In most cases, lower back pain is caused by hypothermia or muscle strain from awkward movements or heavy lifting and can go away on its own. If the pain interferes with the normal rhythm of life, the improvement does not occur for too long, or other suspicious symptoms are present, then the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.
Depending on how long the pain has been bothering the patient, doctors distinguish:
- acute pain - less than 4 weeks,
- subacute pain - from 4 to 12 weeks,
- chronic pain - more than 12 weeks.
During the appointment, the doctor explains to the patient exactly how the back hurts: it can be a sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other different unpleasant sensations-difference. intensity. Based on the duration, location and nature of the pain, the doctor considers the cause.
Pain in the lumbar spine: causes
Pain in the lumbar region can be associated with spinal problems and with other organs and systems in the body. To understand how to heal the lower back, you need to determine what is causing the pain.
There is vertebrogenic pain caused by diseases of the spine:
- Osteochondrosis, indicated by problems with intervertebral discs, facets or facet joints. Disorders occur with age in any person: the intervertebral disc loses moisture and elasticity, the facet joints become denser and become less mobile.
- Overstrain the muscles and ligaments of the spine.
- Spinal nerve root compression - radiculopathies.
- Spinal cord injury.
- Instability of the spine is caused by the weakness of the ligament-muscle system.
Non-vertebral causes include:
Neurological disorders - Lumbosacral plexopathies are damage to the nerve plexus that gives rise to peripheral nerves in the lower leg. Occurs with injuries and metabolic disorders.
- Dystonia is a violation of the tone of the muscles that support the spine. In this case, pain may be accompanied by poor posture. This disease may be congenital.
Systemic disease - Infections affecting vertebrae, discs, spinal cord membranes, or the spinal cord itself, eg, osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in skeletal bone density, fraught with vertebral fractures.
- Rheumatic diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.
Pain from internal organs. It is caused by a source outside the spine and radiates to the lower back, sometimes in the middle, sometimes to the sides - depending on the source organ. This includes:- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pains in the back and sides accompany renal colic when the stone moves along the ureter.
- Aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body forms a bulge. This can cause a throbbing sensation in the stomach.
- Diseases of the hip joint - injury, inflammation, degeneration.
Psychogenic pain Lower back pain may be associated with anxiety disorders or depression.
An injury to the spinal cord or the root of the lower spine, called the cauda equina, is a medical emergency. Compression of this structure can be caused by:
- disc herniation,
- injury,
- malignant or benign tumors,
- infection.
Spinal cord compression is accompanied by severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness in the lower legs, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.
symptoms
Often low back pain is non-specific, that is, caused by a harmless musculoskeletal disorder. The patient in this case described the following complaints:
- Pain, pulling, or squeezing.
- The appearance or increase of pain when a person stands or sits for a long time, lifts something heavy, does physical work with raised hands, for example, hanging curtains, changing light bulbs in a chandelier, bending repeatedly and for a long time: while washing the floor, inhale, remove snow.
- No other symptoms.
The fact that pain can be a symptom of several dangerous conditions is shown by"Red flag":
- Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
- Pain at rest and at night, disturbing sleep. Non-specific pain usually appears with movement or prolonged static load, but disappears after resting in a comfortable position.
- Generalized weakness is also not characteristic of nonspecific pain.
- Unexplained weight loss over the past few months. It may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Body temperature rises, chills. Indicates severe inflammation of various origins.
- Severe or worsening decreased sensitivity or weakness in leg muscles.
- Impaired bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower part of the spinal cord go to the pelvic organs and lower legs. They contain both sensory and motor fibers. Loss of sensation or movement combined with acute pain is a sign of nerve compression, and possibly the spinal cord. If this condition is not treated by a doctor, nerve function or part of the spinal cord may be lost forever.
- Less effect from treatment and transition of acute to chronic pain.
- Characteristics of medical history. For example, if lower back pain appears in a patient with a diagnosis of osteoporosis or a previously established malignant tumor. It doesn't matter how long ago the diagnosis was made. Or the pain has appeared in someone who has recently undergone any serious infection, surgery, or has a dramatically reduced immune system for any reason, for example, has taken glucocorticoids for a long time or has poorly controlled diabetes. In this case, lower back pain may indicate various complications.
