Backache

Back pain is one of the most common reasons patients seek help from medical institutions. Pain syndrome may accompany diseases that affect the spine, kidneys, and other organs and systems. The treatment and prevention of back pain include drug therapy and non-drug therapy. Failure to provide timely medical services may lead to chronic disease and complications.

Back pain is a separate symptom, not a disease classification entity. For example, low back pain is pain located in the lumbar spine. In addition, concepts such as chest pain or neck pain are also distinguished. The accurate location of pathological symptoms is necessary for choosing the correct treatment strategy and the choice of preventive measures.

definition

Pain is a pathophysiological condition that occurs in response to stimulation of pain receptors. It may occur due to direct damage to tissues or organs or exposure to unfavorable psychological factors (stress, anxiety, depression).

Back pain is a multidisciplinary practice in medical practice. This is because the pathology of the musculoskeletal system, pelvic organs, retroperitoneal space (kidney, pancreas, liver, etc. ) may cause pain syndrome.

It should be noted that the pain syndrome may be accompanied by a decline in the patient's cognitive ability-memory impairment and decreased concentration may occur.

In most cases, the appearance of low back pain is a defensive response of the body affected by unfavorable factors. The most common causes of back pain are sciatica, herniated disc, or spondylopathy.

Epidemiology

According to statistics provided by the World Health Organization (WHO), back pain is a concern for more than 40% of the population. In some countries, this number may be as high as 80%.

This problem can lead to early disability of the patient. In addition, pain syndrome is a common cause of temporary disability among workers. This is why pathology is a problem not only in the field of medicine but also in the field of economic activity.

In most cases, people between the ages of 30 and 60 will seek help from the clinic. This is because as we age, degenerative lesions of the spine appear, resulting in acute and chronic pain.

In addition, men are more susceptible to this disease than women. This is due to the particularity of the job, manual labor and other risk factors. According to statistics, lumbosacral pain occurs more often.

Clinicians explain this fact by the fact that physical activity exerts the greatest pressure on this part of the spine.

Risk factors

Not only stress and exercise can cause this pathology to appear. The main risk factors are as follows:

• Working age of 30 years and above;
• male;
• Overweight and obesity (where the body mass index exceeds 30);
• The presence of other pathologies (for example, frequent migraines or heart and blood vessel diseases);
• Static physical activity, there is no difference in diversity;
• Exposure to vibration.

In addition, some researchers pointed out that smoking is a risk factor. Smokers coughing violently may be an indirect cause of pain.

Classification

After detailed examination and examination, the neurologist determines the nature of the pain. There are many classifications, among which low back pain syndrome is subdivided according to the location, duration, cause and other characteristics of the pathology.

In terms of duration, the following types of pain can be distinguished:

• sharp,
• Subacute,
• Chronic.

Patients with acute pain are most often treated in outpatient clinics. Its duration does not exceed 6 weeks. Subacute pain can last for 6 to 12 weeks. If the pathological syndrome troubles the patient for 12 weeks or more, the pain is called chronic pain.

Acute and subacute pain are the most common and can be fully recovered with proper treatment. Chronic pain syndrome can lead to early disability in patients. This is why you should seek medical help from a doctor when the clinical symptoms of pathology first appear. For this, you should consult a neurologist first.

In terms of intensity, the following types of pain can be distinguished:

• Weak
• Average,
• Strong.

According to the nature of back pain, there are:

• burst,
• pain,
• shooting,
• pull,
• stupid.

The nature of the pain depends on the pathology that caused the syndrome. Therefore, for osteochondrosis, traction pain is concerned, and the irradiation of the lower limbs is different. Sciatica can cause tingling, which is usually one-sided.

According to the location of low back pain, there are:

• Local (local),
• reflect,
• Irradiate.

When the pathological focus is directly on the back, local pain occurs. Pain is caused by stimulation, stretching, or other effects on receptors under the skin.

