Today, back pain is the second most common cause for patients seeking medical treatment. According to the American National Institutes of Health, one in five middle -aged people suffers from pain.
At the same time, the incidence of this disease only increases with age. In medical practice, pain (dorsalgia) is considered an interdisciplinary pathology, as there are symptoms in the clinic of both neurological and somatic diseases.
What causes back pain?
Pain in the back in 90% of cases occurs with spinal disease (vertebral pain). In other cases, the cause may be pathology of internal organs, spinal cord, etc. (non-vertebral pain).
Thus, vertebrogenic groups include:
- intervertebral hernia;
- sacra- or lumbarization;
- spondylosis;
- osteoporosis;
- vertebral tumor process;
- trauma (fracture of the spine, spondylolisthesis).
Non -vertebral groups include:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formation (neurinoma) and metastasis;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its intensity and duration vary depending on the underlying pathology.
- Intervertebral hernia.Hernial protrusions appear between the vertebrae with the development of osteochondrosis. In this case, the pain can be sharp or aching and localized (depending on the level of the affected disc). The pain often extends to the limbs, accompanied by numbness and tingling. In further cases (when the hernial sac compresses the nerve root), sensitive and motorized arm and leg disorders may appear. Rarely, there are violations of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacra or lumbarization.Sacralization is a congenital anomaly associated with fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum is separated and becomes an additional lumbar vertebra. Usually the pathology is not symptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, there is lumbar pain in the sacral area, which increases with movement, spreading to the lower part of the leg. Pathology is also characterized by the fact that it occurs at a young age (usually at the age of 20-25 years).
- Spondylosis.Spondylosis (unlike previous diseases) occurs mainly in the elderly. The disease develops as a result of dementia changes in the spinal space - "weariness". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous with injury to the neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens at the end of the day. Sometimes pain syndrome manifests itself not only in movement, but also at rest, which causes insomnia. With uncontrolled disease, there are many cases of immobilization of the vertebral joints, as well as pinching of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis.Osteoporosis is a metabolic disorder, in which the process of bone destruction occurs as opposed to bone formation. The clinical picture of the disease is not much: usually the pathological process is asymptomatic and detected by chance (with X-rays). However, in the later stages of the disease, dull pain appears, as well as postural curvature.
- The process of vertebral growth.Vertebral tumors are often asymptomatic and grow large enough to compress nerve fibers. In such cases, chronic back pain occurs (usually in the lower spine), which can spread to the thighs and lower legs. Sooner or later, tumor growth causes nerve root compression, which is indicated by neurological disorders: loss of sensitivity and movement in the limbs.
- Injuries.Common causes of acute pain, restricted movement and neurological symptoms are spinal injuries: fractures, bruises, dislocations / subluxations, as well as "slipping" of the spine due to damage to the ligament apparatus - spondylolisthesis. Typically, patients report sharp diffuse pain in the back, the presence of bleeding (“bruises”), local swelling and restriction of movement.
- Psychogenic pain.A similar view applies to a full health background after the onset of an emotional or stressful situation. Patients describe pain in different ways, which are limited only by the patient’s imagination. Sometimes something is called. “Painful behavior” when people, while maintaining movement, tend to use additional supports: crutches, crutches and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is very similar to psychogenic pain. At the same time, pain is also caused by excessive stress, climate and emotions. However, an important difference is that pain should be observed for more than three months, accompanied by local sensitivity at characteristic points (place of occipital muscle installation, middle part of trapezius muscle, etc. ). Diagnosis also requires complete exclusion of all types of somatic diseases.
- Pathology of internal organs.Back pain can often appear with diseases of various organs of the body. Thus, with a heart attack, the pain syndrome is localized behind the sternum, spreading under the scapula and left arm, as well as in the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, radiating to the spinal space. The symptom complex arises against the background of difficulty breathing and facial cyanosis. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, arising in the upper part of the abdomen in the form of a "belt", covering the sides and back. Back pain appears along with vomiting and indigestion. A complication of urolithiasis is renal colic - an acute paroxysmal pain syndrome. Usually, the pain is so severe that it causes the patient to bend over to seek relief. Against the background of the attack, the urine turns dirty red due to blood impurities.
- Tumor process.Neurinoma is a tumor of the nerve sheath. When the spinal cord root is affected, back pain usually occurs, as well as loss of sensitivity and motor activity below the level of the lesion. It should be noted that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases of breast, prostate, lung, kidney, etc. cancers.
