Lower back pain

13 March 2022

Lower back pain may be common to almost every modern person. Employability can be affected by a variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be negligent with this, because back pain can not only reach incredible strength, making one’s life unbearable, but also become a symptom of the most dangerous disease.

Lower back pain can vary: acute or dull, painful or burning, local (appearing in one place) or spread throughout the back. Unpleasant sensations also appear in different ways: sometimes suddenly, abruptly, and sometimes gradually, increasing every day.

The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms, and other factors. But in any case, you can not leave the disease by chance. Timely treatment will help avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computation or magnetic resonance imaging. Attacks of pain, lumbosacral, appear during life, in about 80% of the modern population of European countries.

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

Pain syndrome - primary and secondary

Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and non-professionals will not be able to determine the true cause of the problem. In general, medical classification separates primary and secondary pain syndromes that can affect the lumbar region.

Primary low back pain syndrome occurs as a result of morphofunctional musculoskeletal changes. He is the cause of most cases of back pain in the lumbar region. The most notable causes are degenerative-dystrophic changes that occur in various parts of the spine:

osteochondrosis, which is a lesion of bone and cartilage tissue, the disease has a dystrophic character. With that, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or synovial joints.

Secondary pain syndromes have more diverse causes of pain:

scoliosis, which is a curvature of the spine, as well as several other growth diseases;
various inflammations of a non -infectious nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
tumors located in the vertebrae, in the spinal cord itself or in the retroperitoneal space, regardless of whether they are primary or caused by metastasis;
fracture of one or more dorsal vertebrae. This is probably 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. );
a stroke condition in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back is sore;
gastrointestinal tract disease. For example, acute appendicitis with an atypical course, intestinal obstruction;
often back pain is a reflected nature. The same problem can occur with some diseases of organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause referred 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 lost lower back pain is also often observed: in this case, there is a translation of the sensation of pain from internal organs and deeper body structures; in other words, it appears to the patient that the lower back is sore, but in fact a completely different part of the body is affected.

Often, back pain is in the lumbar region, when pain is projected into this area from pelvic organs, kidneys, pancreas, colon, or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear suggestion, what exactly can not be done: to self -medicate. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.

Possible causes of acute back pain include:

The pain is accompanied by acute stretching of the muscles. In this case, the pain signal is localized in the back, it is supplied by a spasmodic long muscle. 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 back pain is vertebral fractures (spinal fractures, including compression). As a rule, this happens with unsuccessful falls, back bends and other injuries; but if a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there is a cancerous tumor and its metastasis in the vertebral area or other lesions on the skeletal system, vertebral fractures can occur literally "out of the blue", and even without fixation by the patient sensation onfracture time.
A similarly unpleasant condition in which the lower back is suddenly sore is a displacement of the intervertebral disc that has occurred in the vertebral area. According to the frequency of lesions, areas are distinguished: LV -SII - most frequent; LIV -LV - second in frequency; LIII-LIV and above are rare cases.

Symptoms include severe back pain, forced posture, limited mobility. Participation in nerve root pathological processes is indicated by:

radicular pain, usually unilateral;
sensitivity disorders (numbness, increased or decreased level of sensitivity);
reduction or loss of the Achilles reflex (in case of damage to the S or S2 root);
decreased intensity or absence of knee jerk (indicating damage to the L3-L4 area).

The general trend is for intervertebral discs to protrude to affect the underlying root (e. g. , LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (ponytail), the function of the bladder and rectum is impaired. Also, the same situation can occur with strong protrusion of the spinal disc.

The back hurts sharply in the lumbar region with facet syndrome: in this case, the disc remains unaffected, and pain appears as a result of compression of the root itself in the outlet of the spinal canal. The most common facet syndrome observed is of the unilateral type in the L5 root region; arises based on an increase in aspects of the intervertebral joints (upper and lower), and, consequently, narrowing of the intervertebral foramen.

Also, severe low back pain accompanies epidural abscesses, a serious disease that requires immediate diagnosis and immediate treatment. Often, the inflammatory process develops in the thoracic region of the spine; the pain becomes very strong with mechanical effects on the pathological area (pressure, knocking).

If there are signs of spinal cord compression, any highly effective medical measure is recommended, including surgery. Another reason why the lower back hurts can be a disease of the hip joint - especially coxarthrosis. In this case, the pain is characteristic, radiating to the lower back, buttocks, and even to the legs to the knees.

Diseases characterized by chronic low back pain:

Deformed spondylosis is a disease in which there are dystrophic changes in the lumbar vertebrae, calcification of their ligament apparatus and subsequent bone growth; bone growth presses on the roots and narrows the spinal canal. In cases when aching pain in the lower back is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which can be caused by narrowing of the spinal canal, should be considered. Examination is necessary, the results of which determine the final diagnosis.
Ankylosing spondylarthrosis (or Bechterew's disease). In the early stages, it is characterized by limited mobility, especially in the morning, with a reduction in chest movement during breathing. There is an excruciating pain in the lower back; subsequently arises and lengthens the curvature of the spine in the thoracic region. X-ray examination corrects anomalies in the sacroiliac joint: destruction, changes in structure, "bamboo" spine. A thorough examination and find out the reason why the lower back hurts is necessary, because the same symptoms and limited mobility of the lower spine can also cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes as back pain: metastatic carcinomas of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). Exceptions were made by X-ray examination and myelographic methods.
Osteomyelitis also causes prolonged pain and soreness in the lower back. If the disease is suspected, x -rays of bone tissue are performed, skin tests with tuberculin and ESR determination are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causative agent of osteomyelitis.
Spinal cord tumors (intradural tumors) of various types. Diseases such as lipomas, neurofibromas, meningiomas can trigger persistent back pain, initially without any accompanying neurological symptoms.