Local pain has its own characteristics. For example, after an injury to the lumbosacral part of the spine, the pain syndrome is persistent. Due to the stimulation of the receptor, its characteristics will change with the change of body position.

Reflex pain occurs in pathologies that affect internal organs. Related to the anatomical features of innervation. Therefore, for the reflex type, the pain occurs in the dermatome. The most common cause of back pain may be the pathology of the pancreas, uterus and its appendages.

Among the characteristics of the type of pain reflected, the lack of connection with physical activity is significant. If the intensity of symptoms increases with changes in body position and local type of pain, then there is no connection in this case.

Radiation pain is related to nerve or root stimulation. In addition, in addition to back pain, patients may complain of decreased sensitivity and goose bumps (paresthesias). Usually, during the examination, neurologists can find pathological reflexes, which are also related to impaired transmission of nerve impulses.

Causes of low back pain

The manifestations of pain syndrome have the following reasons:

• Pathology of the musculoskeletal system (traumas, sprains, hypothermia and other external causes);
• Spinal diseases (osteochondrosis, hernia);
• Diseases affecting organs in the retroperitoneal space (pathology such as gallbladder and pancreas);
• Benign and malignant tumors;
• Mental disorders (depression, anxiety, stress leading to psychogenic pain).

In addition, daily problems may become the cause of pathological symptoms. Therefore, if the sleeping posture is uncomfortable after waking up, the patient may complain of neck or lumbar pain.

Vertebral pain

For this type of pain, a degenerative type of pathological change is observed in the spine. Therefore, the vertebral body and intervertebral disc may be damaged. In most cases, pain from the spine may be related to diseases that affect the joints.

According to statistics, patients seeking medical help complain of acute pain related to spinal injuries. The cause may be herniated disc, spondylopathy, or low back pain.

Spine tumors will be detected in less than 1% of all patients who see a doctor. Metastasis of malignant tumors is rare, but they can also cause back pain to varying degrees.

disease	ICD-10 code	Feature
Osteochondrosis	M42	A disease in which the intervertebral discs and vertebrae are destroyed. Characterized by appearanceShort-term pain caused by strains and radiotherapy.Exposure to external factors in the form of exercise or coughing can cause pain to worsen.
Intervertebral hernia	M51	A disease that forms a bulge in the spinal canal. It appearsSevere pain syndrome that occurs during coughing, sneezing, and physical activity.
Radiculitis	M54. 1	A disease in which degenerative changes are observed in the roots. Characterized by appearancePain related to changes in body position or physical exertion. . . In addition to pain syndrome, sensitivity barriers are also increased.
Discogenic low back pain	M54. 4	A pathology characterized by sudden severe pain in the waist of the spine.The pain is shooting, very obvious.
Spondylosis	M47	A disease characterized by degenerative changes in the vertebrae. Of course there are chronic types,Pain when irradiating lower limbs and neck.

It should be noted that each disease has its own characteristics. This is why when diagnosing, we must not only pay attention to the memory data, but also pay attention to the examination results. For this reason, the use of modern diagnostic instruments can not only identify the pathological focus, but also determine its boundary and degree of inflammation or damage to the spinal anatomical structure.

Back pain is caused by vertebral origin. In addition to the diseases listed above, pain can also occur during trauma and stretching of the musculoskeletal system. Therefore, when excessive physical exertion or lifting weights, acute pain may suddenly appear.

Non-vertebral pain

According to statistics, no more than 2% of patients complain of pain of non-vertebral origin. This category includes back pain diseases and physical diseases.

The most common diseases that cause pain syndromes are pathology of the cardiovascular system, as well as diseases of the gastrointestinal tract, pancreas, and biliary tract. In the first group, there are the following differences:

• Arterial occlusion,
• Labor angina pectoris,
• Aortic aneurysm (in the abdomen or chest area).

