Lower back pain: causes and treatment

In most cases, lower back pain is caused by hypothermia or muscle strain due to awkward movements or heavy lifting and may go away on its own. If the pain disrupts the normal rhythm of life, improvement does not occur for too long, 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 has been bothering the patient, doctors distinguish between:

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

At the appointment, the doctor clarifies with the patient exactly how the back hurts: it can be a stabbing pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other unpleasant sensations of varying degrees of intensity. Based on the duration, location and type of pain, the doctor will determine where it is coming from.

Pain in the lumbar spine: causes

Pain in the lumbar region can be associated with problems in the spine as well as with other organs and systems in the body. To understand how to heal your lower back, you need to figure out what is causing the pain.

There are vertebrogenic pains caused by diseases of the spine:

• Osteochondrosis, which is manifested by problems with intervertebral discs, facet or facet joints. As everyone gets older, disorders occur: intervertebral discs lose moisture and elasticity, facet joints become denser and less mobile.
• Overuse of the muscles and ligaments of the spine.
• Compression of spinal nerve roots – radiculopathies.
• Spinal injury.
• Instability of the spine due to weakness of the ligamentous-muscular system.

Non-vertebral causes include:

1. Neurological disorders

   • Lumbosacral plexopathies are damage to the plexus of nerves leading to the peripheral nerves of the lower extremities. Occurs in injuries and metabolic disorders.
   • Dystonia is a disorder of the tone of the muscles that support the spine. In this case, the pain can be associated with poor posture. The disease can be congenital.

2. Systemic diseases

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

3. Pain from internal organs.It arises from causes outside the spine and radiates into the lower back, sometimes in the middle, sometimes to the side - depending on the organ of origin. These include:

   • Diseases of the gastrointestinal tract – most commonly pancreatitis.
   • Urinary system diseases – infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pains in the back and side are accompanied by renal colic when the stone moves along the ureter.
   • An aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body bulges. This can lead to a feeling of pulsation in the abdomen.
   • Diseases of the hip joints – injuries, inflammation, degeneration.

4. Psychogenic pain

   Lower back pain can be associated with an anxiety disorder or depression.

An 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 prolapse,
• Injury,
• malignant or benign tumor,
• Infection.

Spinal cord compression is associated with extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, and urinary and fecal incontinence, and is therefore difficult to confuse with other diseases.

Symptoms

Back pain is often non-specific and can be attributed to harmless musculoskeletal disorders. In this case, patients describe the following complaints:

• Aching, pulling or pressing pain.
• The occurrence or increase in pain when a person stands or sits for a long time, lifts something heavy, performs physical work with arms raised, e. g. B. Hanging curtains, changing light bulbs in a chandelier, bending over repeatedly and for long periods of time: when washing floors, vacuuming, clearing snow.
• No other symptoms.

The fact that pain can be a symptom of a dangerous condition is indicated by"Red flags":

• Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
• Pain at rest and at night, affecting sleep. Nonspecific pain usually occurs with movement or prolonged static stress, but disappears after resting in a comfortable position.
• General weakness is also not characteristic of nonspecific pain.
• Unexplained weight loss in the last few months. It can 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 decrease in sensitivity or weakness of 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 run to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of feeling or movement combined with acute pain is a sign of compression of a nerve and possibly the spinal cord. If this situation is not treated by a doctor, function of the nerve or part of the spinal cord may be lost forever.
• Lack of effect of treatment and transition from acute to chronic pain.
• Features of the medical history. For example, if a patient with a previously established diagnosis of osteoporosis or a malignant tumor experienced lower back pain. It doesn't matter how long ago the diagnosis was made. Or pain has occurred in a person who has recently had a serious infection or surgery, or who has a severely weakened immune system for some reason, such as: B. if she has taken a glucocorticoid for a long period of time or has poorly controlled diabetes. In these cases, lower back pain can indicate various complications.

