Back pain: causes and treatment

Pain in the lumbar region of the spine and adjacent areas may disturb the patient at any time of the day, standing, sitting, lying down or on-the-go, during exercise or at rest. So this symptom is not specific, that is to say, that they are in a large number of cases that require special attention, in the first place, from the patient: it is necessary to consult immediately with a doctor.

To what doctor to address?

According to statistics, up to 25% of patients seek medical help in relation to the incidence of pain in the lumbar region. 8 of every 10 inhabitants of the world have experienced pain in the back, at least 1 time in my life. Most often suffer from these symptoms of people of working age, slightly fewer people of retirement age and even fewer adolescents (by various estimates, from 8 to 40% in Russia).

Therapist, neurologist, rheumatologist

The first doctors, who address the majority of patients with pain in the lower back, become a therapist and neurologist. But young people with trauma in the recent past, more and more are turning to specialist.

And diagnostic and therapeutic tactics in these professionals are different. Often, the therapist directs the patient to the neurologist, the neurologist determines the "his" of diagnosis and prescribing a treatment. Specialist often working "individual", and in addition to using non-steroidal anti-inflammatory drugs, apply techniques of therapy manual and physiotherapy. The most important thing for the patient – not-to-miss in this situation, not to let yourself be carried away by the promises of instant healing when performing the techniques, not to resort to them again in case of a breakdown or, worse, intensified in the context of this treatment of pain.

When the conservative treatment, that is medication, you must understand that the treatment for four weeks, without result, a strong argument for the revision of the diagnosis, treatment revmatologu, not by the conduct of repeated courses of therapy. There are often situations in which a patient with complaints of pain in the lower back, receives symptomatic (only pain) treatment of some formulaic scheme, without specifying the actual cause of the pain.

Causes of lower back pain

The main causes of pain in the lumbar region is

  • the changes in the structures of the spine, usually age-related (degenerative), degenerative disc disease of the spine, a variety of herniated discs or inadequate work muscle complex. This type of pain is called primary, which is directly associated with the spine;
  • the pathological changes of organs located in the area near painful, but directly to the spine are not related (for example, diseases of the internal organs, the skin). This category of causes include joint inflammation, trauma, endocrine disorders (eg, diabetes), - in short, everything that does not fit the "natural" age-related changes" of the spine. This type of pain is called secondary.
pain in the lower back

Inspection on appointment

The pain, the feeling heavy of the mobility or the increase of the painful muscle tension in the area between the lower ribs and the buttocks denoted by the term "lyumbalgiya". If these symptoms include pain in the leg, this condition is called lyumbalgiya.

The most important thing is the sharpness of the pain, that is to say, the remoteness of their occurrence. The pain of the prescription to 12 weeks (3 months) is called acute, more than 12 weeks – chronic. Chronic pain syndrome can occur with exacerbations and periods of improvement.

Of fundamental importance is how the pain is felt. Or feeling at a certain point, or distribution ("projection", "irradiation") is pain along the nerve in the thigh, buttock, knee, foot, or diffuse, "blunt" pain. You need to understand that restricted the movement of the spine in the moments of pain, of movement or unimpeded (this can indicate the mechanics of the nature of the damage, such as fracture of the vertebra). In what moments there is pain? Does not occur under load, or at rest during a night's sleep? An affirmative answer to the last question is, generally, a "red flag" for experts and makes you wonder about the diagnosis of inflammatory diseases of the spine in a patient (a little later). If the pain increases with the movement of the head, walk, jump, it is probably on the so-called projected pain, the cause of which is damage to nerve structures (most often sciatica).

Osteochondrosis, or spondilez – a condition in which there is compression and deformation of the vertebrae, with the arrival of the little bone surfaces, such as spikes at the edges of the vertebrae. For a long time it was assumed spondilez the result of the natural course of the degenerative processes of old age. However, it was demonstrated that not only the age can be a cause of lower back pain. Sedentary lifestyle, increase in the load on the lumbar spine during prolonged work at a computer or prolonged driving (for example, the profession of truck drivers) contribute to the onset of osteoarthritis, even in young people. Under the influence of all these factors, the intervertebral discs become thinner buffers, and the nerve roots that go from the spinal cord injured raised the marginal spikes of bone. The constant irritation of these roots and causes of pain. In Latin the root is called the radix, so that this inflammation is usually called radikulit.

The so-called inflammatory diseases of the spine – the area of interests of rheumatology. These mysterious diseases can "smolder" for a few years, on the basis, mainly, in young age and mainly affecting men, and resulting in the end in obezdvizhennost' I invalidizatsiyu patient. The patients of this group in general "go to last" and night pain, and morning stiffness in the back, and weakness, and the growing decline of health. Unfortunately, since the appearance of the first symptoms of the disease before the correct diagnosis on average it takes about seven years. During this time, changes in the spine may be irreversible, and functional (locomotor) activity is low. The spine becomes fixed, changes shape, there is a hump. To find this pathology is not as common as low back pain, for example, but the cost of treatment and the total disability of these patients is disproportionately higher.

If in addition to the back pain patient speaks of the inflammation of the joints (most often we are talking about the knee joints, the joints of the hands or the feet), pain in the buttocks, unstable chair with unusual impurities, changes in vision or pain in the eyes, this is also a reason to immediately send it to a specialist for the implementation of certain additional examination and exclusion of diseases from the group spondiloartritov (for example, seronegative spondylitis or crohn's disease).

