Back painindicate a disease or damage to the spine, nerve structures, soft tissues and internal organs, which is observed in febrile diseases of various origins. It happens sharp, boring, constant, periodic, burning, shooting, bursting. Sometimes combined with physical activity, the weather changes. Pathologies manifested by back pain are diagnosed on the basis of complaints, anamnesis, examination data and additional studies: X-ray, MRI, CT. Before making a diagnosis, it is necessary to rest, sometimes it is permissible to use ointments and take analgesics.
Why does the lower back hurt
Congenital abnormalities and acquired diseases of the spine are common causes of back pain. The type of pain syndrome varies. The pain directly caused by the pathological process, more often periodic, local, painful or pulling, is related to the weather, physical exertion and uncomfortable position.
Lumbago (lumbago) occurs as a result of muscle cramps - a sharp pain that is accompanied by restricted mobility. Lumboischialgia is observed with many pathologies of the spine - aching, burning or stabbing pain in the lower back that radiates along the back of the thigh. Painful sensations are often found in the composition of the radicular syndrome. They can be detected in the following diseases of the spine:
- Degenerative pathologies: osteochondrosis, protrusion of the intervertebral disc, herniated disc, spondylosis, spondyloarthrosis.
- Congenital anomalies: sacralization, lumbarization.
- Polyethiological conditions: spondylolysis, spondylolisthesis.
- Vascular diseases: disorders of the cerebrospinal circulation.
- Other diseases: Forestier's disease.
- Secondary lesions of nerve structures: lumbosacral sciatica, lumbosacral plexitis, myelopathy of various origins.
Curvature of the spine
With all types of curvature of the spine, slight or moderate pain occurs, which is associated with an unphysiological redistribution of the load, an overload of the muscles and ligaments of the back. Pain occurs due to an uncomfortable position of the body, sleeping on a bed that is too hard or too soft. The symptom is accompanied by:
- Flat-Back Syndrome.
Pulling or aching pains in the lumbar and thoracic spine have long been the only symptom of osteoporosis. The pain syndrome is mild and increases after exercise, before weather conditions change. The symptom is seen in the following types of osteoporosis:
Similar pain occurs in patients with secondary forms of pathology caused by genetic diseases, endocrine disorders, chronic poisoning and the use of certain drugs. Secondary osteoporosis can also occur on a background of malabsorption syndrome, liver disease, chronic kidney failure, rheumatoid arthritis and SLE.
Increased pain, an increase in the duration of the pain can be associated with the development of a pathological fracture. Other signs of trauma are often not pronounced, so the fracture often goes undiagnosed.
The most common injury is a bruise to the spine. In mild cases, the pathology is manifested in moderate lower back pain, which is aggravated by movement, local edema, and sometimes bruises and bleeding. With severe bruising, neurological disorders are added to the listed symptoms.
A compression fracture of the lumbar spine occurs as a result of forced flexion of the trunk. It is characterized by sharp pain, respiratory failure at the time of injury. Then there is an increase in pain when turning the body, edema of soft tissues is revealed. Palpation of the spinous process is painful. Other possible breaks are damage to arches, transverse processes, and spinous processes.
In addition, patients with traumatic spondylolisthesis and vertebral subluxation experience pain in the lower back. Paroxysmal pain sensations, reminiscent of lumbago, are complemented by a feeling of heaviness and numbness of the lower extremities.
Injuries to soft tissues and kidneys
Soft tissue contusions are associated with mild or moderate local pain that disappears quickly, and mild edema. Bleeding is possible. There is no blood contamination in the urine. Bruises to the kidney manifest as pain and minor short-term hematuria. In moderate kidney injuries, the pain syndrome is intense, the pain radiates to the lower abdomen, groin and genitals. A hematoma is visible in the lumbar region. In severe cases, there is severe pain, persistent gross hematuria. A state of shock develops.
