Today, back pain is the second most common cause for patients seeking medical attention. According to the American National Institutes of Health, one in five middle-aged people suffers from pain.
At the same time, the incidence of the disease increases only with age. In medical practice, pain (dorsalgia) is considered an interdisciplinary pathology, as in the clinic there is a symptom of both neurological and somatic diseases.
What is the cause of back pain?
Back pain in 90% of cases occurs in diseases of the spine (back pain). In other cases, the cause may be pathology of internal organs, spinal cord and others. (Nonvertebral pain).
Thus, the vertebrogenic group includes:
- intervertebral hernia; sacral or lumbalization;
- spondylosis;
- osteoporosis;
- tumor processes of the vertebrae;
- trauma (vertebral fractures, spondylolisthesis).
The nonvertebral group includes:
- psychogenic pain;
- fibromyalgia;
- pathology of the internal organs (heart attack, pneumothorax, pancreatitis, urolithiasis, etc. );
- tumors (neurinomas) and metastases;
- epidural abscess;
- syringomyelia.
Symptoms
The nature of back pain, its severity and duration vary depending on the underlying pathology.
- Intervertebral hernia.Hernial bulge appears between the vertebrae with the development of osteochondrosis. In this case, the pain may be sharp or painful and local in nature (depending on the level of the affected disc). The pain often extends to the extremities, accompanied by tingling and numbness. In advanced cases (when the hernial sac presses on the nerve roots), disorders of the sensitive and motor area of the arms or legs may occur. Rarely, there are disorders of urination, defecation and sexual function (with damage to the pelvic spine).
- Sacra or lumbalization.Sacralization is a congenital anomaly associated with the fusion of the last lumbar vertebra with the sacrum. In this case, the opposite defect is lumbarization, when the first vertebra of the sacrum separates and becomes an additional lumbar vertebra. The pathologies are usually asymptomatic, but the clinic is provoked by excessive physical activity or heavy lifting. In such cases, there is lumbar pain in the sacrum, which increases with movement, spreading to the lower extremities. The pathology is also characterized by the fact that it appears at a young age (usually 20-25 years).
- Spondylosis.Spondylosis (unlike the previous disease) occurs mainly in the elderly. The disease develops as a result of senile changes in the spine - its "wear". The pathology is accompanied by the growth of bone tissue in the form of osteophytes, which can lead to complete fusion of the vertebrae. The latter is dangerous with injuries to the neurovascular bundles, muscles and surrounding organs. The disease is accompanied by chronic pain that worsens at the end of the day. Sometimes the pain syndrome manifests itself not only in movement but also at rest, which leads to insomnia. In uncontrolled disease, there are frequent cases of immobilization of the spinal joints, as well as pinching of nerve fibers with the development of characteristic neurological disorders.
- Osteoporosis.Osteoporosis is a metabolic disorder during which bone destruction processes predominate over bone formation. The clinical picture of the disease is sparse: usually the pathological process is asymptomatic and is detected accidentally (with an X-ray). In the later stages of the disease, however, dull pain appears, as well as distortion of posture.
- Tumor processes of the vertebrae.Vertebral tumors are often asymptomatic until they grow large enough to compress nerve fibers. In such cases, chronic back pain (usually in the lower spine) occurs, which can spread to the thighs and lower legs. Sooner or later, tumor growth leads to compression of the nerve roots, which manifests itself in neurological disorders: loss of sensitivity and movement in the limbs.
- Injuries.Common causes of acute pain, limited mobility and neurological symptoms are spinal injuries: fractures, bruises, sprains / subluxations, as well as "slipping" of the vertebrae due to damage to the ligament apparatus - spondylolisthesis. Patients usually report acute diffuse back pain, bleeding ('bruising'), local swelling and restricted movement.
- Psychogenic pain.A similar view arises against the background of complete health after an emotional outburst or stressful situation. Patients describe the pain differently, which is limited only by the patient's imagination. Sometimes there is the so-called "painful behavior", when people, while maintaining mobility, tend to use auxiliary support: crutches, sticks and even wheelchairs.
- Fibromyalgia.The pain syndrome in fibromyalgia is very similar to that in psychogenic pain. At the same time, the pain is also provoked by stress, climate and emotional overload. An important difference, however, is that the pain should be observed for more than three months, accompanied by local sensitivity at characteristic points (the place of attachment of the occipital muscles, the middle of the trapezius muscles, etc. ). Also, the diagnosis requires complete exclusion of all types of somatic diseases.
- Pathologies of the internal organs.Back pain can often occur in diseases of various organs of the body. So, in a heart attack, the pain syndrome is localized behind the sternum, spreading under the shoulder blade and left arm, as well as in the spine. Pneumothorax (accumulation of air under the lining of the lungs) causes acute chest pain radiating to the spine. The symptom complex occurs against the background of difficulty breathing and cyanosis of the face. In pancreatitis (inflammation of the pancreas), the pain syndrome has a different nature, occurring in the upper abdomen in a "belt" type, covering the sides and back. Back pain occurs along with vomiting and indigestion. A complication of urolithiasis is renal colic - a syndrome of acute paroxysmal pain. Usually the pain is so severe that it makes patients bend down in search of relief. Against the background of the attack, the urine becomes dirty red due to impurities of blood.