- Epidural abscess.An epidural abscess is a group of pus under the hard layer of the spinal cord. The disease is accompanied by acute pain syndrome, which is accompanied by neurological disorders: paresis (decreased muscle strength), loss of sensitivity, pelvic disorders, etc. often appear. The purulent process occurs against the background of infection, wounds, immunodeficiency complications of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system, in which cavities appear in the spinal cord. Injuries, tumors, brain stress, etc. Provokes this disease. In the early stages, there is a slight pain in the spine, which does not cause discomfort. Then there is weight loss, muscle weakness, pain sensitivity disappears, there is no sweat, and bones become brittle. Often there are injuries to the joints, skeletal bones (burns, fractures, wounds), however, due to lack of pain sensitivity, they pass invisible.
Diagnostics
As a diagnosis, a qualitative survey and physical examination of the patient is required with palpation (feeling), percussion (percussion) and auscultation (listening). For some pathologies, it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you need an instrumental diagnostic method: ultrasound or magnetic resonance imaging. While X-rays and computed tomography were used for direct examination of the skeleton.
In some cases, less common techniques may be needed: bone scintigraphy, electromyography, etc.
Back Pain Treatment
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), excluding physical activity, paralyzing the spine if possible. If the pain is unbearable, painkillers can be taken. However, keep in mind that anesthetics “lubricate” the clinic of the disease. After that, this can complicate the diagnosis of the disease. Only the attending physician can prescribe medication.
Herniated Disc
The main drug treatment is based on the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and painkillers (Ketorolac). In some cases, surgery to remove the intervertebral hernia, as well as intervertebral disc endoprosthetics, may be required.
Sacra or moisturizing
When pain occurs, blockade with anesthetics is prescribed, as well as physiotherapy (application of paraffin, electrophoresis, etc. ). With the effectiveness of conservative treatment, reconstructive surgery is indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin), as well as physiotherapy (ultrasound, electrophoresis) are used to relieve inflammatory and pain syndromes.
Osteoporosis
Treatment of osteoporosis begins with a diet high in calcium and vitamin D. 
Probably the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogen, calcitonin and parathyroid hormones is used.
Tumor process
Treatment for tumor disease consists of chemotherapy and surgery. In this case, the amount of help depends on the specific clinical case.
Injuries
In case of minor injury, regime and warm -up are prescribed. In some cases, reduction or traction of the skeleton is required. When neurological symptoms appear, surgery with fixation of the bone fragments is performed.
Psychogenic pain
Help for psychogenic pain consists of complex psychotherapy, as well as taking antidepressants (fluoxetine, Sertraline).
Fibromyalgia
As the cause of the disease is still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), hypnotics (Zopiclone) or sedatives (Diazepam). Adapting to thinking positively, avoiding stressful situations and being in dry and hot climates are also important.
Pathology of internal organs
Each possible internal pathology requires individual treatment tactics. Emergency care for a heart attack is to take Nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - colds, hunger and rest; with pneumothorax - a closed (occlusive) bandage in the event of an open wound of the lungs; with renal colic - antispasmodics (Drotaverin, Metamizole sodium) and warming.
Epidural abscess
Treatment consists of urgent surgery to normalize the pressure in the spinal canal and drain the meninges. Antibiotic therapy (Amoxicillin, Cefotaxime) supports surgical intervention.
Syringomyelia
Usually, patients are advised to protect their skin from cuts and burns (the latter often occurs because the patient loses sensitivity and does not feel trauma). Painkillers, antidepressants (Fluoxetine), and antipsychotics (Chlorpromazine) are also prescribed. In some cases, surgical intervention is possible to study the formed spinal cord cavity.
Relapse Prevention
For the prevention of back pain, it is necessary to prevent the occurrence of each of the pathologies mentioned above. To do this, you need:
- Normalize lifestyle: lose weight to normal; create a proper diet rich in trace elements and vitamins; ensure proper physical activity without overeating.
- Quit bad habits: smoking and alcohol consumption.
- Correct postural curvature (scoliosis, lordosis) and orthopedic pathology (flat feet, flat feet, etc. ).
- Diagnose in a timely manner and treat diseases of the musculoskeletal system or internal organs.
- Prevent or treat spinal injuries properly.
- Avoid emotional expressions and stressful situations.
Keep in mind that back pain is not an isolated pathology, but is a symptom of the disease. Major illnesses can be very serious and, if left untreated, can lead to disability and even death of the patient!