If you have identified at least one of the things listed, immediately consult a doctor for additional examinations.
Diagnostics
Pain is a subjective symptom, so the survey and examination by the doctor play a big role in the diagnosis. The doctor prescribes additional examinations depending on the diagnosis he recommends. For an accurate diagnosis, do:
- Lab test— complete blood count, biochemical blood tests, general urine tests, tests to detect infections, autoimmune diseases.
- Electroneuromyography- the study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of lesions in neurological disorders.
- Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spine, the presence of hernias, spinal nerve root compression.
- Ultrasonographykidney and abdominal cavity - carried out if pathology of internal organs is suspected.
- Assessment of bone condition: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.
If the doctor is absolutely sure that the back pain is non-specific, he can prescribe treatment based only on the examination, without additional tests.
Often, with lower back pain, a person does not see a doctor, but only comes for an MRI of the spine himself. This approach can confuse patients: studies have shown that most adults have a herniated disc without symptoms. The patient attributed the pain to these MRI findings and did not seek further medical treatment. As a result, a person experiences discomfort for a long time, takes painkillers uncontrollably, and experiences complications and side effects.
Which doctor should I contact?
First, if you have lower back pain, you can also consult a general practitioner. He will suggest what is causing the pain and, depending on this, will refer you to another specialist. You can skip this step and immediately make an appointment with a neurologist.
If the neurologist, after a specific examination, suspects a pathology outside the spine, he can refer to:
- rheumatologist,
- surgeons,
- urologist,
- gastroenterologist,
- endocrinologist,
- oncologist.
Doctors of all these specialties regularly encounter the symptoms of lower back pain, because it has a large number of possible causes.
If the diagnosis of mechanical pain has been established, the patient will be treated by physical therapists, reflexologists, physiotherapists and massage therapists.
How to cure back pain
- SurgeryIt is mainly used for signs of compression of the spinal cord or spinal cord root, when the patient has paresis of the limbs or urinary disorders. These symptoms may be caused by an intervertebral hernia, tumor, or injury. Also, consultation with a neurosurgeon may be recommended for patients with chronic pain when conservative treatment is ineffective within 12 weeks. The decision about surgery is made only after visualization of the spine.
Studies have shown that uncomplicated disc herniations can be treated successfully without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.
- Conservative treatmentincluding medical and non-medical methods.
Drug treatment is carried out using non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax muscles.
Non-drug treatments include:
- Physiotherapy— it aims to quickly eliminate pain and inflammation, as well as accelerate tissue recovery and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
- Acupuncture- inserting special sterile needles into biologically active points to reduce pain and relax muscles.
- massage— increases the mobility of the spine and joints, promotes the correct distribution of the load on the back muscles.
- Physical therapy- allows you to relax and strengthen your back muscles. Exercise is effective for acute and chronic back pain.
If the patient experiences pain for more than 12 weeks, we are talking about chronic pain. In its treatment, antidepressants with analgesic effects, as well as cognitive behavioral psychotherapy, are added to all the above methods.
Bed rest is not beneficial in the treatment of mechanical low back pain and is not an alternative to the above methods. Moreover, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly delays recovery.
Consequences
Acute non-specific low back pain has a favorable prognosis. Of those who seek prompt treatment, 70–90% improve within a few days. The frequency of relapse depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with an analgesic effect. If the pain is caused by compression of the spinal nerve root by the hernia, then it may be accompanied by numbness in the limbs, as well as problems urinating and defecating.
Prevention
Helps prevent back pain:
- Moderate exercise for 150 minutes a week: walking, swimming, exercises for the core muscles: stomach, lower back, pelvic floor, thighs and buttocks.
- Maintain a healthy weight.
- Warm up every 40-60 minutes with long static positions.
- Thigh muscle stretching exercises.
- Correct body position when lifting weights: you need to squat, not lean forward.
- Prevention of decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis with densitometry. This is especially important for older people and postmenopausal women.
- Maintain general somatic and psychological health.