Back pain above the lumbar region on the right, left, between the shoulder blades

The modern world is full of various factors that can cause all kinds of pain. Thus, widespread hypodynamia, sedentary work and an unhealthy lifestyle often lead to people having back pain above the waist: this is the area that first reacts to excessive loads and lifting weights. In addition, pain can radiate from other areas and organs.

The main task of a person who has such an unpleasant symptom is to react promptly and quickly and consult a doctor.

Causes back pain above the lower back

There is no single root cause that leads to the occurrence of back pain above the waist. Just as the pain itself can have a varied nature, depending on the causes. In some patients, the pain intensifies under the influence of physical exertion and motor activity, while in others, pain may appear at rest - for example, during a night's rest. Some patients complain only of the occurrence of back pain above the waist, while others indicate several symptoms at once - for example, pain may be combined with fever, nausea, shortness of breath, etc.

If pain occurs, it is wrong to immediately "blame" the spine. Back pain above the waist can be caused by diseases of the internal organs - for example, the digestive system, urogenital system. Some women may experience similar pain during pregnancy and with the onset of the menstrual cycle.

However, doctors consider pathologies and injuries of the spinal column and muscular corset of the back to be the most common cause. According to statistics, pain is often provoked by osteochondrosis, which is accompanied by deterioration of the function of the intervertebral discs.

Sharp back pain occurs during an attack of radiculitis or with an intervertebral hernia. Nagging pain is typical for curvature of the spinal column. Other possible causes may be:

• inflammatory processes, infections (tuberculosis, rheumatoid arthritis, epidural abscess, brucellosis);
• tumor processes in the spine;
• neuralgia, myalgia.

Risk factors

The factors that can provoke back pain above the waist are quite diverse:

• hereditary predisposition;
• features of professional activity (the presence of excessive static-dynamic loads, prolonged stay in an uncomfortable position, exposure to vibration, etc.);
• physical inactivity, sudden transitions to physical activity;
• local and general hypothermia;
• bad posture;
• frequent infections, diseases of the digestive organs;
• obesity, metabolic disorders;
• bad habits, unhealthy diet;
• old age (age-related changes in the musculoskeletal system, presence of chronic diseases);
• osteomalacia, osteoporosis;
• tumor processes in the body;
• diseases affecting the pelvic organs (kidneys, reproductive system).

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Symptoms

To accurately determine the cause of pain, the doctor must determine its location.

• Back pain above the waist on the sides accompanies diseases of the musculoskeletal system. Among such diseases, there may be both ordinary bruises or other injuries, and severe degenerative processes in the spine. In addition, a similar symptom is observed in rheumatological pathologies (for example, osteoarthritis, Bechterew's disease ).
• Back pain on the right above the waist is observed when the lungs are affected simultaneously with the spread of the disease to the pleura. Additional symptoms include limited breathing movements and increased shortness of breath. Just like on the right, back pain on the left above the waist can appear when the pathological process is localized in the lung tissue.
• A sharp pain in the back above the waist does not always mean a pathology of the spinal column. Sometimes the problem should be looked for in the internal organs - for example, in the kidneys. In some patients, a sharp pain in the back became one of the signs of myocardial infarction.
• Back pain in the morning above the waist can accompany spinal diseases such as osteoarthritis, intervertebral hernia, as well as urolithiasis, cardiac pathology.
• Back pain at night above the waist may indicate diseases of the digestive system: peptic ulcer, stomach tumors, cholecystopancreatitis. Such pain is not uncommon when the muscles of the back and spinal column are affected.
• Back pain above the waist when inhaling may be a sign of neurological pathologies, heart disease. But most often, this symptom indicates the presence of intercostal neuralgia.
• Back pain when moving above the waist often appears against the background of damage to the intervertebral discs or osteochondrosis. Unpleasant sensations can spread to the lower limbs, to the groin. Increased pain is observed with physical activity.
• Pain in the muscles of the back above the waist appears with injuries, myositis, after heavy physical work, after sudden hypothermia. To clarify the diagnosis, it is necessary to conduct a comprehensive diagnosis.

Nature of pain

The nature of the pain syndrome is also taken into account when making a diagnosis.