In the second group:

• Stomach ulcer,
• Duodenal ulcer,
• Cholelithiasis,
• Biliary dyskinesia,
• Inflammatory changes in the pancreas.

Cardiovascular disease usually causes back pain. Therefore, for angina, patients worry that the pain in the heart area will radiate to the shoulders, arms or back. This is why during the episode, patients may complain of back pain.

For angina, the pain syndrome has its own characteristics. First, pain is overwhelming. Second, it appears behind the breastbone and radiates to the back, arms or shoulders. Third, the pain syndrome disappeared immediately after the administration. It should be noted that physical activity and stress can cause attacks.

An aortic aneurysm is a split of a blood vessel, which weakens and then bulges. In this case, the patient complained of dull pain in the heart area and exposure to the back and lower extremities when seeking medical help. Symptoms such as dizziness, weakness, and a sharp drop in blood pressure can also be disturbing. Back pain caused by aortic aneurysm can appear in the chest location and abdominal location of the pathological focus.

It should be noted that the pain of aneurysm has nothing to do with physical activity. Instrumental methods are used to diagnose diseases. When an aneurysm is detected, immediately start treatment, including the use of drugs and surgical methods.

Back pain is not only caused by cardiovascular disease. In diseases that affect the organs of the retroperitoneal space, patients may also complain of pain syndromes. This is due to the particularity of innervation-inflammation and degenerative changes in this area can cause back pain.

Back pain during pregnancy

Pregnancy is a physical condition, however, this process may be accompanied by the appearance of pain and other unpleasant symptoms. This is due to changes in organ locations, hormonal changes, and weight gain in the early and late stages.

During pregnancy, low back pain can be caused by physiological and pathological changes.

In the first group, there are:

• Natural weight gain during pregnancy, which will increase the load on the bone and joint system;
• The uterus enlarges and forms a "child" position, in which internal organs are displaced;
• The center of gravity changes during the third trimester, when the fundus of the uterus drops.

The direct cause of back pain during pregnancy may be early. It is characterized by irregular shrinkage. In this case, back and lower back pain may occur due to the active work of the pelvic floor muscles. However, due to the production of female sex hormones and oxytocin, pregnant women may not feel these pains.

Nevertheless, severe back pain during pregnancy may be an objective reason for seeking advice from a gynecologist. If pathology is suspected, pregnant women may be asked to stay in the hospital for further observation.

Severe back pain during pregnancy may be the cause of serious illness. This is because during this period, women’s extragenital diseases may worsen. The most common diagnoses are pyelonephritis and cystitis. In addition, the formation of stones in the gallbladder or biliary tract can cause pain.

The exacerbation of pyelonephritis or cystitis is not only related to the entry of microbial flora into sterile organs. In most cases, extragenital diseases are caused by irritation of organ walls and hormonal changes during pregnancy. The stress that usually accompanies pregnancy can exacerbate symptoms.

Back pain caused by coronavirus

Coronavirus infection can also cause severe back pain. COVID-19 can cause specific symptoms, including a sudden increase in body temperature, dry cough, chest pain, weakness and fatigue. However, some patients also complain of back pain, which is accompanied by the occurrence of coronavirus infection.

The main reasons include:

• Exposure to toxins in the body;
• The deterioration of chronic diseases of the musculoskeletal system;
• New, previously undiagnosed spinal lesions appear;
• Viral radiculopathy.

Poisoning syndrome is often accompanied by diseases that affect the upper and lower respiratory tracts. The main clinical manifestations are weakness, fever, soreness, and pain. For coronavirus, as with other respiratory diseases, non-specific back pain may occur. This is one of the manifestations of poisoning syndrome. With effective medication, the pain intensity will be reduced after a few days.

The body's active fight against infection can lead to the exacerbation of chronic diseases. In addition, in the context of respiratory diseases, previously hidden pathologies may appear. This is why patients may worry about back pain.

