Low back pain: causes and treatment

In most cases, lower back pain is caused by hypothermia or muscle strain from awkward movement or heavy lifting and may go away on its own. If the pain disrupts the normal rhythm of life, improvement does not occur for a long time or there are other suspicious symptoms, the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.

Depending on how long the pain bothers the patient, doctors distinguish:

1. acute pain - less than 4 weeks,
2. subacute pain - from 4 to 12 weeks,
3. chronic pain - more than 12 weeks.

During the consultation, the doctor explains to the patient exactly how the back hurts: it can be sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stitches and other unpleasant sensations of varying degrees of intensity. Based on the duration, location and nature of the pain, the doctor assumes its origin.

Lumbar spine pain: causes

Pain in the lower back can be associated with both spinal problems and other organs and systems in the body. To understand how to heal your lower back, you need to determine what causes the pain.

There are vertebrogenic pains caused by spinal diseases:

• Osteochondrosis, manifested by problems in the intervertebral discs, facets or facet joints. Disorders occur with age in any person: intervertebral discs lose moisture and elasticity, joints become denser and less mobile.
• Excessive tension in the muscles and ligaments of the spine.
• Compression of spinal nerve roots - radiculopathies.
• Vertebral injury.
• Spinal instability due to weakness of the ligamentous-muscular system.

Non-vertebral causes include:

1. Neurological problems

   • Lumbosacral plexopathies are damage to the nervous plexus that gives rise to the peripheral nerves of the lower extremities. It occurs with injuries and metabolic disorders.
   • Dystonia is a violation of the tone of the muscles that support the spine. In this case, the pain may be accompanied by poor posture. The disease may be congenital.

2. Systemic diseases

   • Infections affecting the vertebrae, discs, spinal cord membranes or the spinal cord itself, e. g. osteomyelitis, epidural abscess.
   • Malignant and benign tumors, metastases.
   • Osteoporosis is a decrease in skeletal bone density, fraught with vertebral fractures.
   • Rheumatological diseases such as inflammatory spondyloarthropathy or ankylosing spondylitis.

3. Pain of internal organs.It is caused by causes external to the spine and radiates to the lower back, sometimes in the middle, sometimes to the sides – depending on the organ of origin. These include:

   • Diseases of the gastrointestinal tract - most often pancreatitis.
   • Urinary system diseases - infections such as pyelonephritis and urolithiasis. Severe acute paroxysmal pain in the back and sides accompanies renal colic when the stone moves along the ureter.
   • Aortic aneurysm is a rare and dangerous pathology in which the wall of the body's largest artery forms a bulge. This can cause a pulsing sensation in the abdomen.
   • Hip joint diseases - injuries, inflammation, degeneration.

4. Psychogenic pain

   Low back pain may be associated with an anxiety disorder or depression.

Injury to the spinal cord or lower spinal roots, called the cauda equina, is a medical emergency. Compression of these structures can be caused by:

• disc herniation,
• wound,
• malignant or benign tumor,
• infection.

Spinal cord compression is accompanied by extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness in the lower extremities, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.

Symptoms

Low back pain is often nonspecific, that is, caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:

• Aching, pulling or tight pain.
• Appearance or intensification of pain when the person stands or sits for a long time, lifts something heavy, performs physical work with arms raised, for example, hanging curtains, changing chandelier bulbs, bending down repeatedly and for a long time: when washing floors, vacuum, remove snow.
• No other symptoms.

The fact that pain may be a symptom of some dangerous condition is indicated by"red flags":

• Age over 50 years. This age group is at greater risk of osteoporosis and tumors.
• Pain at rest and at night, interfering with sleep. Nonspecific pain usually appears with movement or prolonged static load, but disappears after resting in a comfortable position.
• General weakness is also not characteristic of nonspecific pain.
• Unexplained weight loss in recent months. It may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
• Increased body temperature, chills. Indicates severe inflammation of various origins.
• Severe or increasing sensitivity or weakness in the leg muscles.
• Impaired bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower extremities. They contain sensory and motor fibers. Loss of sensation or movement combined with sharp pain is a sign of compression of a nerve and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord may be lost forever.
• Lack of treatment effect and transition from acute to chronic pain.
• Features of the medical history. For example, if low back pain appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn't matter how long ago the diagnosis was made. Or the pain appeared in a person who has recently suffered some serious infection, surgery or has a strongly reduced immune system for any reason, for example, has been taking a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, low back pain can indicate several complications.

