Back pain

12 October 2021

Back pain is one of the most common reasons for patients seeking help from medical organizations. Pain syndrome can accompany diseases affecting the spine, kidneys and other organs and systems. Treatment and prevention of back pain includes both medication and non-medication. Untimely provision of medical care can cause chronicity of the disease with the development 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. The exact localization of the pathological symptom is necessary for choosing the correct treatment tactics and the choice of preventive measures.

Definition

Pain is a pathophysiological condition that occurs in response to irritation of pain receptors. It can occur as a result of direct damage to a tissue or organ or when exposed to unfavorable 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 the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidneys, pancreas, liver, and others).

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

In most cases, the appearance of back pain is a defense reaction of the body due to the influence of unfavorable factors. The most common cause of back pain is sciatica, herniated disc or spondylosis.

Epidemiology

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

This problem can cause early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among working people. That is why pathology is a problem not only in the medical, but also in the economic sphere of activity.

Most often, people of working age from 30 to 60 years old turn to the clinic for help. This is due to the fact that with age, pathological changes of a degenerative nature appear in the spine, as a result of which acute and chronic pain appears.

In addition, men suffer from the disease more often than women. This is due to the peculiarities of work, physical labor, as well as other risk factors. According to statistics, pain appears much more often in the lumbosacral region.

Clinicians explain this fact by the fact that it is on this part of the spine that physical activity exerts the most pressure.

Risk factors

Not only stress and exercise can cause this pathology to appear. Among the main risk factors are the following:

working age from 30 years old and older;
male;
overweight and obesity (in which the body mass index exceeds 30);
the presence of other pathologies (for example, frequent migraines or diseases of the heart and blood vessels);
static physical activity, which does not differ from each other in diversity;
exposure to vibration.

In addition, smoking is noted as a risk factor by some researchers. It is possible that an intense cough in a smoker may be an indirect cause of pain.

Classification

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

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

sharp,
subacute,
chronic.

Patients with acute pain are most often treated in the outpatient clinic. Its 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, this pain is called chronic.

Acute and subacute pain most often, with proper treatment, lead to complete recovery. Chronic pain syndrome can cause 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
average,
strong.

By the nature of back pain, there are:

bursting,
aching,
shooting,
pulling,
stupid.

The nature of the pain depends on the pathology that caused the syndrome. So, with osteochondrosis, pulling pain worries, which differs in irradiation to the lower extremities. With sciatica, stabbing pain appears, which is often one-sided.

According to the localization of back pain, there are:

local (local),
reflected,
irradiating.

Local pain occurs when the pathological focus is located directly 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 region of the spine, the pain syndrome is constant. Its character can change with a change in body position due to irritation of the receptors.

Reflected pain occurs with pathology that affects the internal organs. Associated with the anatomical features of the innervation. So, with the reflected type, pain occurs in the area of the dermatomes. The most common cause of back pain can be the pathology of the pancreas, uterus and its appendages.

Among the features of the reflected type of pain, the lack of connection with physical activity is distinguished. If, with a change in body position with a local type of pain, the intensity of the symptom increased, then in this case there is no connection.

Irradiating pains are associated with irritation of a nerve or root. Moreover, in addition to the appearance of pain in the back, the patient may complain of a decrease in sensitivity, the appearance of goose bumps (paresthesia). Often, upon examination, a neurologist can reveal pathological reflexes, which are also associated with impaired transmission of a nerve impulse.

Cause of back pain

Pain syndrome can manifest itself for several reasons:

pathology of the musculoskeletal system (trauma, sprains, hypothermia and other external causes);
spine 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 cause a psychogenic type of pain).

In addition, everyday problems can become the cause of the appearance of a pathological symptom. So, with an uncomfortable posture in sleep after waking up, the patient may complain of pain in the neck or in the lumbar spine.

Pain of vertebral origin

With this type of pain, pathological changes of the degenerative type are observed in the spine. So, vertebral bodies, intervertebral discs can be damaged. Most often, pain of vertebral origin can be associated with a disease affecting the joints.

