Backache

Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndrome can accompany diseases that affect the spine, kidneys and other organs and systems. Treatment and prevention of back pain includes medications and non-medications. The provision of erratic medical treatment can lead to chronic diseases with the occurrence of complications.

Back pain is a separate symptom, not a nosological entity. For example, lumbodynia is pain that is localized in the lumbar spine. Also, concepts such as thoracalgia or cervicalgia are distinguished. Accurate localization of pathological symptoms is required to select the correct treatment tactics and the choice of preventive measures.

Definition

Pain is a pathophysiological condition that occurs in response to pain receptor irritation. It can occur as a result of direct damage to tissues or organs or when exposed to 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 (kidneys, pancreas, liver, etc. ).

It should be borne in mind that pain syndrome may be accompanied by a deterioration of the patient's cognitive abilities - memory impairment may appear, concentration decreases.

In most cases, the appearance of back pain is a reaction of the body’s defenses due to the influence of adverse factors. The most common causes of back pain are sciatica, herniated disc or spondylosis.

Epidemiology

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

This problem can lead to early disability of the patient. In addition, pain syndrome is a cause of temporary disability among workers. That is why pathology becomes a problem not only in medicine, but also in the field of economic activity.

Often, people in their 30s to 60s work to clinics to get help. This is due to the fact that with increasing age, pathological changes of degenerative nature appear in the spine, as a result of which acute and chronic pain appear.

In addition, men suffer from this disease more often than women. This is due to the uniqueness of the job, the physical workforce, as well as other risk factors. According to statistics, pain appears more often in the lumbosacral region.

Doctors explain this fact by the fact that it is in this part of the spine that physical activity provides the highest stress.

Risk factors

It is not only stress and exercise that can cause this pathology to appear. Among the main risk factors are as follows:

• working age from 30 years and above;
• men;
• overweight and obesity (where the body mass index exceeds 30);
• the presence of other pathologies (e. g. , migraines or frequent heart and vascular disease);
• static physical activity, which do not differ from each other in diversity;
• exposure to vibration.

In addition, smoking has been cited as a risk factor by some researchers. It is possible that a strong cough in smokers is an indirect cause of pain.

Welding

A neurologist, after a detailed examination and examination, determines the nature of the pain. There are several classifications, among which the pain syndrome that occurs in the back is divided according to the place of occurrence of pathology, duration, cause and other characteristics.

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

• sharp,
• subacute,
• chronic.

Patients with acute pain are most often treated in outpatient clinics. The duration does not exceed 6 weeks. Subacute pain can last 6 to 12 weeks. If the pathological syndrome bothers the patient for 12 weeks or more, the pain is called chronic.

Acute and subacute pain most often, with proper treatment, result in complete recovery. Chronic pain syndrome can lead to early disability of the patient. That is why at the first appearance of clinical signs of pathology, you should seek medical help from a doctor. To do this, you should undergo an initial consultation with a neurologist.

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

• weak
• on average,
• strong.

With the nature of back pain, there are:

• broken,
• sick,
• shoot,
• attract,
• stupid.

The nature of the pain depends on the pathology causing the syndrome. Thus, with osteochondrosis, attracts pain concerns, which differ in irradiation to the lower part of the foot. With sciatica, a stabbing pain appears, which often becomes unilateral.

According to the localization of back pain, there are:

• local (local),
• reflected,
• shine.

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

Local pain has its own characteristics. For example, after an injury in the lumbosacral area of the spine, the pain syndrome persists. Its character can change with changes in body position due to receptor irritation.

Reflected pain occurs with pathology affecting internal organs. Associated with anatomical features of conservation. So, with the reflected type, pain occurs in the dermatome area. The most common cause of back pain is pathology of the pancreas, uterus and its appendages.

Among the characteristics of the types of pain reflected, lack of contact with physical activity is distinguished. If, with a change of body position with the type of local pain, the intensity of symptoms increases, then in this case there is no relationship.

Radiant pain is associated with nerve or root irritation. Moreover, in addition to the appearance of pain in the back, patients may complain of decreased sensitivity, the appearance of goose bumps (paresthesia). Often, upon examination, the neurologist is able to reveal pathological reflexes, which are also associated with disorders of nerve impulse transmission.

Causes 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 neoplasms;
• mental disorders (depression, anxiety, stress causing psychogenic type pain).

In addition, everyday problems can be the cause of the appearance of pathological symptoms. Therefore, with an uncomfortable posture during sleep, patients may complain of pain in the neck or lumbar spine.