• Aching pain in the back above the waist may indicate lumbar osteochondrosis, spondylosis and other pathological processes in the spinal column. If such pain occurs after hypothermia, then one can assume the development of inflammation of the lumbar muscles (myositis).
• A nagging pain in the back above the waist can be a temporary phenomenon that occurs after intense physical exertion, after a long stay in an uncomfortable position. Nagging sensations are not uncommon for people who have previously had back injuries and now experience so-called "weather" pain.
• Girdle pain in the back above the waist often indicates the presence of pyelonephritis, exacerbation of pancreatitis, gallstone disease, and less often, problems with the heart muscle.
• Severe back pain above the waist can occur due to the movement of kidney stones, as well as during an exacerbation of intestinal inflammatory diseases, during inflammation of the ureter, and during the rupture of a cystic formation in women.
• Acute back pain above the waist is often called "lumbago". It can be a complication of scoliosis, when the nerve is pinched due to the displacement of the discs. Osteochondrosis vertebral deformation with compression of the nerve by an intervertebral hernia occurs no less often.
• A dull pain in the back above the waist sometimes indicates problems with the kidneys. In addition, such pain can also occur as a result of overtraining, after lifting heavy objects or sudden motor activity of the body, which could cause a muscle spasm.
• Shooting pain in the back above the waist is detected with pinched nerve roots, with intercostal neuralgia. An attack of acute cholecystitis or pancreatitis should also be considered as a differentiation.

Back pain above the waist during pregnancy

The body of a pregnant woman works with an ever-increasing load, because it needs to ensure the full development of the future child. Sometimes, the woman's body may suffer from these loads: for example, as a result of the increase in the mass of the fetus, the center of gravity in the body of the expectant mother shifts, which can cause back pain above the waist and between the shoulder blades.

Pregnant women complain of back pain especially often if they had problems with the musculoskeletal system before pregnancy. For example, if a pregnant woman had a curvature of the spine, poorly developed lumbar muscles, or had signs of osteochondrosis, then she automatically falls into the risk group for back pain, including above the waist. Also at risk are women with excess weight: their spine experiences even greater daily stress.

Pain syndrome usually makes itself known no earlier than the second trimester, but early discomfort is also possible. Much depends on the lifestyle of the pregnant woman, the level of physical activity and other factors.

According to statistics, back pain above the waist in women expecting a baby occurs in approximately 40% of cases, and after childbirth - in 68% of cases.

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Diagnostics back pain above the lower back

The first stage of diagnostics is a conversation with a doctor, during which the patient should tell in as much detail as possible about the characteristics of back pain above the waist. A doctor's examination is also of great importance. Already at this stage, the doctor can make a preliminary diagnosis. To make a final diagnosis, further diagnostics are necessary.

Tests are prescribed only when it is necessary to ensure the absence of infection or confirm the presence of an inflammatory process. For this purpose, a general and biochemical blood test is prescribed. If kidney disease is suspected, then a urine test is mandatory, which evaluates kidney function.

If there is a suspicion that back pain above the waist is caused by an underlying pathology, or if the pain has been present for a long time, further instrumental diagnostics are prescribed.

If the problem is suspected to be in the discs, nerves, or tendons, then an X-ray, computed tomography, or magnetic resonance imaging is prescribed.

If kidney damage is suspected, ultrasound diagnostics is indicated.

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Differential diagnosis

Differential diagnostics is aimed at assessing the possibility of developing vertebral and non-vertebral somatic diseases. The details of such differentiation can be briefly described in the table:

Disease	Characteristic symptoms
Dissecting aortic aneurysm	Tendency to high blood pressure, chest pain radiating to the area above the waist and between the shoulder blades, abnormal heart rhythm, signs of aortic regurgitation.
Acute attack of renal colic	Back pain above the waist is caused by dehydration, intense physical activity, and may be accompanied by nausea (up to vomiting), hematuria.
Acute attack of pancreatitis	The pain above the waist is of a girdle nature, it can radiate to the shoulder blades or collarbone on the left side. Vomiting without relief and increased gas formation often occur.
Infectious and inflammatory process in the spine	Increased body temperature, presence of local pain and local hyperthermia, presence of signs of an inflammatory process in a blood test.
Tumor process in the spine	Weight loss without apparent cause, constant pain that is not dependent on exercise, and lack of effect from taking conventional painkillers.
Spinal compression injury	Trauma, history of excessive physical activity, prolonged treatment with glucocorticoids, numbness of the extremities, local pain on palpation.
Spondyloarthritis	Back pain above the waist in the morning, at rest, decreases during movement. Presence of morning stiffness, inflammatory signs in the blood test.

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Treatment back pain above the lower back

No doctor would dare to prescribe treatment for back pain above the waist if he does not know the underlying cause of such a symptom. Only after a thorough diagnosis and after studying its results can adequate therapy be prescribed.

Symptomatic treatment for pain may include medications such as:

• Paracetamol is the most accessible and common drug used for moderate back pain above the waist. Tablets should be taken at regular intervals of 500 mg up to four times a day. The maximum possible daily dosage is 4 g, and the total duration of the treatment course is up to five days. The proposed dosage is safe and is almost never accompanied by the development of side effects (provided there is no hypersensitivity to Paracetamol).
• Non-steroidal anti-inflammatory drugs help to significantly reduce even relatively intense back pain. The analgesic ability of such drugs is higher than that of Paracetamol. A specific non-steroidal drug is selected taking into account possible side effects: for example, due to the high probability of damage to the digestive system, such drugs should not be used for stomach ulcers and duodenal ulcers. In addition, it should be remembered that such a group of drugs will not be able to relieve back pain of radicular origin.