Infections of the spine and spinal cord
Osteomyelitis of the spine can be haematogenic, post-traumatic, contact-related and post-operative. The acute form of the disease manifests itself in rapidly growing back pain in combination with chills, fever, intoxication syndrome and a deterioration in the general condition. The pain twitches, bursts, and is so severe that it impedes movement and forces the patient to freeze in bed. With chronic osteomyelitis, the manifestations are smoothed out, a fistulous passage with purulent discharge is formed.
Tuberculosis of the spine gradually develops. Initially there is periodic deep pain, which increases after exercise and increases skin sensitivity in the projection of the affected vertebrae. The gait becomes stiff. Against the background of significant destruction of bone structures, the nature of the pain changes, as it is caused by compression of the nerve roots. The pain becomes burning, radiates to the legs, supplemented by paresthesia, numbness.
In patients with epidural abscess of the spine, the pain is severe, deep, diffuse, combined with chills, hyperthermia and muscle tension. The knocking on the spinous processes of the vertebrae is painful. As the pathology progresses, radicular syndrome appears, then paresis and disorders of the pelvic organs develop.
Local inflammatory processes
Purulent processes in the superficial tissue and in the perirenal tissue are accompanied by severe pain in the lower back. Possible causes of pain are boils, carbuncles, and paranephritis.
In the first two cases, an abscess forms in the skin that looks like a limited, severely painful lump 1 cm or more in diameter of a purple or purple-cyanotic hue with one or more rods in the center. The pain increases quickly, becomes twitching, throbbing, sleepless. General hyperthermia, mild or moderate disorder of general condition is noted.
With paranephritis, a severe fever occurs at the beginning. The pain syndrome develops in 2-3 days. The pain is very severe and can spread to the abdomen or hypochondrium, which is aggravated by walking, movement, and deep breathing. With some forms of paranephritis, the patient takes a forced position due to pain. The lumbar muscles are tense. Revealed edema, local hyperemia, hyperthermia. The condition is serious.
Diffuse aching pains in the lower back, inducing the desire to change the position of the body, are characteristic of acute infections, which are accompanied by fever and intoxication syndrome. In most cases it is caused by myositis, often associated with pain in the muscles of the limbs. Observed with flu, sore throat, ARVI. Sometimes pain is caused by kidney damage. Infectious diseases that are accompanied by pain in the lumbar region include:
- hemorrhagic fever;
- Japanese mosquito encephalitis;
- Ebola fever;
- foot and mouth disease;
- severe form of coronavirus infection;
- generalized forms of bacterial, fungal and viral infections.
In a number of patients, back pain is observed during a cytokine storm - an inflammatory reaction that develops against the background of serious infectious diseases. Epidemiological myalgia is accompanied by severe paroxysmal pain lasting up to 10 minutes, which occurs not only in the lower back, but also in other parts of the back in the area of the abdominal wall, chest and extremities. Repeat this at intervals of 30-60 minutes. Combined with rhinitis, conjunctivitis, severe hyperthermia.
Other muscle lesions
Painful pains in the muscles of the lumbar spine are noted after intense physical exertion - strength exercises for the back muscles, prolonged stay in a forced position with a tense lower back. The myalgia subsides at rest, increases with movement, weakens after warming up, gentle warming up, disappears after a few days.
Myositis develops into metabolic disorders not only with infectious diseases, but also after hypothermia or overload against the background of exogenous poisoning. They are accompanied by persistent pain. There are also special forms of myositis:
- specific infectious myositis in syphilis and tuberculosis;
- idiopathic, juvenile dermatomyositis and polymyositis;
- Polymyositis and dermatomyositis in oncological pathologies, systemic diseases of the connective tissue.
Chronic diffuse pain throughout the body, including the lower back, occurs with fibromyalgia. Combined with sleep disorders, asthenia, neurotic disorders.
In addition to the listed pathologies, back pain can be disturbed under the following conditions:
- Tumors of the spine, spinal cord: sarcoma, hemangioma, metastases, intramedullary and extramedullary neoplasms of the spinal cord.
