as well as some other growth diseases;
various inflammations that are non-infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
a tumor of the vertebrae, the spinal cord itself, or the retroperitoneal space, whether caused by a primary or metastasis;
fracture of one or more dorsal vertebrae. Perhaps this is one of the most serious causes of back pain;
various infectious diseases leading 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, you may also feel that your lower back hurts;
diseases of the gastrointestinal tract. For example, atypical acute appendicitis, intestinal obstruction;
often back pain is of a reflective nature. A similar problem can occur with some diseases of organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - these diseases cause back pain).

Acute and chronic low back pain

Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called dislocated lower back pain is also often observed: in this case, the feelings of pain come from the deeper internal organs and body structures; in other words, the patient appears to have lower back pain, but in fact a completely different part of the body is affected.

The back pain in the lumbar region is most common when there is pain from the pelvic organs, kidneys, pancreas, colon, or tumors behind the peritoneum. Many patients do not know what to do if their back hurts. But there is a clear recommendation of what not to do: self-medication. The causes of pain are so varied that only a qualified professional can make a correct diagnosis.

Possible causes of acute low back pain include:

The pain is accompanied by an acute stretch of the muscles. In this case, the pain signs are localized in the back, 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 severe causes of severe back pain is a fracture of the spine (a fracture of the vertebrae, including compression). This usually happens with a fall, back bend, and other injuries; but in the case of a patient diagnosed with osteoporosis, hyperthyroidism, Cushing's syndrome, Paget's disease, cancerous tumors and metastases in the vertebral region, or other changes in the skeletal system, vertebral fractures can occur literally "from the flower. ", and even without fixation by feelings, the patient at the time of fracture.
The same awkward situation in which the lower back hurts sharply is the displacement of the intervertebral discs that occurred in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; Cases of LIII-LIV and above are less common.

Symptoms include severe low back pain, compulsion, and limited mobility. Involvement in the pathological process of nerve roots is indicated by:

radical pain, usually unilateral;
sensitivity disorders (numbness, increase or decrease in the level of sensitivity);
decrease or disappearance of the Achilles reflex (in the case of damage to the roots of S or S2);
decrease or absence of knee sprain intensity (indicates damage to the L3-L4 area).

The general trend is that protruding intervertebral disc affects the underlying root (e. g. , displacement of LIV-LV causes L5 root pathology). With the defeat of the cauda equina (ponytail), the function of the bladder and rectum is disrupted. A similar condition can occur with a strong protrusion of the spinal disc.

The back hurts sharply in the lumbar region with facet syndrome: in this case, the disc remains intact and the pain occurs at the exit of the spinal canal due to the compression of the root itself. The most commonly observed unilateral type facet syndrome is in the L5 root area; an increase in the sides of the intervertebral joint (upper and lower) and, as a result, a narrowing of the intervertebral foramen.

In addition, severe low back pain accompanies epidural abscess, a serious disease that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; the pain becomes particularly strong with the mechanical action on the pathology (pressure, tapping).

If there are signs of spinal cord compression, all highly effective medical measures are recommended, including surgery. Another cause of lower back pain may be diseases of the hip joint, primarily coxarthrosis. This is characterized by pain that radiates to the lower back, buttocks, and legs.

Diseases associated with chronic low back pain:

Deforming spondylosis is a disease in which dystrophic changes in the lumbar vertebrae, calcification of their ligament apparatus, and further bone growth occur; bone outgrowths press on the roots and narrow the spinal canal. In the event that painful low back pain is accompanied by leg weakness, numbness, and other neurological symptoms, the possibility of intermittent claudication syndrome, which may be caused by spinal stenosis, should be considered. An examination is required to determine the final diagnosis.
Ankylosing spondylarthrosis (or Bechterew's disease). In the early stages it is characterized by limited mobility, especially in the morning, a decrease in chest movements during breathing. There are pulling pains in the lower back; the curvature of the spine continues to develop and progress in the thoracic region. The anomalies of the sacroiliac joints are recorded by X-ray: destruction, structural change, "bamboo" spine. Thorough examination and investigation of the cause of low back pain is necessary, as similar symptoms and limited movement of the lower spine can cause other diseases - Reiter's syndrome, arthritis, chronic colitis.
Oncological diseases (tumors, metastases), metabolic disorders (including NBO). The following causes of back pain should be ruled out: metastatic carcinoma of the lungs, breast, prostate and thyroid, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). Exceptions are X-rays and myelography.
Osteopyelitis also causes prolonged, aching pain in the lower back. If this disease is suspected, an X-ray of the bone tissue is taken, a skin test is performed with tuberculin and an ESR test is performed to determine the presence / absence of tuberculosis bacteria or piogenous bacteria, usually staphylococci. pathogens of osteomyelitis.
Different types of spinal cord tumors (intradural tumors). Diseases such as lipoma, neurofibroma, meningioma can cause persistent back pain, initially without neurological symptoms.

Causes of intermittent back pain. Many diseases of the internal organs cause intermittent, sharp or pulling pain in the lower back. However, patients do not feel stiffness in the back area, there is no clear localization of the pain, and the pain does not increase in the widest possible range of motion. To the question of what to do if your waist does not hurt continuously but from time to time, the answer is simple: don’t wait until "as you should" but consult a doctor.

