Lumbago

Back pain (synonymous with rash) is one of the most common reasons for visiting a doctor - the second after acute respiratory diseases. Most often, such complaints come to a neurologist, therapist or general practitioner. According to international studies, 19 to 43% of the adult population surveyed recently experienced back pain in the last month, from 27 to 65% in the last year. Those who have experienced it at least once in their lives are 59-84% 1. Almost every fifth adult on our planet can experience severe back pain right now. Their most common locations are the lower back and lower back.

Why does back pain occur?

Among the main reasons for the development of back pain are:

1. Spinal causes - related to spine pathology:
   • pathology of the intervertebral discs, including hernias.
   • narrowing of the spinal canal
   • diseases of the joints
   • the consequences of injuries;
   • congenital malformations and developmental abnormalities
   • metabolic disorders
   • Spondylitis - inflammatory processes in the intervertebral joints.
2. Nonvertebrogenic - not related to spine pathology:
   • sprains of ligaments and muscles associated with heavy loads;
   • Myophase syndrome - chronic muscle pain.
   • inflammation of muscle tissue - myositis
   • diseases of the internal organs
   • pathology of large vessels, for example, aneurysm (abrupt expansion) of the abdominal aorta.
   • Arthritis of the hip joint - an inflammatory-dystrophic disease.
   • mental disorders etc.

Depending on the origin, the following types of pain can be distinguished:

• Specific- is related to a specific disease that can be detected by standard screening methods. This type occupies up to 3% 1 of all cases. These can be compression fractures of the spine, tumor, infectious processes, diseases of the pelvic organs (especially with back pain in women).

  At the same time, there are some specific symptoms, the so-called "red flags", which speak of serious diseases and require a thorough examination. These include:

  • rapid irrational weight loss and / or evidence of a history of oncology (tumors).
  • weakness in the lower extremities, decreased sensitivity and functions of the pelvic organs (cauda equina syndrome).
  • the use of antibiotic therapy, increase in body temperature (infectious processes);
  • previous trauma or previous diagnosis of osteoporosis, over 55 years of age (fracture of the spine)
  • young age - up to 20 years
  • long-term maintenance of painful sensations and their intensity, despite treatment.
  • in combination with general weakness or gait disorder, which worsens at night, does not change with a change in body position.
• Radical- next in frequency (up to 27%). It develops as a result of stinging and / or inflammation of the spinal cord root, which comes out through the openings of the spine. This type may be indicated by increased pain during coughing, sneezing, exercise and other types of activity.
• Non-specialist- more often acute, it is difficult to immediately determine the specific cause of its development, usually the consequences of dystrophic changes in the bone, cartilage tissues of the spine, as well as the muscles and ligaments that are the auxiliary device of the back. In the International Classification of Diseases (ICD-10), there is a special section for the definition of these syndromes - doses.

This rash accounts for up to 85% 1 of all cases and is mainly related to the disruption of the normal functioning of the individual structures of the spine, any of which can become a source of pain impulses. Pain can be compressive (from compression of nerve roots) and reflex - from all other tissues, including spasmodic muscles.

Another type of pain syndrome is described, which is not related to organic lesions of the spine and paravertebral tissues. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.

The location distinguishes:

What is his name	Where does it hurt
neck	sore throat
cervical spondylosis	neck + head
cervical pain	neck and hands
armor	chest and chest pain, lower back pain from the back
lumbago	lower back and lumbar region
sciatica	lower back + leg
sacerdotalism	Holy bone
coccyx	coccyx

In addition to the reasons, it is possible to identify factors that can cause the development of pain syndrome:

• severe physical overload, resulting in over-expansion of muscles and ligaments.
• unpleasant or static postures that a person takes for a long time.
• untrained muscles and overload, inactivity.
• trauma and minor trauma
• hypothermia?
• prolonged immobility, such as bed rest
• alcohol abuse?
• diseases of internal organs
• common pathology?
• overweight;
• individual characteristics: curvature of the spine, crouching
• malnutrition, diseases of the digestive system, which may be accompanied by reduced absorption of vitamins, metabolism of minerals, significant intake of salts that affect the joints.
• Occupational hazards: thermal effects, temperature fluctuations, vibration, working with weights, etc.

The mechanism of development of the spine is connected to a block of intervertebral joints, which can be caused by loads, both static and dynamic, micro-traumatic and abnormal postures. As a result, at one point the muscles spasm and overextension, and at another they excel. All this leads to the development of muscle pain, changes in pain sensitivity and the formation of abnormal pain pulses.

Also, muscle spasm can be a reflex reaction to spinal pathology or to diseases of internal organs. In this case, it is considered a defensive reaction, but at the same time a new cycle of pain begins. In addition, with prolonged maintenance of the spasm, the transmission of nerve impulses to the muscle fibers is interrupted, they become more stimulating, calcium deficiency may occur, and circulatory disorders further aggravate the condition.