- Kidney disease: pyelonephritis, glomerulonephritis, urolithiasis, kidney infarction, renal vein thrombosis, kidney cyst, kidney cancer, purulent processes.
- Hereditary diseases: Pierre-Marie's hereditary cerebellar ataxia.
- Exogenous poisoning: abuse of phenylpropanolamine.
- Pathology of the heart and blood vessels: Leffler endocarditis, abdominal aortic aneurysm.
- Emergencies: blood transfusion shock.
In pelvic diseases, the pain syndrome sometimes radiates to the lower back. The appearance of a symptom is possible with a number of female diseases, prostate cancer, proctitis, sigmoiditis.
The primary diagnosis is carried out by an orthopedic traumatologist. If there are neurological symptoms, the patient is examined by a neurologist. The doctor questions the patient, conducts an objective examination. According to the indications, consultations with a surgeon, rheumatologist, urologist and other specialists are prescribed. The diagnostic program can include:
- Neurological examination.During the examination, the specialist evaluates reflexes, muscle strength, coordination of movements, deep and superficial sensitivity.
- Radiography.X-rays of the lumbar spine show fractures, a decrease in the height of the intervertebral discs, other degenerative changes, masses, signs of inflammation, spondylolisthesis. If necessary, standard x-rays are supplemented by functional tests.
- Other neuroimaging techniques. CT and MRI are used to clarify X-ray data. Computed tomography examines the structure of solid structures in detail, while MRI examines the condition of the ligaments and intervertebral discs. Myelography is done to rule out stenosis.
- Functional studies. The condition of the muscles and nerve conduction is assessed using electromyography, electroneurography, and evoked potential studies.
- Laboratory analyzes. To confirm the infectious nature of the disease, determine the causative agent, blood tests and microbiological studies are carried out. Serological tests are used to detect neuroinfections.
According to the indications, ultrasound examinations of the kidneys, prostate, pelvic organs, urinalysis, ultrasound examinations of the abdominal aorta and other studies are carried out.
Treatment of back pain
In the event of traumatic spinal injuries, the patient must be placed on the shield and immediately taken to a medical facility. With non-traumatic pain, the load on the back should be reduced and the position of the body optimized during work and rest. Acute pain syndrome is an indication to consult a neurologist.
A single dose of analgesics is possible until a specialist examination. With lumbago, lumbar sciatica, caused by previously diagnosed degenerative diseases of the spine, it is allowed to use local warming and anesthetics. Local remedies are not indicated if an infectious process is suspected.
Physiotherapy and drug therapy form the basis of the treatment. A protection mode is assigned to the patient. The following methods are used:
- NSAIDs. Effective for acute and chronic pain in muscles and spine. Used in the form of tablets, topical agents.
- Neurotropic Vitamins. Patients are injected with B vitamins, which enhance the effects of drugs from other groups and help relieve pain.
- Local anesthetics. In the case of persistent and acute pain, therapeutic blockade with anesthetics is carried out. To improve the outcome of the treatment, pain relievers are combined with glucocorticosteroids.
- Physiotherapy. Ultrasound, magnetotherapy, percutaneous electrical stimulation, laser therapy, and drug electrophoresis are used. Perhaps the appointment of massage, manual therapy, acupuncture.
Taking into account the specifics of the pathology, the following surgical interventions are carried out:
- Instability: interbody fusion, transpedicular fixation, plate fixation.
- Tumors, osteoporosis, osteomyelitis, tuberculosis: sequestrectomy, vertebroplasty, kyphoplasty, corporectomy.
- Intervertebral hernias: discectomy, microdiscectomy, nucleoplasty.
- Narrowing of the spinal canal: laminectomy, facetectomy, decompression of the puncture disc.
In the postoperative period, analgesics and antibiotics are prescribed. Rehabilitation activities include exercise therapy, massage, physical therapy.