The pathology of one or another organ clearly affects a certain section of the spine. Thus, pain radiates from the pelvic organs to the sacrum, to diseases of the lower back (segments L3-L5) in the lower abdominal organs, and into the segments in the upper. the upper part of the lumbar zone or the lower part of the chest zone.

Diseases - Causes of lower back pain and pain distribution area:

If the pelvic organs are affected, the lower back is a pain in endometriosis, ovarian or uterine carcinoma. In men, such intermittent pain may be caused by the development of chronic prostatitis or prostate carcinoma.
Various kidney diseases cause pain at the junction of the ribs and spine.
Gastric, duodenal, peptic ulcer, pancreatic tumors (especially if the disease extends beyond the peritoneum) - the pain spreads to the region of the T10-L2 spinal segments;
In case of ulcerative colitis, diverticulitis or colon tumors, the lower back pain;
If the back hurts in the chest / lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.

Diagnosis of low back pain

For low back pain and lumbago, computed tomography (showing the condition of the bone tissue in the spine) and magnetic resonance imaging (allowing the condition of the soft tissues) and ultrasound of the internal organs are recommended. .

One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a number of disorders, from bone fractures to kidney stones. Many of the changes observed only suggest a correct diagnosis, further testing may be needed to confirm this. In addition, some radiological lesions may be an accompanying finding that is not the cause of the pain.

It all starts with a neurological and orthopedic examination by a doctor. The examination assesses the patient's neurological condition and identifies a possible violation of the biomechanics of the spine with a mandatory assessment of the muscles of the back and gluteal region. Already at this stage of the study, a patient with spinal osteochondrosis and back and low back pain can be diagnosed and treated.

Sometimes, based on the results of an orthopedic examination of a patient with a background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:

radiography of the lumbosacral spine with functional tests;
CT examination of the lumbosacral spine;
MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. Annulus fibrosus is surrounded and supported by 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 cartilage discs decreases, the vertebral bodies converge, reducing the intervertebral openings and endangering the nerves and blood vessels in them (osteochondrosis).

The protrusion of the cartilage discs (protrusion of the intervertebral disc) with their further protrusion into the lumen of the spinal canal (disc herniation) most often leads to compression of the nerve roots, causing pain along the compressed nerveweakening of muscle strength in the areas of innervation and violation of sensitivity.

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

In addition to nerve compression, the stability of the spinal segment may also be impaired. In the case of spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). X-rays of the lumbosacral spine with functional examinations may be required to clarify the diagnosis.

Most often, the nerve bundles that make up the sciatic nerve suffer from compression of the hernia or protrusion of the intervertebral disc due to their anatomical location. The sciatic nerve is made up of L5, S1, S2, S3 fibers - spinal nerves.

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

Which doctor should I go to?

For spinal pain, you should first contact a neurologist at the district clinic if the patient is stable or an ambulance should be called. Low back pain can be a symptom of gynecological, urological, surgical, gastroenterological problems.

Lower back pain is combined with various infections, limb injuries. Lower back pain with heart and lung disease is not ruled out. This is established by a thorough examination. Once diagnosed, he or she is usually prescribed medications that reduce back pain, normalize blood circulation, and help nerve tissue recover. These can be tablets, gels, ointments or injections that relieve inflammation and cramps.

Generally, surgery is required to diagnose a disc herniation that is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, restored, and the pain goes away over time.

It is best to relax your spine and paravertebral muscles by sleeping on a hard mattress with a small pillow under your knee. However, bed rest should not last too long because it is fraught with weakening of the paravertebral muscles, which only exacerbates the problem. Even in severe pain, you should try to maintain at least poor physical activity.

How to relieve back pain

The onset of pain is often due to muscle cramps, which can be relieved with special tools called muscle relaxants. Such drugs are actively used in the treatment of spinal diseases.

Therefore, in case of severe, unexpected low back pain, it is recommended to take a muscle relaxant tablet, rubbing the back with a warming anesthetic gel. Strictly follow the instructions when using the basics.

In case of unpleasant symptoms due to inflammatory diseases of the internal organs, it is not recommended to delay the consultation with a doctor, if at some point it is impossible to consult a specialist and the pain is too severe, you can take Pentalgin or No-shpu. The sore spot should not be heated with a heating pad because the heat contributes to the spread of the inflammatory process, thereby exacerbating the accompanying symptoms.

Ointment for back pain

Ointment formulations are often used to treat diseases of the lower spine. These drugs include those that have a pronounced anti-inflammatory, mild analgesic and antipyretic effect.

Treatment is prescribed depending on the severity of the pain symptom. Ointment for back pain is used as a main or adjunctive treatment. With marked symptoms of osteochondrosis, rubbing the lower back with ketoprofen-based ointments with a strong analgesic effect is recommended.

The main advantage of topical preparations is that they do not affect the whole body, but an area that requires a specific treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar drugs in tablet form.

Exercises for back pain

Gymnastics is considered an additional method of treating diseases of the lower spine. The exercises presented to patients are quite simple and do not involve any particular strain on the body. For example, the usual hanging on the crossbar of a horizontal bar has a beneficial effect on the condition of the spine, helping to relax the muscles and eliminating the lumbago - the pain caused by pinching the nerve roots. Therapeutic practices for back disease, accompanied by pain in the lower stages, include:

raising the legs (so that the knee touches the chin);
"Bicycle" performed on its back;
on his knees.

We recommend that you do exercises for up to 10-15 minutes each day, with marked pain - refusing to do them.