Today, back pain is the second most common reason for patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people suffer from pain.
At the same time, the incidence of the disease only increases with age. In medical practice, pain (back pain) is considered an interdisciplinary pathology, because in the clinic there is a symptom of both neurological and somatic diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs with diseases of the spine (spinal pain). In other cases, the cause may be pathologies of the internal organs, spinal cord, etc. (Non-vertebral pain).
Therefore, the vertebrogenic group includes:
- intervertebral hernia;
- sacra or lumbarization;
- spondylosis;
- osteoporosis;
- tumor processes of the vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
Non-vertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumor formations (neuromas) and metastases;
- epidural abscess;
- Syringomyelia.
Symptoms
The nature of back pain, its strength and duration vary depending on the underlying pathology.
- Intervertebral hernia.A hernial protrusion appears between the vertebrae with the development of osteochondrosis. In this case, the pain can be acute or aching and be local in nature (depending on the level of the affected disc). The pain often extends to the limbs, accompanied by numbness and tingling. In advanced cases (when the hernial sac compresses the nerve roots), disturbances of the sensitive and motor spheres of the arms or legs may appear. Rarely, there are violations of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacred or lumbar.Sacralization is a congenital anomaly associated with the 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. Pathologies are usually asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In these cases, there is lower back pain in the sacrum, which increases with movement, spreading to the lower limbs. Pathology is also characterized by the fact that it manifests itself at a young age (usually at 20-25 years).
- Spondylosis.Spondylosis (unlike the previous disorder) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear". 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 injuries of neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens towards the end of the day. Sometimes the pain syndrome manifests itself not only in movement, but also at rest, leading to insomnia. With an uncontrolled disease, there are frequent 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 disease in which the processes of bone destruction prevail over bone formation. The clinical picture of the disease is poor: usually the pathological process is asymptomatic and is detected by chance (with x-ray). However, in the later stages of the disease, dull pains and bending of posture appear.
- Tumor processes of the vertebrae.Vertebral tumors are often asymptomatic until they grow large enough to compress nerve fibers. In these cases, chronic back pain occurs (usually in the lower spine), which can spread to the thighs and lower legs. Sooner or later, the growth of the tumor leads to compression of the nerve roots, which is manifested by neurological disorders: loss of sensation and movement of the limbs.
- Injuries.A common cause of acute pain, limited mobility and neurological symptoms are spinal injuries: fractures, bruises, dislocations / subluxations, as well as "slipping" of the vertebrae due to damage to the ligament system - spondylolisthesis. Typically, patients notice severe widespread back pain, bleeding ("bruising"), local swelling, and restricted movement.
- Psychogenic pain.A similar view occurs against the background of full health after an emotional outburst or stressful situation. Patients describe pain in different ways, which is limited only by the patient's imagination. Sometimes there is a so-called. "Painful behavior" when people, while maintaining mobility, tend to use auxiliary aids: crutches, canes and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is extremely similar to that in psychogenic pain. At the same time, pain is also caused by stress, climate and emotional overload. However, an important difference is that the pain must be observed for more than three months, accompanied by local sensitivity in characteristic points (the attachment point of the occipital muscles, the middle of the trapezius muscles, etc. ). In addition, the diagnosis requires the complete exclusion of all types of somatic diseases.
- Internal organ disorders.Back pain can often manifest itself with diseases of various organs of the body. So, with a heart attack, the pain syndrome is localized behind the sternum, spreading under the shoulder blade and left arm, as well as into the spine. With pneumothorax (accumulation of air under the lining of the lungs), acute chest pain occurs, radiating to the spine. A symptom complex arises against the background of breathing difficulties and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different character, it manifests itself in the "belt" upper abdomen, covering the hips and back. Back pain occurs along with vomiting and indigestion. A complication of urolithiasis is renal colic, an acute paroxysmal pain syndrome. Typically, the pain is so severe that it causes patients to bend down for relief. Against the background of an attack, urine turns dirty red due to blood impurities.