Experts recommend using the following NSAIDs for back pain above the waist:

1. class of non-selective cyclooxygenase 2 inhibitors (Diclofenac from 75 to 150 mg per day in two doses, Ketoprofen from 100 to 300 mg per day in two doses, Dexketoprofen from 25 to 75 mg per day in several doses, Ketorolac 20 mg per day in two doses, Lornoxicam from 8 to 16 mg per day in two doses);
2. class of selective cyclooxygenase 2 inhibitors (Nimesulide 200 mg per day in two doses, Celecoxib from 200 to 400 mg per day in two doses).

• Muscle relaxants – prescribed if back pain above the waist is caused by muscle spasm, and also if there is no effect from taking Paracetamol or non-steroidal drugs. The course of taking muscle relaxants is usually short – up to one week. The doctor may prescribe a benzodiazepine drug (Tetrazepam, Diazepam) or a non-benzodiazepine drug (Baclofen, Flupirtine, Tizanidine, etc.). The dosage of the drugs is determined individually, taking into account possible side effects (dizziness, decreased blood pressure, fatigue). The recommended doses may be as follows:
  • Tizanidine – 2 to 4 mg up to three times daily;
  • Tolperisone – 150 mg three times a day.

If monotherapy with Paracetamol or non-steroidal drugs is not effective, then combination therapy is prescribed:

• one of the non-steroidal drugs + a mild opiate (Tramadol);
• Paracetamol + mild opiate (for example, the combination drug Zaldiar, one tablet up to 3 times a day);
• nonsteroidal drug + muscle relaxant.

Vitamins

To treat back pain above the waist, doctors recommend using medications that contain B vitamins. These medications successfully combat neurological problems and eliminate painful sensations.

• Thiamine, or vitamin B _1, improves the properties of nervous tissue and relieves pain;
• Pyridoxine, or vitamin B _6, potentiates the function of the nervous system and improves the conductivity of nerve impulses;
• Vitamin D normalizes the absorption of calcium, phosphorus, magnesium, improves the composition of bone tissue;
• Ascorbic acid stops oxidative processes in tissues, relieves inflammation, activates metabolism, promotes the production of collagen fibers, and increases the elasticity of vertebral discs.
• Vitamins A and E are taken in tandem. They help restore damaged tissue, increase its elasticity and firmness.

Physiotherapy treatment

It is difficult to imagine treatment for back pain above the waist without the use of physiotherapeutic methods. Physiotherapy procedures have an analgesic, anti-inflammatory effect, relieve tension in spasmodic muscles, and improve the tone of weakened muscles.

For back pain, the following are considered basic methods:

• electrical stimulation – the effect of weak current on muscles to improve tone and strengthen muscle fibers;
• electrophoresis – the introduction of medicinal substances directly into the affected tissues, without additional toxic load on the body;
• phonophoresis is a procedure similar to electrophoresis (ultrasound is used instead of current);
• UHF – exposure to ultra-high frequency electric field pulses (40.68 MHz);
• paraffin therapy – the use of paraffin applications, which improve blood and lymph circulation in tissues and stimulate metabolic processes;
• detensor therapy – a procedure for stretching and unloading the spinal column (may be prescribed for the treatment of compression and traumatic injuries of the spinal column);
• shock wave treatment – used for degenerative-dystrophic diseases of the spine;
• laser therapy – stimulates metabolism in degenerative-dystrophic pathologies of the spine and joints;
• magnetic therapy – activates compensatory-adaptive reactions, stimulates the body’s internal reserves to combat pathology.

Folk remedies

The power of folk methods of treatment is explained by their naturalness. However, they should be used knowing the real cause of back pain above the waist, and also after a preliminary consultation with a doctor.

• A mixture of birch leaf and St. John's wort oils will help relieve back pain. Rub the affected area with this mixture once a day before bed.
• To improve blood circulation and relieve pain, rub the area above the waist with garlic tincture. Chop the garlic cloves and pour vodka over them, and leave in a dark place for 10 days. Compresses based on this tincture also help well, but they can only be applied for 30-40 minutes so as not to irritate the skin.
• Apply fresh crushed Kalanchoe leaves to the sore area above the waist. It is especially good if such applications are carried out after a preliminary back massage.
• Compresses based on horse fat have a good effect. The fat is spread thinly in one layer, covered with film and secured with adhesive tape. Patients claim that the pain in the back above the waist goes away after 1.5 hours.
• Rub fir essential oil into the back area.

