Back pain: treatment, causes and characteristics

causes of back pain

Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most pressing problems of modern health care, and the treatment of back pain is notan easy task.

Although the pain syndrome can occur in any part of the spine, the most common localization is the lower back - according to researchers, the prevalence of low back pain reaches 76% among the adult population.

According to statistics, within a year, about 80% of people complain of at least one attack of pain in the lower back, and within the next 12 months, 75% of them experience a relapse of thepain syndrome.

Types and manifestations of pain syndrome

Depending on the segment of the back affected, the pain syndrome is divided into pain in the neck, middle back (chest pain), lower back (lower back pain) or coccydynia (pain in the coccyx or sacrum).

According to the results of a study involving 46, 000 volunteers from several European countries, chronic pain in various parts of the spine is inherent in 24% of the population, in the lumbar region - 18%, and neck pain occurs in8% of the population.
The duration of pain is acute - up to 12 weeks, or chronic - more than 12 weeks.

The pain can be dull or throbbing, sometimes there is a burning and tingling sensation. Symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the level of spinal damage. Numbness or weakness of the upper and lower extremities is another variant of the accompanying manifestations of back pain. A limitation in the range of certain movements or an increase in pain with a certain position of the body is also observed in some patients with spinal pain syndrome.

Back pain: why does it happen?

The examination may not always be able to determine the immediate cause of back pain, in which case the pain is referred to as "non-specific" or "mechanical". The cause of this pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observed - this subtype of pain syndrome occursin 98% of patients. Secondary pain against the background of the underlying disease is about 2% of cases.

Non-specific back pain has the following characteristics:

  • tends to get better or worse depending on body position - for example, the patient may feel better when sitting or lying down;
  • the pain is often aggravated by movement;
  • an attack can develop suddenly or gradually increase;
  • sometimes back pain is the result of poor posture or awkward lifting, but often appears for no apparent reason;
  • may be caused by a minor injury, such as sprained ligaments or muscles;
  • can occur after stress or overexertion and usually begins to improve within a few weeks.

Risk factors for developing non-specific back pain:

  • heavy physical labor;
  • frequent bending and tilting of the body;
  • lifting weights, especially from a bad position;
  • passive lifestyle;
  • industrial influences, e. g. vibration;
  • pregnancy;
  • age-related changes in the musculoskeletal system.

Acute pain has physiological significance, as it indicates the acute influence of an adverse factor.

The most common causes of acute back pain are:

  • trauma to various spinal structures;
  • 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 - caused by 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 corrects 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 joints in the spine);
  • radiculopathy - inflammation and degeneration of nerves that run from the spinal cord to muscles and joints;
  • arthritis and arthrosis of the joints of the spine of various origins.
Much less often, back pain can be a sign of more serious conditions, such as:
  • infectious process (for example, meningitis, tuberculosis);
  • diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
  • metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Back pain diagnosis

To understand what to do with severe back pain, first of all it is desirable to establish its cause. An accurate diagnosis is the key to a well-designed treatment plan.

After a thorough review of the patient's complaints, history, and nature of symptoms, the doctor may order imaging tests and functional tests to confirm the diagnosis.

  • X-ray of the spineused to detect degenerative diseases and fractures.
  • computed tomographyprovides detailed cross-sectional images of the spine, which even show slight changes in the bones.
  • Magnetic resonance imagingShows both tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves or spinal cord.
  • When drivingmyelogramsa special biological preparation is used - a dye that is injected into the area around the spine for better visualization of the spinal canal and intervertebral discs, as well as the state of nerve fibers in and around the spinevertebral.
  • Electrodiagnostic testsallows you to assess the electrical activity of the nerves of the upper and lower extremities.
  • Positron Emission Bone Scanreveals, first of all, the oncopathology of bones.
  • Densitometry - determination of bone density - indicatedin diseases and conditions that cause a decrease in bone mineral density.

Ways to treat back pain

The complex structure of the pain syndrome in the region of different parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.

Principles of therapy for a patient with chronic back pain, based on evidence-based medicine, involve:

  1. explain to the patient the causes of pain and, as a rule, its benign origin;
  2. Ensuring a sufficient level of daily physical activity;
  3. the appointment of effective and safe treatment, primarily for pain relief;
  4. correction of treatment in case of ineffectiveness after 1 to 3 months.
International clinical recommendations from doctors provide a general algorithm on how to cure chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), non-surgical treatments, physiotherapy, manual therapy, as well as antidepressants and psychotherapy are considered the most effective methods for long-term pain treatment.

Non-drug treatment of back pain

In most cases, a patient with back pain improves within 2-6 weeks. The primary goal of non-specific treatment is to reduce movement restrictions, minimize relapses, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.

Development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of the pain syndrome.

Depending on the duration, the non-drug treatment of back pain can be divided into three phases.

I stage- passive physiotherapy in acute period (6 weeks).

II stage- active exercise during the subacute period (6-12 weeks).

Stage III- physiotherapeutic influence of rehabilitation.

Bed rest is prescribed for acute back pain only for a limited period.

Various physical activities and forms of complementary and alternative medicine can help with pain management, such as:

  1. non-specific physical exercise, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physiotherapy may also be recommended to strengthen the muscles of the abdomen and spine;
  2. therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
  3. the use of acupuncture, manual therapy and spinal traction methods.
Regardless of the method of conservative treatment used, it is important to remember that the patient may not experience immediate relief and improvement will come within a few weeks or months.

Medical pain treatment

The most common medical treatments for back pain are:
  1. Nonsteroidal anti-inflammatories and muscle relaxants.
  2. Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduces inflammation and pain in the back. However, this type of therapy is not intended for long-term use due to the side effects of medications.

When is surgery used?

While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may need surgical correction of spinal conditions. Generally, a patient with back pain can be operated on if the following criteria are met:
  • a structural problem has been diagnosed and confirmed by imaging (such as X-ray or MRI);
  • conservative treatments such as physiotherapy or medication have failed to provide adequate pain relief;
  • back pain is debilitating - it interferes with participation in daily activities or physical activity;
  • symptoms adversely affect physical or emotional health;
  • there are objective reasons, confirmed by diagnostic methods, to believe that spine surgery will be beneficial;
  • there is neurological damage.

Back pain prevention

Maintaining a healthy lifestyle is key to preventing back pain. Being overweight puts a strain on your back, so it's important to maintain a healthy weight. Regular exercise strengthens abdominal and back muscles. Smoking accelerates the aging of blood vessels and many body tissues, including contributing to the aging of the spine. Therefore, refusing to use tobacco products is another step towards a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.