Depending on the duration of the rash, there may be:

• acute - lasts up to 6 weeks.
• subacute - from 6 to 12 weeks.
• years - last 12 weeks or more.

Symptoms

The symptoms of snoring depend on the cause, the mechanism of development and the presence of concomitant diseases.

For non-specific pain, the following points are typical:

• pain or pulling pain, sometimes tightening
• increases with the load or movements of the spine, as well as in some positions, may decrease during kneading or rubbing the muscles, as well as after resting in a comfortable position.
• possible pain in the sides of the back or pain in the back.
• during detection, compression, contour changes, the intensity is determined, but there are no disturbances in sensitivity in the painful area, reduction of muscle strength, reflexes do not change.

When the nerve root is compressed (root disease), the pain varies in intensity, it can shoot, it often radiates to the leg, and in the extremity it can be stronger than in the back. During the examination, there are symptoms of damage to a specific nerve root - muscle weakness, decreased sensitivity in a particular area.

Diagnostics

The diagnostic algorithm for acute and chronic dorsal is somewhat different.

Sharp pain

In order to determine the course of treatment, the doctor should, if possible, determine the cause of the pain syndrome: nerve stings or their roots, trauma, tumor, inflammation, infection, osteoporosis, diseases of internal organs, etc. As a rule, these types of pain have rather vivid and specific clinical manifestations. After examination and palpation, patients are referred to appropriate specialists or for further examination, for example:

• X-ray examination?
• MRI and CT of the spine.
• scintigraphy - a method of visualization using the introduction of a contrast agent.
• Densitometry - determination of bone density.
• laboratory tests for the determination of tumor markers, rheumatic tests, biochemical blood tests, etc.

Patients with non-specific acute pain usually do not need additional research.

Chronic pain

As the mechanisms of its development have not yet been adequately studied, it can be difficult to determine the source, especially if it is a dysfunctional species that reflects the pathology of other organs. It can be a manifestation of diseases such as irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and others. In each case, a thorough interview and examination of the patient is performed to decide on further treatment regimens.

For pain syndrome that occurs in the context of dystrophic changes in the joints, after any mechanical stress or under the influence of other factors, it is possible to use magnetic resonance imaging to monitor the dynamics of the condition of the spine.

How to deal with acute back pain

Physicians who adhere to the principles of evidence-based medicine use the following tactics to manage patients with acute rash:

1. inform the patient about the causes of the pain syndrome.
2. exclude bed rest and we recommend that you maintain normal activity.
3. prescribe effective medication and non-medication;
4. monitor the dynamics and adjust the treatment.

When choosing a drug, pay attention to the analgesic effect, its speed of action and its safety. First of all, non-specific anti-inflammatory drugs (NSAIDs) are prescribed, as their effectiveness has been proven for back pain. One such drug is naproxen.

Naproxen is available as an oral tablet and gel for external use. The drug is indicated as a painkiller for back pain associated with trauma, overload, inflammation. It also has anti-inflammatory and antipyretic effects, the duration of the effect can last up to 12 hours. If you do not get a chance to see a doctor soon and the pain is severely uncomfortable, then you can take naproxen as follows: 2 tablets as a starting dose and then 2 tablets every 12 hours or 1 tablet every 8 hours. The course of admission without consulting a doctor does not exceed 5 days.

While maintaining the intensity of the pain, it is possible to prescribe other groups of painkillers and sedatives (sedatives).

Non-pharmacological treatments include:

• heating
• manual therapy?
• physiotherapy;
• massage;
• physiotherapy;
• acupuncture and other alternative methods.

Treatment of chronic back pain

If the pain is detected and the source of the pain pulses is found, then topical treatment is used - blockades, intra-disc effects and other procedures. For the rest of the patients, no such treatment is used for back and waist pain, so a different treatment is used. Its main goal is to reduce the intensity of pain and maintain quality of life.

Also, as in acute pain, drugs from the NSAID group are prescribed, such as naproxen, other analgesics, muscle relaxants and vitamins B3. Antidepressants are recommended as required. Manual therapy should be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic treatment methods are used.

Prophylaxis

To prevent rash, it is necessary to identify all possible risk factors and work to eliminate them.

For all types of pain, the following will be helpful:

• Adequate physical activity and muscle strengthening, including the back.
• early treatment of chronic diseases of the internal organs.
• Maintaining a normal posture during work.
• to quit smoking and alcohol.
• regular preventive examinations;
• appropriate treatment and prevention of infections;
• balanced nutrition;
• wearing comfortable shoes and clothes.
• proper organization of the workplace and life to protect the back;
• prevention of stress and emotional overload.

Comprehensive treatment and complete rehabilitation of patients with back pain allow you to maintain a quality of life, reduce the number of disability cases and prevent the transition to a chronic form of the disease.