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Herbal treatment

• The comfrey plant has proven itself to be excellent in the treatment of back pain associated with osteochondrosis and intervertebral hernias. Fresh rhizomes of the plant are minced and mixed with an equal share of honey. The resulting mass is consumed 1 teaspoon daily on an empty stomach. The duration of therapy is 10 days, after which they take the same break and continue the treatment again. Usually 2-4 such courses are carried out.
• There is also an external method of treatment with comfrey. Soak 50 g of the plant's rhizome in water, pour in 0.7 l of vodka and leave for two weeks. The resulting tincture is filtered and used to apply compresses to the site of back pain (above the waist). The duration of treatment is 10 days, after which a similar break is taken. In total, 2-4 courses are carried out.
• Pour 300 g of crushed cinquefoil rhizome with enough vodka to cover the raw material completely. Then place the container in a dark place and keep for 21 days, after which filter the tincture and drink 1 tbsp. three times a day (you can wash it down with a sip of water). Drink the entire tincture this way, take a break in treatment for 4 weeks and repeat the course.
• Fresh pine buds are minced in such quantity that a 3-liter jar is full. 200 g of sugar are added there, mixed, covered with a lid and placed in the refrigerator. When the mass turns brown, the medicine is ready. Take it orally 30 minutes before meals, up to 4 times a day, 1 teaspoon. The course of treatment ends when all the medicine has been eaten.

Homeopathy

A noticeable improvement in the patient's condition with back pain above the waist can be expected if the treatment includes several treatment methods at once. This includes taking medications, exercise therapy, reflexology, and also treatment with homeopathic drugs.

For the treatment of the lumbar spine, as well as areas above the waist, injections with the following drugs are used:

• Ziel T is administered intramuscularly or subcutaneously, one ampoule twice a week.
• Traumeel S is administered intramuscularly or segmentally (biopuncture) one ampoule daily in the acute phase of back pain. After the condition has normalized, you can switch to taking Traumeel S tablets.
• Discus compositum is administered intramuscularly or subcutaneously, one 2.2 ml ampoule one to three times a week. Duration of therapy is 1-1.5 months.

The listed remedies relieve the inflammatory reaction, stabilize metabolic processes, and initiate a restorative reaction at the level of cellular structures. The risk of side effects is minimal: homeopathic preparations are safe and rarely cause any additional negative symptoms.

Surgical treatment

The most common diseases that cause back pain and require surgical intervention are intervertebral hernia and lumbar stenosis. These pathologies cause pain at or above the lumbar region, with possible irradiation to the lower extremities. Some patients complain of difficulty walking or urinating, and sometimes muscle paralysis develops.

Indications for surgical treatment may also include:

• spondylolisthesis (displacement of vertebrae);
• tumors of the spine, kidneys.

The question of surgical intervention is decided on an individual basis.

Complications and consequences

Since the causes of back pain above the waist can be very different, it is quite difficult to talk about any specific consequences or complications. Pathologies that cause pain syndrome can be localized directly in the lumbar region (in the spinal column, muscular-ligamentous apparatus, nerve roots, etc.), as well as in other organs. Often, pain is a consequence of some diseases of the central nervous system, neuroses, blood flow disorders in the abdominal aorta, pathologies of organs located in the small pelvis and abdominal cavity. In no case should you immediately “diagnose yourself” with radiculitis and begin self-treatment at the first signs of back pain above the waist. Even a doctor, without having diagnostic results in hand, will not be able to accurately indicate the cause of such pain.

If you treat yourself incorrectly or ignore treatment altogether, a variety of complications may develop:

• chronic pain syndrome associated with damage to the nerve roots and muscles of the back;
• radiculopathy, myositis;
• pyelonephritis, renal failure;
• chronic pancreatitis;
• hernias and other diseases of the spinal column.

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Prevention

To avoid back pain above the waist, or other pathologies associated with back pain syndrome, you need to listen to the following recommendations:

• sleep in comfortable conditions using an orthopedic mattress;
• be careful and follow safety rules when playing sports, do not overload the musculoskeletal system, and avoid injury;
• monitor the position of your back, learn to maintain posture;
• avoid physical inactivity, practice moderate physical activity;
• do not neglect walking;
• do not overeat, watch your body weight;
• drink sufficient amounts of fluid;
• get enough sleep, maintain an adequate sleep and rest regimen;
• Do not self-medicate and consult a doctor if necessary.

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Forecast

In most patients, back pain above the waist is a benign condition that generally has a favorable prognosis. In the future, after completion of treatment, it is necessary to determine the patient's belonging to the appropriate risk group in order to prevent relapses and chronic pain. Particular attention should be paid to the characteristics of professional activity, psychosocial factors, lifestyle and nutrition of the patient.

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