Pain in the lumbar region

Pain in the lower back is familiar to every person, few of those who have not encountered it. Sometimes it is enough to spend a long time in the sitting position to have a pain in the lower back. According to statistical data, pain in the lumbar region is felt by 60-90% of people. Back pain is second only to acute respiratory diseases and is a frequent cause of temporary disability.

In 80% Pain in the lumbar region is associated with the pathology of the spine, the remaining 20% - associated with concomitant diseases of internal organs. Pain in the lumbar region can be an innocent functional disorder that disappears without a trace, or may indicate serious problems with the spine or internal organs. Therefore, it is important, in time to see a doctor, diagnose the problem and avoid serious complications.

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Causes of pain in the lumbar region

The causes of pain in the lumbar region are manifold. They can be primary, associated with the pathology of the spinal column and secondary, associated with diseases of the internal organs. Together with the causes, it is necessary to take into account and predisposing factors that can provoke or intensify the pain syndrome. Such factors include: 

• Features of professional activity (heavy physical activities, such as loaders, builders or athletes who lift weights, etc.).
• Prolonged sitting position, especially daily. 
• Sedentary lifestyle. 
• Overweight.
• Unbalanced nutrition (lack of calcium, phosphorus, protein, vitamins in the body). 
• Harmful habits - the use of alcohol and alcohol.

By reducing or eliminating the above-described factors of influence on the body, this is a huge step to improve overall health and spinal status, and as a result, elimination or reduction of back pain.

After understanding the predisposing factors, let's move directly to the causes of pain in the lumbar region.

Primary causative factors of back pain are associated with degenerative-dystrophic processes in the spine, these include: 

1. Osteochondrosis is degenerative-dystrophic changes in the intervertebral discs and cartilages, which leads to deformation of the discs and the appearance of a hernia. 
2. Spondylosis is a degenerative process, in which the formation of bone growths on the vertebrae (ie, proliferation of bone tissue), as a compensatory reaction to excessive loads. The proliferation of bone tissue leads to muscle spasms around the spine, limits its mobility, it is possible to injure the radicular nerves in the lumbar-sacral region and the spinal cord membranes. 
3. Spondyloarthrosis is a progressive degeneration of the articular surface of the vertebrae of the lumbosacral spine, involving ligaments, muscles, articular capsule and the growth of marginal osteophytes in the pathological process. This process leads to deformation of the intervertebral discs, joint space decreases, the spinal mobility is limited, pain and tension of the muscles around the spine are noted. Spinal roots can be compressed over time. 
4. Spondylolisthesis - characterized by displacement of the vertebrae relative to each other, as a result of which the lumen of the spinal canal changes, spinal roots are injured. 
5. Hernia of intervertebral discs.

Secondary causative factors arising from concomitant pathology in the body include: 

1. A metabolic disorder, a lack of micro- and macroelements in the body, as a result of which the skeleton changes (for example - osteomalacia, osteoporosis, hemochromatosis, alkaponuria). 
2. Curvature of the spinal column (lordosis, kyphosis, scoliosis). 
3. Located near the spinal column of a malignant neoplasm or its metastasis in the spine. 
   • Metastases in the vertebrae or epidural. 
   • Lymphogranulomatosis, lymphoma or myeloma. 
4. Infectious diseases: 
   • Epiduritis (spinal epidural abscess). 
   • Spondylitis (spine osteomyelitis). 
   • Disease of the sweat (tuberculous spondylitis). 
   • Purulent discitis.
5. Injuries of the spinal column (eg, vertebral fractures). 
6. Autoimmune diseases: 
   • Rheumatoid arthritis. 
   • Reiter's syndrome (simultaneous defeat of the joints, urinary system and conjunctiva of the eyes). 
   • Bechterew's disease (ankylosing spondylitis). 
7. Back pain is psychogenic (mental disorders), and after a stroke. 
8. Diseases of the gastrointestinal tract (eg, intestinal obstruction, appendicitis). 
9. Specific and nonspecific diseases of the pelvic organs (renal colic, inflammation of the ovaries, venereal diseases). 
10. Back pain during physiological processes in women (during menstruation and pregnancy).

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How is the pain in the lower back?

How does the pain in the lumbar region manifest itself, you ask? Differently. Pain in the lower back may be depending on the degree of its severity:

• Sharp, shooting character, strong enough, sudden (lumbago). 
• Chronic, lasting more than three months. Such pain is often dull, aching in nature (lumbulgia or lumboeishalgia).

In addition, the pain in the lumbar region can take a recurring course and from time to time make itself felt.

The development of low back pain is associated with infringement of the nerve roots, spasmodic, swelling and irritation of the muscles, ligaments, vertebrae and intervertebral discs of the lumbosacral section.

Pain in the lumbar region can be: 

• Mechanical, which occurs or increases usually in the second half of the day, after physical exertion and decreases or passes after rest. The occurrence of such pain is due to degenerative-dystrophic or functional disorders of the structures of the back. It is noted in middle-aged people or in the elderly. 
• Inflammatory - occurs or increases in the first half of the day, decreases when performing physical exertion and taking non-steroidal anti-inflammatory drugs, characterized by morning stiffness. The cause of this pain is inflammatory spondylopathy. The onset of the disease is observed at a young age.

