Back pain is a symptom of a large group of diseases and conditions with similar manifestations, and is one of the most pressing problems in modern healthcare, and treating back pain is a daunting task.
Although pain can occur in any part of the spine, the most common location is the lower back - according to researchers, the prevalence of low back pain is up to 76% in adults.
According to statistics, within 1 year, about 80% of people complain of at least one pain in the lumbar region, and over the next 12 months, 75% of them have a recurrence of the pain syndrome.
Types and manifestations of pain syndromes
Depending on the part of the back affected, the pain syndrome is divided into pain in the neck, middle back (chest pain), lower back (lumbar pain) or coccydynia (pain in the coccyx or sacrum).
According to the results of a study with the participation of 46 thousand volunteers from several European countries, chronic pain in different parts of the spine is characteristic of 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8% of the population.
The duration of the pain is acute - lasting up to 12 weeks or chronic - more than 12 weeks.
The pain can be dull or sharp, sometimes with a burning and tingling sensation.Symptoms of some diseases also spread to the arms and hands, legs or feet, depending on the extent of damage to the spine.Numbness or weakness in the upper and lower extremities is another option for accompanying symptoms of back pain.Limitation in certain range of motion or increased pain in certain body locations is also observed in some patients with spinal pain syndrome.
Back pain: why does it happen?
On examination, it is not always possible to determine the direct cause of back pain, in which case the pain is called “nonspecific” or “mechanical.”The cause of this pain is pathological changes in the musculoskeletal system, but lesions of the cervical, thoracic, lumbar and sacral nerve roots as well as specific diseases of the spine are not observed - this type of pain syndrome occurs in 98% of patients.Pain secondary to underlying disease accounts for about 2% of cases.
Non-specific back pain has the following characteristics:
- tends to improve or worsen depending on body position - for example, the patient may feel more comfortable sitting or lying down;
- The pain is often worse with movement;
- The attack can develop suddenly or gradually;
- Sometimes back pain is the result of sitting incorrectly or lifting something incorrectly, but often occurs for no apparent reason;
- may be caused by a minor injury, such as a sprain or sprain;
- can occur after stress or overwork and usually begins to subside within a few weeks.
Risk factors for developing non-specific back pain:
- hard manual labor;
- Bend and flex your body frequently;
- lifting heavy objects, especially from incorrect positions;
- sedentary lifestyle;
- industrial impacts such as vibration;
- pregnant;
- Age-related changes in the musculoskeletal system.
Acute pain has physiological significance because it indicates the acute effect of an adverse factor.
The most common causes of acute back pain are:
- injuries to various structures in the spine;
- spondylolisthesis - displacement of the vertebrae relative to each other;
- sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the lower back to the feet
- cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
- intercostal neuralgia - due to compression or irritation of the nerve roots of the intercostal nerves;
It is important to remember that acute pain signals the onset of a disorder, while chronic pain captures this pathological effect and is reminiscent of a developing disorder.
Conditions that can cause chronic back pain include:
- displacement or prolapse of the intervertebral disc;
- autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
- radiculopathy - inflammation and degeneration of the nerves running from the spinal cord to the muscles and joints;
- Arthritis and arthritis of the spinal joints have different origins.
- infectious process (eg, meningitis, tuberculosis);
- diseases of internal organs (abdominal aortic aneurysm or gynecological diseases);
- metastasis or certain types of cancer, such as multiple myeloma, a type of bone marrow cancer.
Diagnosis of back pain syndrome
To understand what to do when you have severe back pain, you should first determine its cause.Accurate diagnosis is key to a well-developed treatment plan.
After carefully examining the patient's complaints, medical history, and nature of symptoms, the doctor may order imaging studies and functional tests to confirm the diagnosis.
- X-ray of the spineused to detect degenerative diseases and bone fractures.
- Computed tomographyprovides detailed cross-sectional images of the spine, revealing subtle changes in the bones.
- Magnetic resonance imagingshows both tissue and bone structure and is used to identify slipped or herniated discs, pinched nerves, or spinal cord.
- When proceedingmyelographyA special biological dye is used to inject into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
- Electrodiagnostic testingallows you to evaluate the electrical activity of nerves in the upper and lower limbs.
- Positron emission scan of bonesFirst revealed about cancer of the bones.
- Densitometry - which determines bone density - is shownfor diseases and conditions that lead to reduced bone mineral density.
Methods to combat back pain
The complex structure of pain in different parts of the back and the stages of pathological changes indicate the need to combine pharmacological and non-pharmacological treatment.
The principles of treatment for patients with chronic back pain, based on evidence-based medicine, imply:
- explain to the patient the cause of pain and, as a rule, its benign origin;
- ensure adequate levels of daily physical activity;
- prescribe effective and safe treatment, primarily pain relief;
- Adjust therapy if not effective after 1–3 months.
Treat back pain without medication
In most cases, patients with back pain will improve within 2-6 weeks.The main goal of non-specific treatment is to minimize limitation of movement, minimize recurrence, and although good physical fitness cannot prevent all pain, it helps to resolve it.
Developing precise movement patterns and physical therapy are important areas in non-pharmacological pain management.
Based on duration, non-pharmacological back pain treatment can be divided into three stages.
Phase I- passive physiotherapy in the acute phase (6 weeks).
Phase II– active exercises during the subacute phase (6–12 weeks).
Phase III- Effects of physical therapy on rehabilitation.
Bed rest is only prescribed for acute back pain for a limited period of time.
Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:
- Non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy may also be recommended to strengthen the abdominal and spinal muscles;
- Therapeutic massage is used for short-term pain relief but does not provide long-term functional improvement;
- the use of acupuncture, manual therapy and spinal traction.
Medicines to treat pain
The most common medical treatments for back pain are:- Nonsteroidal anti-inflammatory drugs and muscle relaxants.
- Injecting steroid hormones into the joint space or epidural space of the spine, helps reduce inflammation and pain in the back.However, this type of therapy is not intended for long-term use due to drug side effects.
When is surgical treatment used?
While the vast majority of people with back or neck pain will recover over time without medication or nonsurgical treatment, some patients may need surgery to correct spinal disorders.In general, a patient with spinal pain can undergo surgery if the following criteria are met:- structural problem that has been diagnosed and confirmed by imaging (e.g., X-ray or MRI);
- Conservative treatments such as physical therapy or medication do not provide satisfactory pain relief;
- Back pain is debilitating and prevents you from participating in daily activities or physical activity;
- symptoms that negatively affect physical or mental health;
- have objective reasons, confirmed by diagnostic methods, to believe that spine surgery will be beneficial;
- nerve damage occurs.
Prevent back pain
Maintaining a healthy lifestyle is key to preventing back pain.Excess weight puts strain on your back, so it's important to maintain a healthy weight.Regular exercise helps strengthen your abdominal and back muscles.Smoking speeds up the aging of blood vessels and many of the body's tissues, including contributing to aging of the spine, so stopping the use of products containing tobacco is another step toward a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.