There are diseases manifested by pain in the lower back completely virgin of vertebrates or the structures neural. A disease – myofascial pain syndrome. Patients (especially young patients), indicate that spending long periods of time, in an awkward position or physical overload, preceded the development of pain. When doctors drew the attention of a sharp pain when pressure on certain points located near the spine. This condition significantly reduces the patient's quality of life, but some minor changes in the muscle tissue (local strain) is not a danger to the nerve roots or in the internal organs. Usually, the therapeutic effect can be achieved by means of the purpose of muscle relaxants, low-dose nonsteroidal anti-inflammatory drugs, local injection (injection) in the "pain point" - steroidal anti-inflammatory drugs.

Exam

It is considered that if a patient with complaints of pain in the lower part of the back does not have "red flags" (discussed below), then additional proof is not necessary, and the treatment can be carried out by the physician without tests, and even x-rays. But, as practice shows, almost every patient these "signs" can be detected, and therefore there is a need to give blood as the least common (and better – more immune) of the analysis, and perform x-rays of the lumbar spine in two projections (ideally with the "capture" of the pelvis).

  • - Blood tests to detect the increase of the erythrocyte rate sedimentation (esr), which indicates inflammation, probably immune in origin, or infection. To increase the level of leukocytes also suggests infection or inflammation, and anemia in severe – on the possible presence of cancer.
  • - Urinalysis for rent with suspected kidney disease. Pain in the lumbar region is periodic in nature, often "broadcast" up to the bottom of the ribs. If there are changes in the urine analysis performed ultrasound renal, and tactics is discussed in detail with a therapist or urologist.
  • - X-ray – the cheapest of instrumental examinations, is the method of choice in the diagnostic finding in this case. On the radiograph you can see the violation of the structures of the spine, signs of inflammation of the vertebral joints, on circumstantial evidence to determine the location of the compression of nerves. "Transparency" of the vertebrae in the x-rays will give rise to the idea of osteoporosis (fragility) bone of the skeleton. As you know, on the background of osteoporosis, the most common complications such as the fracture of vertebra. If the fracture is, alas, to take place, it can also be seen in the radiograph. The possibilities of this method of research is very large, but if the pathology is found, one must ask how serious the damage is, not whether the patient needs surgical intervention to the spine. This has required a more precise study – level (CT). There are two types of tomography – computed x-ray and magnetic resonance imaging.
  • - Computed tomography (CT). Survey method that allows you to literally look inside of the spine. All the bone structure, which are not visible in x-ray, tomogram will be perfectly visible. If it is necessary, using the data and a special computer program can reconstruct a 3D model of any structure.
  • - Magnetic resonance imaging (MRI). No x-ray method of research. Different from CT that allows the doctor to more closely assess the condition of the soft structures of the spine (visible on CT only os elements): the spinal cord, the roots. More details when the survey is seen vertebral hernias, vascular changes and muscle. In general, for a specialist in magnetic RESONANCE imaging remains the last word in the diagnosis of the search and the definition of new tactics.

Signs that you should pay attention

Secondary back pain that is not related to lower back pain is an alarming symptom, forcing you to start a search of the primary pathological process causing the pain. A brief description of the symptoms, which may indicate possible secondary (i.e., that are not directly related to the spine) character of pain and requires an increase of the monitoring, the doctor and the patient:

  • fast sudden loss of body weight (may be a suspected tumor);
  • the infection of the kidneys and the bladder (in this case, the pain can be a symptom of pyelonephritis);
  • increased pain at rest or after a night's sleep (this symptom is especially interested in rheumatology, as it can be a sign of developing Bechterew's disease);
  • the increase of the body temperature;
  • changes in blood tests (increased blood clotting, discovered when you run coagulogram, increased level of leukocytes or drop in hemoglobin and increased ESR (erythrocyte sedimentation rate) in the overall analysis, the increased levels of C-reactive protein analysis);
  • diagnosis "osteoporosis", or take medicines that reduce the amount of calcium in the bones;
  • age over 50 years (risk of osteoporosis in women in menopause) or under 20 years of age, especially for children;
  • link to the injury, regardless of its limitations (for example, a drop of over 2 metres, and for the elderly a major injury falling from height of own body);
  • signs of severe disorders neurological (impairment of the sensitivity of the skin, urination or bowel movement is usually an indication that a deep injury of the spinal cord);
  • the inefficiency of the "routine" treatment for 4 weeks.
pain

To maintain activity and mobility

A common mistake is to comply with bed rest for acute back pain. The movement in this pathology of the locomotor system is not only necessary, but essential! In all cases, except for the compression radicular syndrome (diagnosis is established by the neurologist), being in a horizontal position increases the cost of treatment and prolongs the time of recovery. And when syndrome root, the total time in bed should not be more than two days.

In inflammatory diseases of the spine and of the joints sacroiliac physical activity is the primary means of combat the next disability. Recall that this group of diseases slowly progressive in nature, and serves as a purpose the maintenance of the flexibility, and the development and strengthening muscular "corset" of the spine can be considered as an effective method of special treatment such as therapy anti-inflammatory drugs of different groups, appointed by the specialists.