Low back pain is one of the most common reasons patients seek help from a neurologist or therapist. Pain in the lower back can be permanently disabling, making mobility and self-care impossible. Acute low back pain affects both men and women equally often. With greater frequency in middle and old age, low back pain can often be observed in adolescents and young adults. This is due to rapid growth, weakening of the delicate muscles of the lower back, trauma. Therefore, back pain is the most pressing problem that anyone can face.
Possible causes of back pain in the lumbar region
Pain in the lumbar spine may be related to processes occurring both within and outside the spine. . . Consider the main pathological conditions in which acute low back pain can be observed.
- The most common problem and cause of pain is systemic osteonecrosis. . . It is caused by age-related idiopathic changes in the spine, dystrophy (malnutrition) of the respective segments of the spine and cartilage, and decreased height of the vertebrae. These pathological processes lead to bone growth and invasion of nerve roots at the site of narrowing. As a result, severe pain develops in the back (spine) part. Spinal osteosarcoma develops more often in obese individuals, as well as in patients subjected to prolonged physical exertion, contributing to the wear and tear of all vertebral structures. Frequent trauma, falling back, carrying heavy loads and at the same time having osteoporosis aggravate the picture and course of the disease. Pain in the auricle area is also related to the involvement of vertebral fibers (which cause muscle tension) and ligaments in this process.
- A herniated disc is an equally rare cause, the clinical manifestation is pain in the back. The disc (the nucleus inside the spinal cord) exposed to prolonged trauma, as well as with age, loses its elastic properties and resilience. With continued exposure (overweight, trauma, progressive osteoporosis), the fibrous annular discs become thinner and defects form in them. Through these weaknesses in annular fibrosis, the medullary nucleus of the disc can shift and even protrude.
A herniated disc is formed when the annular fibrous fibers rupture and the nucleus pulposus presses on elements of the nerve root leaving the spinal cord. The compression leads to the pain in the lower back becomes extremely intense, sometimes unbearable. Pain in the lumbar spine during a herniated disc can be accompanied by sensory disturbances and various types of numbness in the respective segments of the decompression (compression). Lower back pain radiates to the lower extremities, causing muscle tension due to spasm. With a protracted process, a herniated disc causes chronic pain in the auricle area. Muscle strain in the back, on a constant basis, further aggravates the pain syndrome, making it chronic.
- Narrowing (narrowing) of the spinal canalPain in the back noted in association with prolonged walking or exertion. Acute low back pain may be accompanied by weakness in the legs, symptoms of convulsions in the lumbar region, buttock muscles. With significant damage, there may be disturbances of sensory functions.
- Tumor lesions of the segments of the dorsal vertebraUsually manifested by pain in the lower back with varying degrees of severity. Usually, lower back pain tends to get worse as the process progresses. The nature of the tumor lesion can be benign (vertebral cyst) and malignant (spinal tumor, or metastatic lesion due to distant tumor). In terms of morphology, tumors can be osteosarcoma, hemangioma, or develop due to myeloma. Pain in the auricle with this pathology is often uncomfortable for the patient day and night (continuous, without light gaps), increases with rest, when shaking, percussion. Lower back pain with muscle tension, cramps, sensory disturbances, weight loss, blood changes (anemia).
- Osteoporosis (bone loss)- quite often, it is the cause of pain in different locations. Osteoporosis develops because calcium excretion from the bones is accelerated, with the result that all bones become brittle, prone to fracture with little mechanical impact (usually of a water nature). Low back pain in osteoporosis, combined with other pain in the bone, has a moderate degree of pain syndrome. Pain in the low back can cause muscle tension and cramps, often associated with a decrease in the patient's height. The most common type of osteoporosis is postmenopausal, which develops in women after ovarian function declines.
- Ankylosing spondylitisoften, along with pain throughout the spine, is characterized by pain in the lumbar region and ileum joints. This disease leads to spinal stiffness over time and to other peripheral joints in the chronic course.
In addition to these conditions, pain in the low back can be caused by the following reasons that are not related to a spinal deformity:
- kidney disease, renal pelvis(acute exacerbation of chronic pyelonephritis), urolithiasis of the kidney, cancers of the kidney and metastasis of tumors to the kidney. At the same time, the pain in the lumbar region is somewhat higher (in the projection of the kidney), pain in the lumbar region is not very typical. Pain accompanied by other characteristic changes (frequent urination, dysuria, changes in urinalysis, temperature response);
- disease in the upper gastrointestinal tract(peptic ulcer, pancreatitis, pancreatic cancer) at a given site sometimes manifests as pain in the lumbosacral region. But back pain is not related to movement, it can be combined with other complaints (vomiting, stool disorders, nausea, burning along the esophagus);
- Acute back pain, in some cases, can occurfor female pelvic inflammatory diseases(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during or just before menstruation. During pregnancy, there may also be heaviness and pain in the lower back and sacrum;
- degenerative deformity of hip joint(coxarthrosis), especially with exacerbation of the process, in addition to gait disturbances, difficulty walking, it can cause pain in the gluteal region, muscle region of the buttocks on the corresponding side of the lesion, muscle tension inlower back and buttocks.
Acute low back pain: what to do?
If the patient has acute low back pain, it is necessary to immediately seek the help of a specialist doctor to diagnose the cause of the pain. More often, the patient visits a neurologist, where, after a proper diagnosis (X-ray, computed tomography, MRI) and neurologic examination, he is diagnosed with the disease. Spine.
In the absence of convincing data on the pathology of the spine (osteoma, herniated disc), additional methods may be necessary (ultrasound imaging of internal organs, densitometry, ultrasonography). pelvic floor) and consult with relevant specialists (oncologist, gynecologist, endocrinologist).
Treatment of low back pain.
Acute low back pain, according to the doctor's prescription, stop with non-steroidal anti-inflammatory drugs (in the form of tablets or injections), prescribe muscle relaxants, rest, lie in bed, apply anti-inflammatory ointments, thepressure of compression. Treatment in the acute phase can be carried out in a static setting or in a general clinic.
Prescribe drugs that improve microcirculation, in cases of acute back pain, blockade is used. Sometimes, with the ineffectiveness of other types of therapeutic effects, they must be treated with surgery (nerve root compression). When combined with degenerative joint disease, chondroprotectors are used long-term, in osteoporosis preparations - calcium and vitamin D3. It is possible to use physiotherapeutic effects (as long as there are no contraindications), physiotherapeutic exercises, and at the stage of rehabilitation - subsequent treatment in sanatoriums.