Back pain: treatment, causes and characteristics

causes of back pain

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 treating back pain is not an easy task.

Although the pain syndrome can occur in any part of the spine, the most common localization is the lower back - according to researchers, the prevalence of low back pain reaches 76% among the adult population.

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 relapse of the pain syndrome.

Types and manifestations of pain syndromes

Depending on the affected segment of the back, the pain syndrome is divided into neck pain, middle back pain (chest pain), low back pain (lumbar pain) or coccydynia (pain in the coccyx or sacrum).

According to the findings of a study involving 46 thousand volunteers from several European countries, chronic pain in various parts of the spine is characteristic of 24% of the population, in the lumbar region - 18%, and neck pain occurs in 8% of the population.
The duration of the pain is acute - lasting up to 12 weeks, or chronic - longer than 12 weeks.

The pain can be dull or shooting, sometimes there is burning and stinging. Symptoms in some diseases also extend to the arms and hands, legs or feet, depending on the level of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of accompanying manifestations of back pain. Limitation of the range of some movements or increased pain in a certain position of the body is also observed in some patients with vertebral pain syndrome.

Back Pain: Why Does It Happen?

Examination may not always be able to determine the immediate cause of back pain, in which case the pain is referred to as "non-specific" or "mechanical". The cause of such pain is pathological changes in the musculoskeletal system, however, damage to the cervical, thoracic, lumbar and sacral nerves and specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients. Secondary pain on the background of the underlying disease is 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;
  • pain often worsens with movement;
  • the attack may develop suddenly or increase gradually;
  • sometimes back pain is the result of poor posture or awkward lifting, but often appears for no apparent reason;
  • it can be caused by a minor injury, such as a sprained ligament or muscle;
  • it can occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for developing non-specific back pain:

  • hard physical work;
  • frequent bending and leaning of the body;
  • lifting weights, especially from the wrong position;
  • passive lifestyle;
  • industrial influences, for example, vibrations;
  • pregnancy;
  • age-related changes in the musculoskeletal system.

Acute pain is of physiological importance, because it indicates the acute influence of some unfavorable factor.

The most common causes of acute back pain are:

  • trauma of various structures in the spine;
  • spondylolisthesis - movement of the vertebrae in relation to each other;
  • sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the human body), which runs from the lower back to the feet
  • cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
  • intercostal neuralgia - caused by compression or irritation of the nerve roots of the intercostal nerves;

It is important to remember that acute pain signals the onset of the disorder, while chronic pain corrects this pathological effect and resembles a developing disorder.

Conditions that can cause chronic back pain include:

  • displacement or prolapse of the intervertebral disc;
  • autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
  • radiculopathy - inflammation and degeneration of the nerves that go from the spinal cord to the muscles and joints;
  • arthritis and arthrosis of the spine joints of different origins.
Much less often, back pain can be a sign of more serious conditions, such as:
  • infectious process (for example, meningitis, tuberculosis);
  • diseases of internal organs (aneurysm of the abdominal aorta or gynecological pathology);
  • metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Diagnosis of back pain

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

After a thorough examination of the patient's complaints, history and nature of symptoms, the doctor may prescribe imaging tests and functional tests to confirm the diagnosis.

  • X-ray of the spineit is used to detect degenerative diseases and fractures.
  • CT scannerprovides detailed cross-sectional images of the spine, showing even small changes in the bones.
  • M. R. IIt shows tissue and bone structures and is used to detect slipped or herniated discs, pinched nerves or the spinal cord.
  • When conductingmyelogramsa special biological preparation is used - a dye that is injected into the area around the spinal column for better visualization of the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
  • Electrodiagnostic examinationenables the assessment of the electrical activity of the nerves in the upper and lower extremities.
  • Positron emission from bonesreveals, above all, bone oncopathology.
  • Densitometry - determination of bone density - indicatedin diseases and conditions that lead to a decrease in bone mineral density.

Ways to solve back pain

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

Principles of therapy for a patient with chronic back pain, based on evidence-based medicine, include:

  1. explaining to the patient the cause of the pain and, as a rule, its benign origin;
  2. Ensuring a sufficient level of daily physical activity;
  3. determination of effective and safe treatment, primarily for pain relief;
  4. correction of therapy in case of its ineffectiveness after 1-3 months.
International clinical recommendations of doctors provide a general algorithm for curing chronic back pain. Non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical treatment, physical therapy, manual therapy, as well as antidepressants and psychotherapy are considered the most effective methods for treating long-term pain.

Back pain treatment without drugs

In most cases, a patient with back pain improves within 2-6 weeks. The main goal of non-specific treatment is to reduce movement restrictions, minimize recurrence, and although good physical condition cannot prevent all painful episodes, it facilitates the resolution of these episodes.

The development of the correct motor stereotype and exercise therapy are important areas of non-pharmacological correction of pain syndromes.

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

I stage- passive physiotherapy during the acute period (6 weeks).

II phase- active exercise during the subacute period (6-12 weeks).

Phase III- rehabilitative physiotherapeutic influence.

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 treat pain, such as:

  1. non-specific physical exercises, such as daily walking, cycling, swimming. For uncomplicated back pain, regular physical activity and light stretching exercises are recommended to improve long-term results. Physiotherapy may also be recommended to strengthen the abdominal and spinal muscles;
  2. therapeutic massage is used for short-term pain relief, but does not lead to long-term functional improvement;
  3. application 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 feel immediate relief and improvement will come in weeks or months.

Medical treatment for pain

The most common medical 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 reduces inflammation and back pain. However, this type of therapy is not intended for long-term use due to the side effects of the drugs.

When is surgery used?

While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may require surgical correction of spinal disease. In general, a patient with spinal pain can be operated on if the following criteria are met:
  • the structural problem is diagnosed and confirmed by imaging (such as an X-ray or MRI);
  • conservative treatments such as physiotherapy or medication have failed to provide adequate pain relief;
  • back pain is debilitating - interferes with participation in daily activities or physical activity;
  • symptoms negatively affect physical or emotional health;
  • there are objective, confirmed by diagnostic methods, reasons to believe that spine surgery will be useful;
  • there is neurological damage.

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 contributing to the aging of the spine, so avoiding the use of tobacco products is another step towards a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.