If you have identified at least one of the listed points, immediately consult a doctor for further examination.

Diagnosis

Pain is a subjective symptom, therefore, a medical examination and examination play an important role in diagnosis. The doctor prescribes additional tests depending on the diagnosis he suggests. For an accurate diagnosis, perform:

• Laboratory tests— complete blood count, biochemical blood test, general urine test, tests to detect infections, autoimmune diseases.
• Electroneuromyography- study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
• Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help visualize all the structures of the spine, the presence of hernias, compression of the spinal nerve roots.
• Ultrasoundkidneys and abdominal cavity - carried out if pathology of internal organs is suspected.
• Assessment of bone condition: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.

If the doctor is absolutely certain that the low back pain is non-specific, he or she may prescribe treatment based on the examination alone, without additional tests.

Often, with low back pain, a person does not go to the doctor, but just does an MRI of the spine on their own. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic herniated discs. The patient attributes the pain to this finding on the MRI and does not seek further medical attention. As a result, the person suffers discomfort for a long time, takes painkillers uncontrollably and develops complications and side effects.

Which doctor should I contact?

First, if you have lower back pain, you can also see a general practitioner. He will suggest what is causing the pain and, depending on this, refer you to another specialist. You can skip this step and immediately make an appointment with a neurologist.

If a neurologist, after specialized examination, suspects a pathology outside the spine, he may refer to:

• rheumatologist,
• surgeon,
• urologist,
• gastroenterologist,
• endocrinologist,
• oncologist.

Doctors from all these specialties periodically encounter the symptom of low back pain, as it has a large number of possible causes.

If the diagnosis of mechanical pain is established, the patient will be treated by physiotherapists, a reflexologist, a physiotherapist and massage therapists.

How to cure low back pain

• SurgeryThey are mainly used for signs of compression of the spinal cord or spinal nerve roots, when the patient has paresis of a limb or urinary disorder. These symptoms may be caused by an intervertebral hernia, tumor or injury. Additionally, consultation with a neurosurgeon may be recommended to the patient in case of chronic pain when conservative treatment is ineffective within 12 weeks. The decision about surgery is made only after visualizing the spine.

  Studies have shown that uncomplicated disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.

• Conservative treatmentincludes medicinal and non-medicinal methods.

  Drug treatment is carried out with non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.

  Non-drug treatment includes:

  • Physiotherapy— aims to quickly eliminate pain and inflammation, as well as accelerate tissue restoration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
  • Acupuncture- insertion of special sterile needles into biologically active points to reduce pain and relax muscles.
  • Massage— improves the mobility of the spine and joints, promotes adequate distribution of the load on the back muscles.
  • Physiotherapy- allows you to relax and strengthen your back muscles. Exercises are effective for both acute and chronic back pain.

  If the patient has had pain for more than 12 weeks, we are talking about chronic pain. In its treatment, antidepressants with an analgesic effect, as well as cognitive-behavioral psychotherapy, are added to all of the above methods.

Bed rest has no benefit in treating mechanical low back pain and is not an alternative to the above methods. Furthermore, it should be avoided as much as possible by the patient. Prolonged bed rest causes joint stiffness, muscle tension and significantly slows down recovery.

Consequences

Acute nonspecific low back pain has a favorable prognosis. Of those who seek treatment immediately, 70–90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with analgesic effects. If the pain is caused by compression of the spinal nerve roots by a hernia, it may be accompanied by numbness in the limbs, as well as problems with urination and defecation.

Prevention

Help prevent lower back pain:

• Moderate exercise for 150 minutes per week: walking, swimming, exercises for core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
• Maintain a healthy weight.
• Warm up every 40-60 minutes with a long static position.
• Thigh muscle stretching exercises.
• Correct body position when lifting weights: you need to squat and not lean forward.
• Prevention of decreased bone density with calcium and vitamin D intake, early diagnosis of osteoporosis by densitometry. This is especially important for elderly people and postmenopausal women.
• Maintain general somatic and psychological health.