According to statistics, patients who seek medical help complain of acute pain associated with spinal injury. The cause may be a herniated disc, spondylosis, or lumbago.

In less than 1% of all cases of visiting a doctor, neoplasms in the spine are detected. Metastasis of malignant tumors is rare, but they can also cause back pain of varying intensity.

Disease	ICD-10 code	Peculiarities
Osteochondrosis	M42	A disease in which intervertebral discs and vertebrae are destroyed. Characterized by the appearancepulling and short-term pains 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 bulge forms in the spinal canal. It appearsa sharp pain syndrome that occurs when coughing, sneezing and physical exertion.
Radiculitis	M54. 1	A disease in which degenerative changes are observed in the roots. Characterized by the appearanceaching pain associated with a change in body position or physical exertion. . . In addition to the pain syndrome, sensitivity disorders are added.
Discogenic lumbodynia	M54. 4	A pathology characterized by the sudden onset of severe pain in the lumbar region of the spine.The pain is shooting and very pronounced.
Spondylosis	M47	A disease manifested by degenerative changes in the vertebrae. Has a chronic type of course,pain while aching with irradiation to the lower extremities, neck.

It should be noted that each disease has its own characteristic features. That is why, when diagnosing, one should focus not only on anamnestic data, but also on the results of examinations. For this, modern diagnostic instrumental methods are used, which allow not only to identify the pathological focus, but also to determine its boundaries and the degree of inflammation or destruction of the anatomical structures of the spine.

It is vertebrogenic causes that provoke 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. So, with excessive physical exertion or lifting weights, an acute aching pain may suddenly appear.

Pain of non-vertebral origin

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 provoke the appearance of pain syndrome are the pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas and biliary tract. Among the first group, the following are distinguished:

occlusion of arteries,
exertional angina,
aortic aneurysm (in the abdominal or thoracic region).

Among the second group:

stomach ulcer,
duodenal ulcer,
cholelithiasis,
dyskinesia of the biliary tract,
inflammatory changes in the pancreas.

Cardiovascular diseases often provoke the appearance of pain in the back. So, with angina pectoris, the patient is worried about pain in the region of the heart, which radiates to the shoulder, arm or back. That is why, during an attack, patients may complain of aching back pain.

With angina pectoris, pain syndrome has its own characteristic features. First, the pain has a crushing character. Secondly, it appears behind the sternum radiating to the back, arms or shoulder. Thirdly, the pain syndrome disappears after immediate administration of the drug. It should be noted that physical activity and stress provoke the appearance of an attack.

An aortic aneurysm is a splitting of a blood vessel that weakens and then bulges out of the wall. In this case, the patient, when seeking medical help, complains of the appearance of dull pain in the region of the heart radiating to the back and lower extremities. Symptoms such as dizziness, weakness, a sharp drop in blood pressure will also disturb. Back pain with aortic aneurysm can appear both with the thoracic localization of the pathological focus, and with the abdominal one.

It should be noted that pain in aneurysm is not associated with physical activity. Instrumental methods are used to diagnose the disease. When an aneurysm is detected, treatment measures are immediately started, including the use of medication and surgical methods.

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

Back pain during pregnancy

Pregnancy is a physiological condition, however, the 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, in which the internal organs are displaced;
a change in the center of gravity in late pregnancy, when the bottom of the uterus descends.

The immediate cause of back pain during pregnancy can be the preliminary period. It is characterized by the appearance of contractions that are irregular. 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 these pains.

Nevertheless, the appearance of severe back pain during pregnancy can be an objective reason for seeking advice from a gynecologist. If a 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 the cause of a 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 biliary tract can cause pain.

An exacerbation of pyelonephritis or cystitis is associated not only with the ingress of microbial flora into sterile organs. Most often, extragenital diseases are caused by irritation of the walls of organs, hormonal changes during pregnancy. The stress that often accompanies pregnancy aggravates the symptoms.

