Back pain

Back pain (synonymous with dorsalgia) is one of the most common reasons to see a doctor - the second after acute respiratory diseases1. Most often, such complaints come to a neurologist, therapist or family doctor. According to international studies, 19 to 43% of the recently surveyed adult population experienced back pain in the last month, 27 to 65% - in the last year. 59-84% of those who have experienced this at least once in their lives 1. Almost every fifth adult on our planet currently suffers from severe back pain. Their most common localization is the lower back and lower back.

Why does back pain occur?

The main reasons behind developing back pain include:

1. Causes of the vertebrae - associated with the pathology of the spine:
   • Pathology of intervertebral discs, including hernias;
   • Narrowing of the spinal canal;
   • Joint disease;
   • the consequences of injuries;
   • congenital malformations and developmental abnormalities;
   • Metabolic disorders;
   • Spondylitis - inflammatory processes in the intervertebral joints.
2. Not vertebrogenic - not related to the pathology of the spine:
   • Sprains of ligaments and muscles associated with heavy loads;
   • myofascial syndrome - chronic muscle pain;
   • Inflammation of muscle tissue - myositis;
   • Diseases of internal organs;
   • Pathology of large vessels, for example, aneurysm (sharp expansion) of the abdominal aorta;
   • osteoarthritis of the hip joint - an inflammatory-dystrophic disease;
   • mental disorders, etc.

Depending on the origin, a distinction is made between the following types of pain:

• Specific- is associated with a specific disease that can be detected by standard screening methods. This type accounts for 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 a number of specific symptoms called "red flags" that indicate serious illness and require thorough investigation. These include:

  • rapid inadequate weight loss and / or evidence of a history of oncopathologies (tumors);
  • Weakness of the lower extremities, impaired sensitivity and functions of the pelvic organs (cauda equina syndrome);
  • the use of antibiotic therapy, an increase in body temperature (infectious processes);
  • previous trauma or diagnosis of osteoporosis, age over 55 (spinal fracture);
  • young age - up to 20 years;
  • long-term maintenance of painful sensations and their intensity despite treatment;
  • combined with general weakness or with gait disorders that worsen at night, does not change with a change in posture.
• Radicular- next frequency (up to 27%). It is caused by entrapment and / or inflammation of the root of the spinal cord that exits through the openings in the spine. This type can be indicated by increased pain with coughing, sneezing, exertion, and other activities.
• Unspecific- more often acute, it is difficult to immediately determine the specific cause of its development, it is usually the consequences of dystrophic changes in the bone, cartilage tissue of the spine, as well as the muscles and ligaments that make up the supporting apparatus of the back. In the International Classification of Diseases (ICD-10) there is a special section for the definition of such syndromes - dorsopathies.

This dorsalgia accounts for up to 85% 1 of all cases and is mainly associated with a disruption of the normal function of individual structures of the spine, each of which can become a source of pain impulses. The pain can be more compressive (by compressing the nerve roots) and reflex - from all other tissues, including spasmodic muscles.

Another type of pain syndrome is described that is not associated with organic lesions of the spine and paravertebral tissue. This is known as dysfunctional pain. It can be caused by mental health problems and chronic stress.

Localization distinguishes:

What is your name	Where does it hurt
cervicalgia	Annoyance
Cervicocranilagy	Neck + head
Cervicobrachialgia	Neck and gives the hand
Thoracic algia	Chest and chest pain, pain under the shoulder blades from behind
Lumbodynia	lower back and lumbosacral region
sciatica	lower back + leg
Sacralgia	Sacrum
coccyx	coccyx

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

• severe physical overload, which leads to overstretching of muscles and ligaments;
• uncomfortable or static postures that a person adopts for a long time;
• untrained muscles and their overload, inactivity;
• Trauma and microtrauma;
• Hypothermia;
• prolonged immobility, such as bed rest;
• Alcohol abuse;
• Diseases of internal organs;
• common pathology;
• Obesity;
• individual characteristics: curvature of the spine, stooping;
• poor nutrition, diseases of the digestive system, which can be accompanied by impaired absorption of vitamins, mineral metabolism, significant absorption of salts that affect the joints;
• Occupational hazards: thermal effects, temperature fluctuations, vibrations, working with weights, etc.