The cause of back pain is intermittent. Many diseases of the internal organs cause periodic, sharp or exciting pain in the lower back. At the same time, the patient had no feeling of stiffness in the back area, no obvious localization of pain, and the pain did not increase with the maximum possible range of motion. To the question of what to do if the lower back hurts not always, but from time to time, the answer is simple: do not wait until it hurts "as it should", but seek medical advice.

There is a clear influence on the pathology of one or another organ on a particular part of the spine. So, from the pelvic organs, pain radiates to the sacrum, in diseases of organs located in the lower part of the abdominal cavity, it radiates to the lower back (segments L3 -L5), and in the upper - to the segment. the upper part of the lumbar zone or the lower part of the chest zone.

Diseases - causes of lower back pain, and areas of pain distribution:

If the pelvic organs are affected, with endometriosis, ovarian or uterine carcinoma, the lower back hurts. In men, intermittent pain can be caused by chronic prostatitis or the development of prostate carcinoma.
Various kidney diseases cause pain at the junction of the ribs and spine.
Tumors of the stomach, duodenum, peptic ulcer, tumors of the pancreas (especially if the disease spreads beyond the peritoneum) - the pain spreads to the area of the spinal segment T10 -L2;
With ulcerative colitis, diverticulitis, or colon tumors, the lower back is sore;
If the back is sore in the thoracic / lumbar region, aortic dissection (dissecting the aneurysm) should be omitted.

Diagnosis for low back pain

For low back and lumbago pain, it is recommended to undergo computer (showing the state of spinal bone tissue) and magnetic resonance (allows you to assess the state of soft tissue) tomography and ultrasound scan of internal organs.

One method of diagnosis is radiography, which is relatively inexpensive and can be useful in detecting a wide range of disorders, from fractures to gallstones. Most of the changes detected only suggest a correct diagnosis, and additional studies may be needed to confirm them. In addition, some radiological changes may be concurrent findings that are not the cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the neurological status of the patient is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the posterior and gluteal muscles. Already at this stage of the study, patients with spinal osteochondrosis and pain in the back and lower back can be diagnosed and treated.

Occasionally, according to the results of examination by an orthopedic specialist of a patient with symptoms of pain on the background of spinal osteochondrosis, the following additional diagnostic procedures may be prescribed:

lumbosacral spine radiography with functional testing;
CT scan of the lumbosacral spine;
MRI of the lumbosacral spine.

The center of the intervertebral disc is occupied by a gelatinous nucleus pulposus. It is surrounded and supported by a fibrous annulus, which is composed of 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 disc decreases, the vertebral bodies approach each other, reducing the intervertebral foramina and harming the nerves and ducts located within them (osteochondrosis).

Disc protrusion (intervertebral disc protrusion) with further prolapse into the lumen of the spinal canal (disc hernia) most often leads to nerve root compression, causing pain along the compressed nerve (pain radiating to the legs, arms, back of the head, neck, intercostal spacein depending on the degree of nerve compression) with weakness of muscle strength in their conservation area and violation of sensitivity.

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

In addition to nerve compression, the stability of spinal segments may also be affected. With spinal instability, the vertebrae move forward (anterolistesis) or backward (retrolisthesis). To clarify the diagnosis, an x-ray of the lumbosacral spine with functional testing may be needed.

Often, the nerve bundles that make up the sciatic nerve because of its anatomical location experience hernia compression or intervertebral disc protrusion. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord that pass through it. That is why in the case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods, and in cases of ineffectiveness, surgical treatment.

Which doctor should I call?

With pain in the spine, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Lower back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.

Lower back pain combined with various infections, limb injuries. Pain in the lower back with heart and lung disease is not excluded. This is evidenced by in -depth examination. After a patient is diagnosed, he or she is usually given medications that reduce back pain, normalize blood circulation and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and cramps.

Surgical intervention is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, it is restored, and the pain passes with time.

It is best to relax the spine and paravertebral muscles if you sleep on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this is fraught with weakness of the paravertebral muscles, which will only exacerbate the problem. Even with severe pain, you should try to maintain at least some vigorous physical activity.

How to relieve back pain

The occurrence of pain symptoms is often caused by muscle spasms, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

Therefore, with strong and unexpected pain in the lower back, it is recommended to take muscle relaxant tablets, rub the back with a warming anesthetic gel. When using funds, you should strictly follow its instructions.

In cases where unpleasant symptoms are due to the presence of inflammatory diseases of internal organs, it is recommended not to delay contact a doctor, if at a certain time it is impossible to visit a specialist, and the pain is too strong, you can take Pentalginor No-shpu. The sore spot should not be heated with a heating pad, because the heat contributes to the spread of the inflammatory process, and, consequently, to the intensification of the accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have clear anti-inflammatory, analgesic and antipyretic effects.

The course of treatment is determined taking into account the severity of pain symptoms. Ointments for back pain are used as a primary or adjunctive treatment. With obvious symptoms of osteochondrosis, rubbing the lower back with an ointment based on Ketoprofen, a substance with a strong analgesic effect, is indicated.

The main advantage of local preparations is due to its effect not on the whole body as a whole, but on specific areas that need treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects than similar medications in tablet form.

Exercise for back pain

Gymnastics is considered an additional method of treatment of lower spine diseases. The exercises shown to the patient are relatively simple and are not accompanied by special loads on the body. For example, regular hanging on a horizontal bar has a beneficial effect on the condition of the spine, helping to relax the muscles and eliminate lumbago - pain caused by pinching the nerve roots. Therapeutic exercises for back pain, accompanied by pain in the lower back, include exercises:

raise the legs (so that the knees touch the chin);
"bike", done lying on your back;
walk on your knees.

Every day it is recommended to give exercise no more than 10-15 minutes, with significant pain - to refuse to perform it.