Among the main reasons, the emergence of viral radiculopathy is also obvious. It is not only related to the formation of intervertebral hernia. When viral agents cause inflammation or irritation of the spinal cord roots, radiculopathy is worthy of attention.

Diagnostic measures

If you experience back pain, you should seek help from a medical institution immediately. To diagnose diseases in the area, you should see a neurologist.

Experts at the reception desk should perform neurological examinations on the patient after collecting memory data in detail. In the information collection phase, focus on the following aspects:

• Back pain for the first time;
• The link between pain and physical activity;
• The presence of accompanying diseases;
• Location of pain syndrome;
• Duration of pain;
• The appearance of other symptoms.

After collecting the medical records, the neurologist conducts an examination. At this stage, the expert will pay attention to the walking of the pathological patient, the position of the spine, and check the presence or absence of reflexes.

In order to study the patient's gait, the neurologist asked the patient to walk a few meters in the office and perform some tests. If the patient is unable to transfer the support to his leg while walking, perform unnecessary exercise-this is one of the obvious signs of neurological disease.

In addition, the position of the spine must be evaluated. The neurologist will pay attention to the presence of kyphosis, lordosis, and scoliosis. Experts evaluate the patient's response to reflex stimuli with the help of tests.

When back pain occurs, the disease may be accompanied by changes in sensitivity. This is why neurologists assess the state of touch, temperature, and other types of sensitivity. In addition, experts will pay attention to the appearance of pathological sensations, such as peristaltic or tingling sensations in the back.

After the examination, the neurologist may prescribe some additional studies. When the precise location of the pathological focus needs to be established, instrumental inspection is necessary. Modern methods allow for a safe and painless examination, and the patient will receive the result a few days later.

In order to diagnose the cause of back pain, neurologists can allow patients to undergo the following diagnostic measures:

• Magnetic resonance imaging (MRI);
• Computer tomography (CT);
• X-rays of abdominal organs.

In some cases, additional tests may not be needed to make a diagnosis. After receiving the results of the instrumental diagnosis, the neurologist will choose the best treatment strategy.

Back pain treatment

The treatment of acute or chronic back pain must be carried out under the supervision of a doctor. The use of drugs alone will not only lead to ineffective treatment, but also lead to complications of the disease. This is why it is recommended to seek medical help from a specialist in case of back pain. After passing the diagnostic test, the patient will be treated according to the clinical characteristics, pathogenesis and course of the disease.

A few years ago, in medicine, when back pain occurred, strict bed rest was recommended. Now there is no need to restrict the patient's activities. In addition, it is recommended to wear special bandages and use crutches or stilts when walking.

Modern treatment for back pain is based on evidence-based medicine. They use not only drugs, but also non-drug treatments.

The following groups of drugs are used as drugs to treat back pain in medical practice:

• Non-steroidal anti-inflammatory drugs;
• Muscle relaxants to reduce muscle tone;
• Analgesics.

The listed drug groups can be used alone or in combination to achieve drug effects. It is recommended to use manual therapy together with medications for back pain.

In the case where the patient’s pain syndrome is very obvious, it is necessary to limit daily activities and follow the recommendations of other doctors, but in general, the previous level of physical activity should be maintained.

For chronic back pain, in addition to the listed treatments, physical therapy exercises (exercise therapy) can also be used. In addition, the neurologist may recommend massage courses. Pay special attention to cognitive behavioral therapy and the intake of antidepressants.

The duration of treatment is determined by the neurologist. In the case of ineffective treatment, you should change the medication group and conduct additional studies.

forecast

With timely diagnosis and correct selection of treatment strategies, back pain may subside in a few weeks. In the course of chronic disease, long-term relief can be achieved if the attending physician’s recommendations are followed.

prevention

In order to prevent back pain, you should stick to a healthy lifestyle and allocate physical activity appropriately so as not to burden various parts of the spine. In addition, concomitant diseases should be diagnosed and treated promptly.