The mechanism of the development of dorsalgia is associated with blockage of the intervertebral joints, which can be caused by static and dynamic loads, microtraumas and non-physiological postures. As a result, the muscles cramp and overstretch in one place and overstretch in another. All of this leads to the development of muscle pain, changes in pain sensitivity and the formation of pathological pain impulses.

Muscle spasms can also be a reflex reaction to the pathology of the spine or to diseases of the internal organs. In this case it is seen as a defense reaction, but at the same time it starts a new cycle of pain. In addition, if the spasm is maintained for a long time, the transmission of nerve impulses to the muscle fibers is disturbed, they become more excitable, calcium deficiency can occur and circulatory disorders further aggravate the situation.

Depending on the duration of the dorsalgia:

• acute - lasting up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic - last 12 weeks or longer.

Symptoms

Symptoms of dorsalgia depend on the cause, the mechanism of development, and the presence of concomitant diseases.

The following signs are characteristic of unspecific pain:

• aching or aching pain, sometimes attracting;
• increases with load or movements of the spine, as well as in certain positions, can decrease when 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;
• when probing, compressing, changes in contour, tension are noted, but there are no sensitivity disorders in the painful area, a decrease in muscle strength, reflexes do not change.

When the nerve root is compressed (radiculopathy), the pain varies in intensity, can be stabbing, often radiates into the leg and can be stronger in the extremity than in the back. When examined, symptoms of damage to a particular nerve root are observed - muscle weakness, impaired sensitivity in a certain area.

diagnosis

The diagnostic algorithm for acute and chronic dorsalgia is slightly different.

Sharp pain

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

• X-ray examination;
• MRI and CT of the spine;
• Scintigraphy - a visualization method using a contrast agent;
• Densitometry - determination of bone density;
• Laboratory tests to determine tumor markers, rheumatoid tests, biochemical blood tests, etc.

Patients with unspecific acute pain usually do not need any additional examinations.

Chronic pain

Since the mechanisms of its development have not yet been adequately studied, identifying the source can be problematic, 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 any case, a thorough questioning and examination of the patient is carried out in order to decide on further treatment tactics.

With a pain syndrome that occurs against the background of dystrophic changes in the joints, after any mechanical load or under the influence of other factors, it is possible to use magnetic resonance imaging to follow the dynamics of the state of the spine.

Dealing with acute back pain

Doctors who adhere to the principles of evidence-based medicine use the following tactics to treat patients with acute dorsalgia:

1. inform the patient about the causes of the pain syndrome;
2. Exclude bed rest and recommend maintaining normal activity;
3. prescribe effective drug and non-drug treatment;
4. Monitor dynamics and adjust therapy.

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

Naproxen is available as an oral tablet and a gel for topical use. The drug is indicated as a pain reliever for back pain related to trauma, congestion and inflammation. It also has anti-inflammatory and antipyretic effects, and the effects can last up to 12 hours. If you do not have the opportunity to see a doctor soon and the pain is causing significant discomfort, 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 medical consultation is no longer than 5 days.

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

Non-drug treatments include:

• Heat;
• manual therapy;
• Physical therapy;
• Massage;
• Physical therapy;
• Acupuncture and other alternative methods.

Treating Chronic Back Pain

When the localization of the pain and the source of the pain impulses can be identified, local therapy is used - blockages, intradiscal influences and other procedures. For the rest of the patients, such treatment for back and lower back pain is not used, so a different treatment regimen is used. Its main goal is to reduce the intensity of pain and maintain quality of life.

As with acute pain, drugs from the NSAID group are prescribed, including naproxen, other analgesics, muscle relaxants, and B3 vitamins. Antidepressants are recommended when needed. Manual therapy should be carried out by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic treatment methods are used.

prophylaxis

In order to prevent dorsalgia, it is necessary to identify all possible risk factors and work on their elimination.

With all types of pain, the following are useful:

• adequate physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• Maintaining a physiological posture during work;
• quit smoking and alcohol;
• regular check-ups;
• adequate treatment and prevention of infections;
• balanced nutrition;
• wear comfortable shoes and clothes;
• correct organization of work and life to protect the back;
• Prevention of stress and emotional overload.

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