Back pain: causes, treatment

Back pain is a pressing medical issue. While back pain is one of the most common reasons for seeking medical attention, many aspects of this problem remain poorly understood, and there are very few treatment methods that have a solid evidence base.

During their lifetime, 70-80% of the population suffers from back pain at least once. According to epidemiological studies, the prevalence of lower back pain reaches 40-80%. In 10-20% of patients of working age, acute back pain transforms into chronic pain. It is this group of patients that is characterized by an unfavorable prognosis in terms of recovery, and it accounts for 80% of all health care costs for the treatment of back pain.

Back pain is familiar to everyone. Even those who have never heard of doctors sometimes experience aching sensations that arise both when walking and at rest, in public transport, at work, even during sleep. As a rule, the first signs of discomfort in the back are attributed to fatigue, overwork, excessive physical activity. And indeed, back pain often goes away on its own, after a few hours of rest. However, chronic painful sensations cause concern. And for good reason. After all, this can be one of the first signs of diseases of the spine or other internal organs.

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What causes back pain?

As a rule, this type of unpleasant sensation is caused by injuries or simply damage, namely:

• Fractures;
• Scoliosis;
• Spasms;
• Muscle strains;
• Heart and kidney diseases;
• Hernia;
• Osteochondrosis.

In girls, a nagging 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 do physical labor associated with carrying heavy objects. Also, poor nutrition, smoking, and excessive alcohol consumption can contribute to the appearance of painful sensations.

What are the symptoms of back pain?

Clinical manifestations of vertebrogenic pathology are compression-ischemic syndromes, mainly radiculopathy (5 to 10%) and muscle-tonic reflex syndromes that accompany radiculopathy or are observed in isolation (90%).

Each local pain stimulus causes, first of all, a reflex in the corresponding segment. In this zone, we observe a section of cutaneous hyperalgesia, muscle tension, painful points of the periosteum, limitation 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 motor segment provoke a reaction in 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 of protecting 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, emotional instability in pain assessment is noted, as well as exaggeration of external manifestations of pain or, conversely, unreasonably excessive caution in movements. At the same time, aspects of health and work, their combination with economic indicators, the risk of job loss are closely combined. Only a general practitioner can take into account all the variety of factors when treating a patient.

Long-term back pain that requires a visit to the doctor is caused by damage to the vertebrae themselves, intervertebral discs and joints, ligamentous or muscular framework of the spine. At the same time, the disease that caused the pain can be either relatively favorable in terms of treatment and prognosis (for example, osteochondrosis) or fatal (metastases to the spine, myeloma disease).

In addition, lower back pain may be accompanied by diseases of internal organs, such as pyelonephritis, diseases of the internal genital organs, and lower intestines.

Back pain associated with various degenerative-dystrophic lesions of the spine has common pathogenetic features. Currently, three main pathophysiological mechanisms of back pain development are recognized. The first mechanism is associated with peripheral sensitization, i.e., with increased excitability of peripheral pain receptors (nociceptors) due to trauma, infection, or other factors. The nociceptors responsible for back pain are located in the fibrous ring of the intervertebral disc, posterior longitudinal ligament, supraspinous, interspinous, and intertransverse ligaments, areas of the dura mater, facet and sacroiliac joints, spinal nerve roots, spinal ganglia, and paravertebral muscles. The vertebrae and yellow ligament usually do not have nociceptors. The central part of the intervertebral disc contains a large amount of the enzyme phospholipase A ₂, 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, which cause pain, can be released from sensory fibers surrounding the dorsal horn of the spinal cord. 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). Sensitization of receptors occurs as a result of damage to the musculoskeletal tissues of the back and the release of the listed proinflammatory 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 due to 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, 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 stimulus occurs, it intensifies in the spinal cord, resulting in increased pain. In this case, even weak stimulation of afferents contributes to the emergence of so-called central pain. Direct brain damage (spinal cord injury, stroke) can also provoke central sensitization.

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What is the nature of back pain?

As a rule, back pain is aching, pulling, concentrated in a certain area of the spine. However, there are also sharp, unexpected attacks, the so-called lumbago. Radiating back pain is also possible, spreading to the limbs, neck, shoulders. Thus, various manifestations of back diseases are possible, which indicates the attention that must be paid to determining the stage of the disease and its type.

How to recognize back pain?

In order to determine the necessary treatment, doctors usually first talk to the patient, asking about the symptoms, what caused the back pain, and the condition of other organs. Blood and urine tests, as well as a direct examination, may also be required.

Among the modern diagnostic methods used are:

• X-ray;
• Magnetic resonance imaging;
• Computed tomography.

How is back pain treated?

Unfortunately, it is impossible to completely get rid of such a condition as back pain, however, the probability of minimizing discomfort is high. For this, medication methods are used, as well as conservative medicine techniques.

So, the most commonly used medications are:

1. Anti-inflammatory drugs;
2. Chondroprotectors;
3. Muscle relaxants;
4. Painkillers.

However, remember that excessive consumption of all these medications may 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 cause complications, however, they should also be used as prescribed by a doctor who will take into account your back pain. For example, in case of heart disease, hernias, 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 highlight:

• Therapeutic massage;
• Physiotherapy procedures;
• Methods of manual therapy;
• Acupuncture;
• Laser therapy;
• Electrophoresis, etc.

Remember that any of these activities should only be carried out by professionals!

The course of treatment usually lasts about two to three weeks, and to consolidate the result, you can add treatment in a sanatorium.

How to prevent back pain?

To ensure that back pain rarely bothers you, follow these rules:

• Maintain good posture, do not slouch;
• Do not work in the same position for a long time;
• Try to sit with your legs crossed less;
• Make fewer sudden movements;
• Sleep on a hard bed;
• Eat right, give up smoking and alcohol;
• Play sports, go to the gym or swimming pool, attend aerobics or yoga classes;
• Avoid wearing high heels for long periods of time.

Back pain is quite unpleasant, especially in chronic manifestations and sudden attacks, however, proper treatment and an active lifestyle will easily help you cope with this problem!