- Tumor processes. Neurinoma is a tumor of the nerve sheath. When the roots of the spinal cord are affected, back pain usually occurs, as well as loss of sensitivity and motor activity below the level of the lesion. It is also worth noting that this tumor process is usually benign. However, such a clinical picture can be caused by metastases of cancer of the breast, prostate, lung, kidney and others.
- Epidural abscess.An epidural abscess is a collection of pus under the hard lining of the spinal cord. The disease is accompanied by an acute pain syndrome, which is complemented by neurological disorders: paresis (decreased muscle strength), loss of sensitivity, pelvic disorders and others often occur. Purulent process occurs against the background of infections, wounds, immunodeficiency or as a complication of lumbar puncture (or epidural anesthesia).
- Syringomyelia.Syringomyelia is a pathology of the nervous system, during which cavities appear in the spinal cord. Injuries, tumors, compression of the brain, etc. provoke the disease. In the initial stages, there is a slight pain in the spine, which does not cause discomfort. Then there is weight loss, muscle weakness, sensitivity to pain is lost, there is no sweating and the bones become brittle. There are often injuries to the joints, bone skeleton (burns, fractures, cuts), but due to lack of sensitivity to pain they pass imperceptibly.
Diagnostics
Diagnosis requires quality examination and physical examination of the patient by palpation (sensation), percussion (percussion) and auscultation (listening). For some pathologies it is necessary to conduct laboratory blood tests (heart attack, pancreatitis, tumor processes).
To visualize soft tissues and internal organs, you will need instrumental diagnostic methods: ultrasound or magnetic resonance imaging. While X-ray and computed tomography are used for direct examination of the skeleton.
In some cases, less common techniques may be needed: bone scintigraphy, electromyography, etc.
Treatment of back pain
To relieve acute back pain, apply ice (for 20 minutes every 4 hours), exclude physical activity, immobilizing the spine if possible. If the pain is unbearable, painkillers may be taken. However, it is worth remembering that anesthetics "lubricate" the clinic of the disease. Subsequently, this can complicate the diagnosis of the disease. Only your doctor can prescribe medication.
Disc herniation
The main drug treatment is based on the use of anti-inflammatory drugs (diclofenac, ibuprofen) and painkillers (ketorolac). In some cases, surgical removal of the intervertebral hernia may be required, as well as intervertebral disc arthroplasty.
Sacra or lumbalization
When pain occurs, blockades with anesthetics are prescribed, as well as physiotherapy (paraffin applications, electrophoresis, etc. ). With the ineffectiveness of conservative treatment, reconstructive surgeries are indicated.
Spondylosis
Anti-inflammatory drugs (Meloxicam, Indomethacin) as well as physiotherapy (ultrasound, electrophoresis) are used to eliminate inflammation and pain syndrome.
Osteoporosis
Treatment of osteoporosis begins with a diet high in calcium and vitamin D. 
Perhaps the appointment of these substances in the form of drugs. In some cases, hormone therapy with estrogen, calcitonin and parathyroid hormones is used.
Tumor processes
The treatment of tumors consists of chemotherapy and surgery. In this case, the amount of aid depends on the specific clinical case.
Injury
In case of minor injuries, a gentle regimen and warm-up are prescribed. In some situations, reduction or skeletal traction is required. When neurological symptoms occur, operations to fix bone fragments are performed.
Psychogenic pain
Help with psychogenic pain consists of complex psychotherapy, as well as taking antidepressants (fluoxetine, sertraline).
Fibromyalgia
Given that the causes of the disease are still unknown, symptomatic therapy is prescribed: antidepressants (paroxetine, amitriptyline), anticonvulsants (pregabalin), hypnotics (zopiclone) or tranquilizers (diazepam). Self-adjustment for positive thinking, avoiding stressful situations and staying in a warm dry climate are also important.
Pathologies of the internal organs
Each of the possible internal pathologies requires individual treatment tactics. Emergency treatment for heart attack is the intake of nitroglycerin (one tablet every 5 minutes until the ambulance arrives); with pancreatitis - cold, hunger and rest; with pneumothorax - a sealed (occlusive) dressing in case of an open lung wound; with renal colic - antispasmodics (drotaverine, metamizole sodium) and warming.
Epidural abscess
Treatment consists of emergency surgery to normalize the pressure in the spinal canal and drain the meninges. Antibiotic therapy (amoxicillin, cefotaxime) supports surgery.
Syringomyelia
Patients are usually advised to protect their skin from cuts and burns (the latter often occur because patients lose sensitivity and do not feel trauma). Painkillers, antidepressants (fluoxetine) and antipsychotics (chlorpromazine) are also prescribed. In some cases, surgery is possible to revise the formed cavities of the spinal cord.
Back Prevention
For the prevention of back pain it is necessary to prevent the occurrence of any of the pathologies noted above. To do this, you need to:
- Normalize your lifestyle: reduce your body weight to normal; compose a proper diet rich in trace elements and vitamins; ensure proper physical activity without overexertion.
- Give up bad habits: smoking and alcohol consumption.
- Proper posture distortion (scoliosis, lordosis) and orthopedic pathologies (flat feet, flat feet, etc. ).
- Timely diagnose and treat concomitant diseases of the musculoskeletal system or internal organs.
- Prevent or properly treat spinal injuries.
- Avoid emotional outbursts and stressful situations.
It is worth remembering that back pain is not an isolated pathology, but a symptom of a disease. The underlying disease can be extremely serious and, if left untreated, can result in injury and even death to the patient!