Pain of vertebral origin

With this type of pain, pathological changes of the degenerative type are observed in the spine. So, the vertebral body, the intervertebral disc can be damaged. Often, the original pain of the vertebrae can be associated with a disease affecting the joints.

According to statistics, patients seeking medical help complain of the appearance of acute pain associated with damage to the spine. The cause may be a herniated disc, spondylosis, or lumbago.

In less than 1% of cases visiting a doctor, neoplasms in the spine are detected. Malignant tumor metastasis is rare, but it can also cause back pain of varying intensity.

Disease	ICD-10 code	Specificity
Osteochondrosis	M42	Diseases in which the intervertebral discs and vertebrae are destroyed. Characterized by appearanceinteresting and short -term pain with irradiation.Exposure to external factors in the form of exercise or coughing contributes to increased pain.
Intervertebral hernia	M51	A disease in which a lump forms in the spinal canal. He appearedacute pain syndrome that occurs when coughing, sneezing and physical exercise.
Radiculitis	M54. 1	Diseases in which degenerative changes are observed at the roots. Characterized by appearancepain associated with changes in body position or physical activity. . . In addition to the pain syndrome, sensitivity disorders are added.
Discogenic lumbodynia	M54. 4	Pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain was shooting and very noticeable.
Spondylosis	M47	Diseases manifested by degenerative changes in the vertebrae. Has a chronic type,pain during pain with irradiation to the lower legs, neck.

It should be remembered that each disease has its own special characteristics. That is why, when diagnosing, attention should be focused not only on the anamnestic data, but also on the results of the examination. For this, modern diagnostic instrumental methods are used, which make it possible not only to identify the pathological focus, but also to determine its boundaries and the degree of inflammation or destruction of the anatomical structure of the spine.

This is a vertebrogenic cause that provokes the appearance of pain in the back. In addition to the diseases listed above, pain can appear during trauma and stretching of the musculoskeletal system. Therefore, with excessive physical activity or lifting weights, acute pain may suddenly appear.

The original pain was not vertebral

According to statistics, patients complain of pain of non -vertebral origin in no more than 2% of cases. This category includes diseases and somatic conditions in which there is pain in the back.

The most common diseases that give rise to the emergence of pain syndrome are pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and bile ducts. Among the first groups, the following are distinguished:

• arterial blockage,
• unusual angina,
• aortic aneurysm (in the abdominal or thoracic region).

Among the second group:

• stomach ulcer,
• duodenal ulcer,
• cholelitiasis,
• bile duct dyskinesia,
• inflammatory changes in the pancreas.

Cardiovascular disease often causes pain in the back. Thus, with angina pectoris, patients are concerned about pain in the heart area, which radiates to the shoulders, arms or back. That is why, during an attack, patients may complain of back pain.

With angina pectoris, the pain syndrome has its own special characteristics. First, pain has a devastating character. Second, it appears behind the sternum radiating to the back, arms or shoulders. Third, the pain syndrome disappeared after immediate medication administration. It should be noted that physical activity and stress give rise to the appearance of attacks.

An aortic aneurysm is the rupture of a blood vessel that weakens and then inflates outward. In this case, the patient, when seeking medical help, complains of the onset of dull pain in the heart area with irradiation to the back and lower legs. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also interfere. Back pain with aortic aneurysms can appear both with thoracic localization of the pathological focus, and with abdominal pain.

It should be noted that pain at aneurysms is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, immediate treatment measures are initiated, including the use of medications and surgical methods.

Back pain can be caused not only by cardiovascular disease. In diseases affecting the organs of the retroperitoneal space, patients may also complain of pain syndrome. This is due to the peculiarity of preservation - inflammatory and degenerative changes in this area give rise to the appearance of back pain.

Back pain during pregnancy

Pregnancy is a physiological condition, however, this course may be accompanied by the appearance of 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.

Among the first group, there 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, where the internal organs are displaced;
• changes in the center of gravity at the end of pregnancy, when the fundus of the uterus descends.

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

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

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

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

Back pain with coronavirus

Coronavirus infection can also cause severe back pain. COVID-19 causes certain symptoms, including a sudden rise in temperature, an unproductive cough, chest pain, and weakness and fatigue. However, some patients also complain of back pain, which appears concurrently with the onset of coronavirus infection.