Back pain with coronavirus

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

Among the main reasons are:

exposure to toxins on the body;
exacerbation of chronic diseases of the musculoskeletal system;
the emergence of new, previously not diagnosed pathologies of the spine;
viral radiculopathy.

Intoxication syndrome often accompanies diseases affecting the upper and lower respiratory tract. Its main clinical manifestations are weakness, fever, aches, and pain. With coronavirus, as with 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 cause an exacerbation of chronic diseases. In addition, against the background of a respiratory disease, previously hidden pathologies may appear. That is why patients may be concerned about back pain.

Among the main reasons, the appearance of viral radiculopathy is also distinguished. It can be associated not only with the formation of an intervertebral hernia. Radiculopathy is of concern when a viral agent causes inflammation or irritation of the roots of the spinal cord.

Diagnostic measures

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

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

the first appearance of back pain;
the connection of pain with physical activity;
the presence of concomitant diseases;
localization of pain syndrome;
the duration of the pain;
the appearance of other symptoms.

After collecting the anamnesis, the neurologist proceeds to the examination. At this stage, the specialist pays attention to the walking of the patient with pathology, the position of the spinal column, checks the presence or absence of reflexes.

To study the patient's gait, the neurologist asks the patient to walk a few meters in the office, as well as perform some tests. If, while walking, the patient cannot transfer support to his leg, performs unnecessary movements - this is one of the clear signs of a neurological disease.

In addition, the position of the spine must be assessed. A neurologist pays attention to the presence or absence of kyphosis, lordosis, and scoliosis. The specialist evaluates with the help of tests the patient's response to irritation of reflexes.

When back pain occurs, the disease may be accompanied by a change in sensitivity. That is why a neurologist evaluates the state of tactile, temperature and other types of sensitivity. Also, the specialist pays attention to the appearance of pathological sensations, for example, a feeling of creeping or tingling in the back.

After the examination, the neurologist may prescribe a number of additional studies. Instrumental examination is necessary when it is necessary to establish the exact localization of the pathological focus. Modern methods allow for a safe and painless examination, the results of which the patient receives after a few days.

To diagnose the causes of back pain, a neurologist can send a patient to undergo the following diagnostic measures:

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

In some cases, additional tests may not be required to make a diagnosis. After receiving the results of instrumental diagnostics, the neurologist chooses the optimal treatment tactics.

Back pain treatment

Treatment of acute or chronic back pain should be mandatory under the supervision of a physician. Independent use of drugs can lead not only to ineffective treatment, but also to 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. After passing the diagnostic tests, the patient will be prescribed treatment based on the characteristics of the clinic, pathogenetic mechanisms and the course of the disease.

A few years ago, in medicine, when pain in the back appeared, it was recommended to observe strict bed rest. Now there is no need to restrict the patient's movement. In addition, wearing special bandages and using crutches or stilts when walking is also recommended.

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

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

non-steroidal anti-inflammatory drugs;
muscle relaxants to reduce muscle tone;
analgesics.

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

In the case when the patient's pain syndrome is very pronounced, it will be necessary to limit daily activity, as well as adhere to other doctor's recommendations, but in general, the level of the previous physical activity should be maintained.

For chronic back pain, in addition to the listed methods of treatment, methods of physiotherapy exercises (exercise therapy) can also be used. In addition, a neurologist may recommend massage sessions. Particular attention is paid to cognitive-behavioral therapy along with the intake of antidepressants.

The duration of treatment is determined by a neurologist. In the case when the treatment was ineffective, you should change the group of drugs, as well as conduct additional research.

Forecast

With timely diagnosis and correctly chosen treatment tactics, back pain may recede after a few weeks. In a chronic course, long-term remission can be achieved if the recommendations of the attending physician are followed.

Prevention

In order to prevent the appearance of back pain, you should adhere to a healthy lifestyle and properly distribute physical activity so as not to create an overload on various parts of the spine. In addition, concomitant diseases should be diagnosed and treated in a timely manner.