Back pain

Back pain (synonymous with back pain) is one of the most common reasons to visit a doctor, second only to acute respiratory diseases1. Very often, these complaints go to a neurologist, therapist or GP. According to international studies, from 19 to 43% of the adult population that has been surveyed recently, noticed back pain in the last month, from 27 to 65% - in the last year. Those who have experienced this at least once in their life, there are 59-84% 1. Almost one in five adult inhabitants of our planet may experience severe back pain at this time. Its most common location is the lower back and lower back.

Why does back pain occur?

Among the main reasons for the development of back pain are:

1. Vertebral causes - associated with pathology of the spine:
   • pathology of the intervertebral discs, including hernias;
   • narrowing of the spinal canal;
   • joint diseases;
   • the consequences of injuries;
   • congenital malformations and developmental abnormalities;
   • metabolic disorders;
   • spondylitis - inflammatory processes in the intervertebral joints.
2. Non-vertebrogenic: not associated with pathology of the spine:
   • ligament and muscle sprains associated with heavy loads;
   • myofascial syndrome - chronic muscle pain;
   • inflammation of muscle tissue - myositis;
   • diseases of the internal organs;
   • large vessel pathology, eg aneurysm (acute expansion) of the abdominal aorta;
   • arthrosis of the hip joint - an inflammatory-dystrophic disease;
   • mental disorders, etc.

Depending on the origin, the following types of pain are distinguished:

• Specific- is associated with a specific disease that can be detected by standard examination methods. This type occupies up to 3% 1 of all cases. These can be compression fractures of the spine, tumors, infectious processes, diseases of the pelvic organs (especially with back pain in women).

  At the same time, there are a number of certain symptoms, the so-called "red flags", which speak of serious diseases and require an in-depth examination. These include:

  • rapid and unreasonable loss of body weight and / or an indication of a history of oncopathology (tumors);
  • weakness in the lower extremities, impaired sensation and functions of the pelvic organs (cauda equina syndrome);
  • the use of antibiotic therapy, an increase in body temperature (infectious processes);
  • previous trauma or previous diagnosis of osteoporosis, age over 55 years (spinal fracture);
  • young age - up to 20 years;
  • long-term preservation of painful sensations and their intensity, despite treatment;
  • combined with general weakness or gait disturbance, aggravated at night, does not change with a change in body position.
• Root- next in frequency (up to 27%). It develops as a result of pinching and / or inflammation of the root of the spinal cord, which exits through the openings of the spine. This type may be indicated by increased pain when coughing, sneezing, physical exertion, and other types of activity.
• Nonspecific- 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 form 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.

Such back pain accounts for up to 85% 1 of all cases and is primarily associated with disruption of the normal functioning of individual structures in the spine, any of which can become a source of pain impulses. The pain can be compressive (by compression of the nerve roots) and reflex, of all the other tissues, including the spasmodic muscles.

Another type of pain syndrome is described, which is not associated with any organic lesion of the spine and paravertebral tissues. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.

The location distinguishes:

What is the name of	Where it hurts
cervicalgia	Pain in the neck
cervicocranilagia	neck + head
cervicobrachialgia	neck and hand
thoracalgia	pain in the thoracic back and chest, pain under the shoulder blades of the back
lumbodynia	lumbosacral and lumbar region
sciatica	lower back + leg
sacralgia	sacrum
coccydynia	coccyx

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

• severe physical overload, resulting in overstretching of muscles and ligaments;
• uncomfortable or static postures that a person takes for a long time;
• untrained muscles and their overload, inactivity;
• trauma and microtrauma;
• hypothermia;
• prolonged immobility, such as bed rest;
• Alcohol abuse;
• diseases of the internal organs;
• joint pathology;
• over weight;
• individual characteristics: curvature of the spine, stooping;
• poor nutrition, diseases of the digestive system, which can be accompanied by poor absorption of vitamins, mineral metabolism, a significant intake of salts that affect the joints;
• Occupational risks: thermal effects, temperature fluctuations, vibrations, work with weights, etc.

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

In addition, muscle spasm can be a reflex reaction to a pathology of the spine or diseases of the internal organs. In this case, it looks like a defensive reaction, but at the same time, it starts a new cycle of pain. In addition, with the prolonged preservation of spasm, the transmission of nerve impulses to the muscle fibers is interrupted, they become more excitable, calcium deficiency may occur, and circulatory disorders further aggravate the situation.

Depending on the duration of the back pain, there may be:

• acute - lasts up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic: lasts 12 weeks or more.

Symptoms

The symptoms of back pain depend on the cause, the mechanism of development and the presence of concomitant diseases.

For nonspecific pain, the following signs are characteristic:

• sharp or drawing pain, sometimes tightness;
• increases with the load or movements of the spine, as well as in certain positions, it 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, compaction, changes in contours, tension is determined, but there are no disturbances in sensitivity in the painful area, a decrease in muscle strength, reflexes do not change.

When the nerve root is compressed (radiculopathy), the pain differs in intensity, it can be stabbing, it often radiates to the leg, and in the limb it can be stronger than in the back. On examination, symptoms of damage to a specific nerve root are observed: muscle weakness, altered sensitivity in a certain area.

Diagnostics

The diagnostic algorithm for acute and chronic back pain is somewhat different.

Sharp pain

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

• X-ray examination;
• Magnetic resonance and computed tomography of the spine;
• scintigraphy - a visualization method that uses the introduction of a contrast agent;
• densitometry: determination of bone density;
• laboratory tests to determine tumor markers, rheumatic tests, biochemical blood tests, etc.

Patients with acute nonspecific pain usually do not need further investigation.

Chronic pain

Since the mechanisms of its development have not yet been sufficiently studied, it can be problematic to identify the source, 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 either case, a thorough interview and examination of the patient is conducted to decide on further treatment tactics.

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

How to deal with acute back pain

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

1. inform the patient about the causes of 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, nonspecific anti-inflammatory drugs (NSAIDs) are prescribed, as they have been proven effective for back pain. One of those drugs is naproxen.

Naproxen is available as an oral tablet and gel for external use. The drug is indicated as an analgesic for back pain associated with trauma, overuse, and inflammation. It also has anti-inflammatory and antipyretic effects, the duration of the effect can last up to 12 hours. If you do not have the opportunity to visit a doctor soon and the pain causes you 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 consulting a doctor is not more than 5 days.

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

Non-drug treatments include:

• heating
• manual therapy;
• physiotherapy;
• massage;
• physiotherapy;
• acupuncture and other alternative methods.

Chronic back pain treatment

If the localization of pain and the source of pain impulses can be identified, then local therapy is used: blockages, intradiscal influences and other procedures. For the rest of the patients, this treatment for back and low back pain is not used, so a different treatment regimen is used. Its main objective is to reduce the intensity of pain and preserve quality of life.

Also, as in acute pain, drugs from the group of NSAIDs are prescribed, including naproxen, other painkillers, muscle relaxants, and vitamins B3. Antidepressants are recommended as needed. Manual therapy should be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic treatment methods are used.

Prophylaxis

For back pain prevention, you need to identify all possible risk factors and work to eliminate them.

For all types of pain, the following will be helpful:

• adequate physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• maintain a physiological posture during work;
• stop smoking and drinking alcohol;
• regular preventive exams;
• adequate treatment and prevention of infections;
• balance diet;
• wear comfortable clothes and shoes;
• correct organization of the workplace and life to protect the back;
• prevention of stress and emotional overload.

Comprehensive treatment and complete rehabilitation of patients with back pain allows you to preserve the quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.