Back pain: treatment, causes and characteristics

Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and is one of the most urgent problems of modern healthcare, and the treatment of back pain is a difficult task.

Although pain can occur in any part of the spine, the most common location is the lower back - according to researchers, the prevalence of low back pain in the adult population is as high as 76%.

According to statistics, within 1 year, about 80% of people complain of at least one attack of pain in the lower back, and in the next 12 months, 75% of them experience a recurrence of the pain syndrome.

Types and manifestations of pain syndrome

Depending on the affected segment of the back, the pain syndrome is divided into pain in the neck, middle of the back (chest pain), lower back (lumbar pain) or coccydynia (pain in the tail or palate).

According to the results of the research conducted with the participation of 46 thousand volunteers from several European countries, chronic pain in different parts of the spine characterizes 24% of the population, in the lumbar region - 18%, and neck pain characterizes 8% of the population.
Duration of pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.

The pain can be dull or shooting, sometimes there is a burning and tingling sensation.Symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the level of spinal involvement.Another possible symptom of back pain is numbness or weakness in the upper and lower limbs.Limitation of the range of certain movements or increased pain in certain positions of the body is also observed in some patients with back pain syndrome.

Back Pain: Why Does It Happen?

During examination, it is not always possible to determine the direct cause of back pain, in this case the pain is called "non-specific" or "mechanical".The cause of this pain is pathological changes in the musculoskeletal system, but damage to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients.Secondary pain due to underlying disease accounts for about 2% of cases.

Non-specific back pain has the following characteristics:

• Tends to improve or worsen depending on body position - for example, the patient may feel better when sitting or lying down;
• The pain often worsens when moving;
• The attack may develop suddenly or gradually increase;
• Sometimes back pain is the result of bad posture or awkward lifting, but often it occurs for no apparent reason;
• Can be caused by a minor injury, such as a sprained ligament or muscle;
• Can occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for the development of non-specific back pain:

• hard physical work;
• frequent bending and bending of the body;
• lifting heavy objects, especially from the wrong position;
• lifeless lifestyle;
• industrial impacts such as vibration;
• pregnancy;
• Age-related changes in the musculoskeletal system.

Acute pain has physiological significance because it indicates the acute impact of an unfavorable factor.

The most common causes of acute back pain are:

• damage to various structures of the spine;
• spondylolisthesis - displacement of vertebrae relative to each other;
• Sciatica – inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the back to the legs.
• cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
• Intercostal neuralgia - caused by compression or irritation of nerve roots of intercostal nerves;

It is important to remember that acute pain indicates the onset of a disorder, whereas chronic pain captures this pathological effect and suggests a developing disorder.

Conditions that can cause chronic back pain include:

• intervertebral disc displacement or prolapse;
• Autoimmune diseases of the joints, such as ankylosing spondylitis (swelling of the spinal joints);
• Radiculopathy - inflammation and degeneration of the nerves leading from the spinal cord to the muscles and joints;
• Arthritis and arthrosis of spinal joints of various origins.

Less often, back pain can be a sign of more serious diseases, such as:

• infectious process (for example, meningitis, tuberculosis);
• diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
• Metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Diagnosis of back pain syndrome

In order to understand what to do with severe back pain, it is advisable to first determine its cause.An accurate diagnosis is the key to a well-designed treatment plan.

After carefully examining the patient's complaints, medical history, and nature of symptoms, the doctor may order imaging studies and functional tests to confirm the diagnosis.

• X-ray of the spineIt is used to detect degenerative diseases and fractures.
• Computed tomographyProvides detailed cross-sectional images of the spinal column that show even subtle changes in the bones.
• Magnetic resonance imagingShows both tissue and bone structures and is used to identify slipped or herniated discs, pinched nerves, or the spinal cord.
• while conductingmyelogramsA special biological dye is used, which is injected into the spinal area, to better visualize the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
• Electrodiagnostic testingAllows you to evaluate the electrical activity of the nerves in the upper and lower limbs.
• Positron emission scanning of bonesIt reveals, first of all, bone oncopathology.
• Densitometry - determination of bone density - is indicatedFor diseases and conditions that cause a decrease in bone mineral density.

Methods of combating back pain

The complex structure of pain in different parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.

The principles of therapy for patients with chronic back pain, based on evidence-based medicine, include:

1. explain to the patient the causes of pain and, as a rule, its benign origin;
2. ensuring a sufficient level of daily physical activity;
3. prescribing effective and safe treatment, primarily for pain relief;
4. Correction of therapy if it is ineffective after 1-3 months.

International clinical recommendations of doctors provide a general algorithm on how to treat chronic low back pain.Non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical treatments, physical therapy, manual therapy, as well as antidepressants and psychotherapy are believed to be the most effective methods of long-term pain treatment.

Non-narcotic treatment of back pain

In most cases, a patient with back pain will improve within 2-6 weeks.The main goal of non-specific treatment is to reduce movement limitations, minimize recurrences, and although good physical exercise cannot prevent all painful episodes, it helps to resolve these episodes.

Development of correct motor stereotypes and physical therapy are important areas of non-pharmacological pain management.

Depending on the duration, non-drug treatment of back pain can be divided into three phases.

Stage I- Passive physiotherapy during the acute period (6 weeks).

II stageActive exercises in the subacute period (6-12 weeks).

III stage- Rehabilitation physiotherapeutic effects.

Bed rest is prescribed for acute back pain only for a limited period of time.

Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:

1. Non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular exercise and gentle stretching are recommended to improve long-term results.Physical therapy to strengthen the abdominal and back muscles may also be recommended;
2. Therapeutic massage is used for short-term pain relief but does not lead to long-term functional improvement;
3. Use of acupuncture, manual therapy and spinal traction methods.

Regardless of which method of conservative treatment is used, it is important to remember that the patient may not experience immediate relief and improvement will occur over several weeks or months.

Pain medication treatment

The most common drug treatments for back pain are:

1. Nonsteroidal anti-inflammatory drugs and muscle relaxants.
2. Injections of steroid hormones into the joint cavity or epidural space of the spine, which reduce inflammation and pain in the back.However, this type of therapy is not intended for long-term use due to the side effects of the drugs.

When is surgical treatment used?

Although the vast majority of people with back or neck pain will recover over time without medication or non-surgical treatment, some patients may require surgical correction of spinal abnormalities.In general, a patient with back pain can undergo surgery if the following criteria are met:

• A structural problem has been identified and confirmed by imaging (eg, X-ray or MRI);
• Conservative treatments such as physical therapy or medications have not provided adequate pain relief;
• Back pain is debilitating and prevents participation in daily activities or physical activity;
• Symptoms negatively affect physical or emotional health;
• There are objective reasons, confirmed by diagnostic methods, to believe that spine surgery will be useful;
• Neurological damage occurs.

Prevention of back pain

Maintaining a healthy lifestyle is the key to preventing back pain.Being overweight puts stress on your back, so it's important to maintain a healthy weight.Regular exercise strengthens the abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues in the body, including the spine, so quitting tobacco products is another step toward a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective means of preventing back pain.