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

diagnosis

Pain is a subjective symptom, so questioning and examination by a doctor plays a large role in the diagnosis. Depending on the diagnosis, the doctor will prescribe further examinations. For an accurate diagnosis, perform the following:

• Laboratory tests— complete blood count, biochemical blood test, general urine test, tests to detect infections, autoimmune diseases.
• Electroneuromyography- Study of impulse conduction 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)This helps to detect all structures of the spine, the presence of hernias and compression of the spinal nerve roots.
• UltrasonicKidneys and abdominal cavity – carried out if there is suspicion of pathology of internal organs.
• Assessment of bone condition: Densitometry – if osteoporosis is suspected, bone scintigraphy – for malignant lesions.

If the doctor is absolutely sure that the pain in the lower back is nonspecific, he can prescribe treatment only on the basis of an examination and without additional tests.

If you have pain in your lower back, you often don't go to the doctor, but just come alone for an MRI scan of the spine. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic disc herniations. The patient attributes the pain to this MRI finding 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?

Firstly, if you have lower back pain, you can also see a family doctor. He will suggest the cause of the pain and depending on that, refer you to another specialist. You can skip this step and make an appointment with a neurologist immediately.

If, after a special examination, a neurologist suspects pathology outside the spine, he can contact:

• Rheumatologist,
• The surgeon,
• Urologist,
• gastroenterologist,
• Endocrinologist,
• Oncologist.

Doctors from all of these specialties regularly encounter the symptom of lower back pain, as it has a variety of possible causes.

If the diagnosis of mechanical pain is made, the patient is treated by physiotherapists, a reflexologist, a physiotherapist and masseurs.

How to cure lower back pain

• surgeryThey are mainly used for signs of compression of the spinal cord or spinal nerve roots, if the patient suffers from limb paresis or urinary tract disorder. These symptoms can be caused by an intervertebral hernia, a tumor, or an injury. In case of chronic pain, the patient may also be recommended to consult a neurosurgeon if conservative treatment remains ineffective within 12 weeks. The decision about surgery is only made after visualization of the spine.

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

• Conservative treatmentincludes medical and non-medical methods.

  Drug treatment involves nonsteroidal anti-inflammatory drugs, which reduce pain and inflammation, and muscle relaxants, which relax the muscles.

  Non-drug treatment includes:

  • physical therapy— The aim is to quickly eliminate pain and inflammation and accelerate tissue recovery and muscle relaxation. The most effective methods: magnetic field therapy, laser therapy and shock wave therapy.
  • acupuncture- Inserting special sterile needles into biologically active points to relieve pain and relax muscles.
  • massage— improves the mobility of the spine and joints and promotes the correct distribution of load on the back muscles.
  • physical therapy- allows you to relax and strengthen your back muscles. Exercises are effective for both acute and chronic back pain.

  If the patient has pain for more than 12 weeks, it is called chronic pain. In addition to all of the methods mentioned above, antidepressants with pain-relieving effects and cognitive behavioral psychotherapy are added to their treatment.

Bed rest provides no benefit in the treatment of mechanical lower back pain and is not an alternative to the above methods. In addition, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly slows recovery.

Follow

Acute nonspecific lower back pain has a favorable prognosis. Of those who seek treatment immediately, 70-90% experience improvement within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts longer than 12 weeks, requiring treatment with antidepressants with analgesic effects. If the pain is caused by compression of the spinal nerve roots by an inguinal hernia, it may be accompanied by numbness in the limbs and problems with urination and bowel movements.

prevention

Help prevent back pain:

• Moderate exercise for 150 minutes per week: walking, swimming, exercises for the core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
• Maintain a healthy weight.
• Warm up in a long static position every 40-60 minutes.
• Stretching exercises for the thigh muscles.
• Correct posture when lifting weights: You need to squat, not bend forward.
• Prevention of reduced bone density by taking calcium and vitamin D, early detection of osteoporosis through densitometry. This is particularly important for older people and postmenopausal women.
• Maintaining general somatic and mental health.