- Tumor processes. A neuroma is a tumor of the nerve sheath. When the spinal cord roots are affected, back pain usually occurs, as well as loss of sensation and motor activity below the level of the lesion. It is also worth noting that this tumor process is usually benign. However, a similar clinical picture can be caused by metastases of breast, prostate, lung, kidney, etc. cancer.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by acute pain syndrome, which is complemented by neurological disorders: paresis (decrease in muscle strength), loss of sensation, pelvic disorders, etc. often appear. A purulent process occurs against the background of infections, wounds, immunodeficiency or as a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a disease of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, brain compression, etc. They provoke the disease. In the initial stages, there is a slight pain in the spine, which does not bring discomfort. Then there is weight loss, muscle weakness, pain sensitivity is lost, there is no sweating, and the bones become brittle. Often there are injuries to the joints, bone skeleton (burns, fractures, cuts), however, due to the lack of pain sensitivity, they imperceptibly pass.
Diagnostics
As a diagnosis, a qualitative investigation and physical examination of the patient by palpation (sensation), percussion (percussion) and auscultation (listening) is required. For some pathologies, it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize the soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or magnetic resonance. Whereas X-rays and computed tomography are used for direct examination of the skeleton.
In some cases, less common techniques may be needed: bone scan, electromyography, etc.
Treatment of back pain
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), exclude physical activity, immobilizing the spine if possible. If the pain is unbearable, pain relievers can be taken. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. Subsequently, this can complicate the diagnosis of the disease. Only the attending physician can prescribe drugs.
Herniated disc
The main drug treatment is based on the use of anti-inflammatory drugs (Diclofenac, Ibuprofen) and painkillers (Ketorolac). In some cases, surgical removal of the intervertebral hernia, as well as endoprosthesis of the intervertebral disc, may be necessary.
Sacred or lumbarization
When pain occurs, blocks with anesthetics and physiotherapy (paraffin applications, electrophoresis, etc. ) are prescribed. With the ineffectiveness of conservative treatment, reconstructive operations are indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin) and physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a diet rich in calcium and vitamin D. 
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogen, calcitonin and parathyroid hormones is used.
Tumor Processes
Treatment for cancer consists of chemotherapy and surgery. In this case, the amount of assistance depends on the specific clinical case.
Injury
In case of minor injuries, a gentle regimen and warm-up are prescribed. In some situations, skeletal reduction or traction is required. When neurological symptoms appear, operations with fixation of bone fragments are performed.
Psychogenic pain
Help against psychogenic pain consists of complex psychotherapy and the intake of antidepressants (fluoxetine, sertraline).
Fibromyalgia
Since the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (Paroxetine, Amitriptyline), anticonvulsants (Pregabalin), hypnotics (Zopiclone) or tranquilizers (Diazepam). Self-tuning for positive thinking, avoiding stressful situations, and being in a hot, dry climate are also important.
Internal organ disorders
Each of the possible internal pathologies requires individual treatment tactics. The emergency room for a heart attack is taking nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis: cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in the case of an open wound of the lung; 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 the surgery.
Syringomyelia
Patients are usually advised to protect the skin from cuts and burns (the latter often occur because patients lose sensation and feel no trauma). Analgesics, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is possible to review the formed cavities of the spinal cord.
Back Prevention
For the prevention of back pain, it is necessary to prevent the occurrence of each of the aforementioned pathologies. To do this, you need:
- Normalize lifestyle: reduce body weight to normal; compose a correct diet rich in trace elements and vitamins; ensure proper physical activity without excessive effort.
- Give up bad habits: smoking and alcohol consumption.
- Correct curvature of posture (scoliosis, lordosis) and orthopedic pathologies (flat foot, clubfoot, etc. ).
- Promptly diagnose and treat concomitant diseases of the musculoskeletal system or internal organs.
- Prevent or adequately treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The main ailment can be extremely serious and, if left untreated, lead to the patient's disability and even death!