Back pain is an urgent problem in medicine. Along with the fact that back pain is one of the most common reasons for visiting a doctor, many aspects of this problem are still poorly understood, and there are very few treatments that have a strong evidence base.
During a lifetime, 70-80% of the population suffers back pain at least once. According to epidemiological studies, the prevalence of pain in the lower back reaches 40-80%. In 10-20% of patients of working age, acute back pain transforms into chronic. It is this group of patients that is characterized by an unfavorable prognosis in terms of recovery, and it accounts for 80% of all healthcare costs for the treatment of back pain.
Back pain is familiar to everyone. Even those who did not know about doctors sometimes experience aching sensations that occur both when walking and at rest, in public transport, at work, even during sleep. As a rule, the first manifestations of discomfort in the back are attributed to fatigue, overwork, excessive physical exertion. Indeed, back pain often goes away on its own after a few hours of rest. However, chronic pain is a cause for concern. And not in vain. After all, this can be one of the first signals of diseases of the spine, or other internal organs.
What causes back pain?
As a rule, injuries or simply injuries lead to this type of discomfort, namely:
- Muscle stretching;
- Diseases of the heart, kidneys;
In girls, pulling back pain, accompanied by fatigue, indicates pregnancy. Back pain is common for people who move little, work at a computer for a long time, or are engaged in physical labor associated with carrying heavy objects. Also contribute to the appearance of painful sensations malnutrition, smoking, excessive alcohol consumption.
What causes back pain?
Clinical manifestations of vertebrogenic pathology are compression-ischemic syndromes, mainly radiculopathy (from 5 to 10%) and muscular-tonic reflex syndromes that accompany radiculopathy or are observed in isolation (90%).
Each local painful irritation first of all causes a reflex in the segment corresponding to it. In this zone, we observe an area of skin hyperalgesia, muscle tension, painful points of the periosteum, restriction of movement in the corresponding segment of the spine, and (possibly) dysfunction of the internal organ. However, the reflex effect is not limited to one segment. Dystrophic changes in one spinal motion segment provoke a reaction of a significant number of segments, which causes tension in the extensor muscles of the back. Pathology in the periphery causes a central reaction; this leads to a change in the stereotype of movement as a way to protect the damaged structure. Thus, an altered type of movement arises, which can persist even after the elimination of the peripheral process that caused it.
Back pain is characterized not only by local pain syndrome, but also by significant psychological manifestations. At the height of pain, a pronounced feeling of anxiety develops, up to depression. At the same time, there is emotional instability in the assessment of pain, as well as an exaggeration of the external manifestations of pain, or, conversely, unreasonably excessive caution in movements. At the same time, aspects of health and work are closely combined, their combination with economic indicators, the risk of losing a job. Only a general practitioner can take into account all the variety of factors in the treatment of a patient.
Prolonged back pain, which makes you see a doctor, is caused by damage to the vertebrae themselves, intervertebral discs and joints, ligamentous or muscular frame of the spine. At the same time, the disease that led to the appearance of pain can be both relatively favorable in terms of treatment and prognosis (for example, osteochondrosis), and fatal (metastases to the spine, multiple myeloma).
In addition, back pain may be accompanied by diseases of the internal organs, such as pyelonephritis, diseases of the internal genital organs, lower intestines.
Back pain in various degenerative-dystrophic lesions of the spine has common pathogenetic features. Three main pathophysiological mechanisms for the development of back pain are currently recognized. The first mechanism is associated with peripheral sensitization, that is, with an increase in the excitability of peripheral pain receptors (nociceptors) due to trauma, infection, or other factors. Nociceptors responsible for back pain are located in the annulus fibrosus of the intervertebral disc, posterior longitudinal ligament, supraspinatus, interspinous and intertransverse ligaments, areas of the dura mater, facet and sacroiliac joints, spinal nerve roots, spinal ganglia, paravertebral muscles. The vertebrae and ligamentum flavum do not usually have nociceptors. The central part of the intervertebral disc contains a large amount of the enzyme phospholipase A2, which is involved in the metabolism of arachidonic acid, resulting in the formation of pain mediators such as prostaglandins and leukotrienes. In addition, neurogenic pain mediators, such as substance P, vasoactive intestinal peptide (VIP), and calcitonin gene-regulated peptide, can be released from the sensory fibers surrounding the dorsal horn, which cause pain. Substance P and VIP promote an increase in the enzymatic activity of proteases and collagenases and can enhance degenerative processes in the three-articular complex (intervertebral disc, vertebra and facet joint). Receptor sensitization occurs as a result of damage to the musculoskeletal tissues of the back and the release of these pro-inflammatory substances. As a result, even weak mechanical stimuli activate nociceptors and cause pain.
The second pathophysiological mechanism - neural ectopia - is caused by damage to the root, nerve or spinal ganglion during injury, compression or ischemia. The excitability threshold of sensory neurons decreases, ectopic sources of spontaneous impulses appear, resulting in neuropathic or radicular pain, which is difficult to treat. Another potential source of radicular pain is the spinal ganglion.
The third mechanism is associated with central sensitization, which is characterized by an increase in the number of functioning structures in the spinal cord and brain when nociceptive stimulation occurs in the periphery. Whenever a painful irritation occurs, it intensifies in the spinal cord, causing the pain to increase. At the same time, even weak stimulation of afferents contributes to the appearance of the so-called central pain. Direct brain injury (spinal injury, stroke) can also provoke central sensitization.
What is the nature of back pain?
As a rule, back pain is aching, pulling, concentrating in a certain area of the spine. However, there are also sharp, unexpected attacks, the so-called lumbago. It is also possible irradiating back pain with its spread to the limbs, neck, shoulders. Thus, various manifestations of diseases of the back are possible, which indicates the attention with which it is necessary to treat the determination of the stage of the disease and its type.
How to recognize back pain?
In order to determine the necessary treatment, doctors, as a rule, first talk with the patient, being interested in the symptoms that caused back pain, as well as the condition of other organs. Blood and urine tests, as well as a physical examination, may also be required.
Among the modern diagnostic methods used:
- Magnetic resonance imaging;
- CT scan.
How is back pain treated?
Unfortunately, it is impossible to completely get rid of such a condition as back pain, however, the likelihood of minimizing discomfort is high. For this, medical methods are used, as well as methods of conservative medicine.
So, of the drugs most often used:
- Anti-inflammatory drugs;
- Muscle relaxants;
However, remember that excessive consumption of all these drugs can lead to side effects, so buy and use them only on the advice of a doctor.
Conservative medicine methods are usually painless and do not bring complications, however, they should also be used under the direction of a doctor who will take into account your back pain. For example, with past heart disease, hernia, problems with blood vessels and blood circulation, manual therapy methods can only do harm. Among the non-drug methods widely used in various clinics, we can distinguish:
- Physiotherapy procedures;
- Methods of manual therapy;
- Laser therapy;
Remember that any of these activities should only be carried out by professionals!
The course of treatment, as a rule, lasts about two to three weeks, and to consolidate the result, you can connect treatment in a sanatorium.
How to prevent back pain?
In order for back pain to rarely bother you, follow these rules:
- Keep your posture, do not slouch;
- Do not work long in the same position;
- Try to sit cross-legged less;
- Make less sudden movements;
- Sleep on a hard bed;
- Eat right, give up smoking and alcohol;
- Go in for sports, go to the gym or swimming pool, attend aerobics or yoga sections;
- Do not walk for a long time in high heels.
Back pain is quite unpleasant, especially in its chronic manifestations and sharp attacks, however, proper treatment and an active lifestyle can easily help you cope with this problem!