Among the main reasons are:

• exposure to toxins in the body;
• exacerbation of chronic diseases of the musculoskeletal system;
• the emergence of new and undiagnosed spinal pathology;
• viral radiculopathy.

Intoxication syndrome often accompanies diseases that affect the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches, and pains. With coronavirus, like other respiratory diseases, nonspecific back pain may appear. This is one of the manifestations of intoxication syndrome. With effective drug therapy, the pain intensity decreases after a few days.

The body’s active fight against infection can lead to worsening chronic disease. In addition, against a background of respiratory disease, previously hidden pathologies may emerge. That is why patients may be concerned about back pain.

Among the main causes, the appearance of viral radiculopathy is also distinguished. It can be associated not only with the formation of intervertebral hernias. Radiculopathy becomes a concern when viral agents cause inflammation or irritation to the spinal cord roots.

Diagnostic measures

If you experience back pain, you should immediately seek help from a medical organization. To diagnose disease in this area, you must see a neurologist.

The specialist at the reception, after detailed collection of anamnestic data, should conduct a neurological examination of the patient. At the information gathering stage, attention is given to the following aspects:

• first appearance of back pain;
• the relationship of pain to physical activity;
• the presence of concomitant diseases;
• localization of pain syndrome;
• period of pain;
• the appearance of other symptoms.

After collecting the anamnesis, the neurologist proceeded with the examination. At this stage, the specialist pays attention to the gait of the patient with pathology, the position of the spinal space, checks for the presence or absence of reflexes.

To study the patient’s gait, the neurologist asked the patient to walk a few meters in the office, and also performed some tests. If, while walking, the patient is unable to transfer support to his feet, performs unnecessary movements - this is one of the obvious signs of neurological disease.

In addition, the position of the spine must be assessed. A neurologist observes the presence or absence of kyphosis, lordosis, and scoliosis. Specialists assess with the help of tests the patient's response to reflex irritation.

When back pain occurs, the disease may be accompanied by changes in sensitivity. That is why neurologists evaluate the state of sensitivity, temperature and other types of sensitivity. Also, specialists note the appearance of pathological sensations, for example, a creeping feeling or tingling in the back.

After the examination, the neurologist may prescribe some additional studies. Instrumental examination is required when necessary to determine the exact localization of the pathological focus. Modern methods allow a safe and painless examination, the result of which the patient receives after a few days.

To diagnose the cause of back pain, a neurologist may send a patient to undergo the following diagnostic steps:

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

In some cases, additional tests may not be needed to make a diagnosis. After receiving the instrumental diagnostic results, the neurologist selects the optimal treatment tactics.

Treatment of back pain

Treatment of acute or chronic back pain must be done under the supervision of a physician. The independent use of drugs not only leads to ineffective treatment, but also the emergence of complications of the disease. That is why it is recommended to seek medical help from a specialist in case of back pain. Upon passing diagnostic tests, patients will be given treatment based on clinical features, pathogenetic mechanisms and disease course.

A few years ago, in medicine, when pain in the back appeared, it was recommended to observe rest in a tight bed. Now there is no need to restrict the movement of the patient. In addition, wearing a special bandage and using a cane or cane while walking is also recommended.

Modern treatments for back pain are based on evidence -based medicine. They use not only drugs, but also non-drug treatment methods.

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

• non-steroidal anti-inflammatory drugs;
• muscle relaxation to reduce muscle tone;
• analgesic.

The groups of drugs listed can be used in monotherapy and combination to achieve a medicinal effect. Along with medications for back pain, manual therapy is recommended.

If the patient's pain syndrome is very pronounced, it should be done to limit daily activities, as well as adhere to the recommendations of other doctors, but in general, the previous level of physical activity should be maintained.

For chronic back pain, in addition to the treatment methods listed, physiotherapy training methods (exercise therapy) can also be used. In addition, a neurologist may recommend a massage session. Particular attention is given to cognitive-behavioral therapy in conjunction with antidepressant intake.

The duration of treatment is determined by a neurologist. If treatment is not effective, you should change medication groups, as well as do additional research.

Prediction

With timely diagnosis and properly chosen treatment tactics, back pain can go away after a few weeks. In the chronic course, long -term remission can be achieved if the recommendations of the attending physician are adhered to.

Prophylaxis

To prevent the onset of back pain, you should adhere to a healthy lifestyle and spread physical activity properly so as not to cause excessive load on various parts of the spine. In addition, concomitant diseases should be diagnosed and treated in a timely manner.