Depending on what structures are damaged, the following types of pain in the lumbar region: 

1. Local (local) pain in the lumbar region. It arises due to damage and irritation of the structures of the lumbar region (joints, musculoskeletal system, ligaments). This pain is clearly localized, of a permanent nature, usually not strong. It can vary depending on the position of the body. 
2. Reflex (reflected) pain in the lumbar region. 
   • Pain that radiates to the lumbar spine due to diseases of the internal organs (pelvic organs and abdominal cavity). This pain can give to the buttocks and thighs. Such pain is deep, pulling and aching, does not pass alone. 
   • The pain that arises from the defeat of the sacrum. Can irradiate into the groin and the area of the buttocks, thighs, down to the feet. The pain is long, dull, absent-minded. 
3. Radicular pain in the lumbar region. It arises from the irritation of the roots of the spinal nerves. Radicular pain in intensity is stronger than reflex and radiates from the spine to the periphery. Such pain is in the innervation of the spinal root and can give in the lower limbs to the toes. Coughing, sneezing or other stress increases the radicular pain. 
4. Muscle pain (fibromyalgia) is a pain that arises from a protective muscle spasm. It occurs most often and occurs with many diseases of the spine. Long, chronic muscle tension causes aching, sometimes convulsive pain.

Dull and aching pain in the lumbar region

Dull and aching pain in the lumbar region may be the manifestation of a wide variety of diseases of the spine and internal organs (osteochondrosis, intervertebral hernias, infections, tumors, etc.). There are pains of this nature, as a rule, gradually. But depending on the severity of the pathological process, dull and aching pain can progress and transform into an acute one. Most dull and aching pain in the lumbar region occurs in women during menstruation, during pregnancy and with infections of the genitourinary system (for example, pyelonephritis). To correctly determine the causal factor of dull pain in the lumbar region, you need to seek help from a specialist who will conduct differential diagnosis and prescribe the optimal therapy.

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Sharp back pain in the lumbar region

Acute pain in the lumbar region arises suddenly, rather painful and brings severe discomfort, significantly restricts motor activity. It can arise as a result of sudden movements - twists of the trunk, slopes, lifting of weights, a sharp rise from the sitting position. Acute pain in the lumbar region may indicate severe diseases of the spine or internal organs. Causes of acute pain in the lower back can be: 

• trauma to the spine (eg, fracture), 
• sharp stretching of the back muscles, 
• displacement of intervertebral discs, 
• intervertebral lumbar hernia, 
• arthrosis of intervertebral joints (facet syndrome), 
• arthrosis of the hip joints (coxarthrosis), 
• epiduritis, 
• infection of the genitourinary system.

In the case of acute pain in the lower back, you need a bed rest (take the most convenient position, in which the pain is least noticeable) and call the doctor. Self-medication is best not to deal with, because this can lead to serious complications right up to disability.

Diagnosis of back pain in the lumbar region

Diagnosis of pain in the lumbar region is performed by a neurologist, a vertebrologist and is based on the following activities. 

1. Collection of an anamnesis (medical history) by a doctor. Causal and predisposing factors are elucidated (possible injuries, concomitant diseases, peculiarities of professional activity, etc.). 
2. Examination (including palpation), which assesses the general condition, orthopedic and neurological status (assess mobility of the lower back, sensitivity in the lumbar region, etc.). 
3. Additional survey methods: 
   • carrying out X-rays of the lumbosacral spine, 
   • computer tomography of the spine (assessing the condition of the vertebrae, intervertebral discs, soft tissues, blood vessels, etc.) 
   • magnetic resonance imaging of the spine, 
   • if necessary, is assigned myelography (X-ray diffraction study of the conductive pathways of the spinal cord - inject a contrast agent into the spinal canal, make an X-ray and thus determine its permeability, which can be disturbed due to tumors, hernias, stenoses) 
   • Bone scintigraphy (radionuclide study), is prescribed in case of non-informativity of previous methods of X-ray examination. With it, you can identify tumors, arthritis, etc. 
   • general clinical studies (general blood and urine analysis, biochemical blood test) 
4. Consultation of narrow specialists (if necessary): 
   • surgeon, 
   • orthopedist, 
   • urologist or nephrologist, 
   • gynecologist, 
   • infectiologist, 
   • proctologist, 
   • cardiologist, 
   • gastroenterologist, 
   • the oncologist.

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Treatment of back pain in the lumbar region

Treatment of pain in the lumbar region depends on the cause of its occurrence, on the severity of the process and, as a rule, conservative (surgical treatment is not excluded). 

1. Elimination of the cause that caused pain in the lower back (treatment of concomitant diseases, osteochondrosis, hernias, etc.). 
2. Bed rest, the bed should be stiff (usually put a shield under the mattress). 
3. A balanced diet with enough vitamins, protein, micro- and macro elements (especially calcium and phosphorus). 
4. Symptomatic therapy:
   • non-steroidal anti-inflammatory drugs - dicloberl, movalis, ibuprofen - effectively eliminate inflammation and pain, 
   • it is possible to use analgesics such as - analgin, baralgin, 
   • the use of muscle relaxants, which reduce muscle spasm and tension (midokalm, tizanidine), 
   • prescribe vitamins of group B (improve metabolic processes in the cell) and vitamin C (strengthens blood vessels and increases immunity), 
   • use of topical products (ointments, gels or compresses) - finalgon, fastem - gel, ketonal, indomethacin or orthophane ointment. Compresses with dimexide or novocaine. 
   • antiviral drugs and immunomodulators (Anaferon, Echinacea), 
5. Use of drugs that reduce degenerative - dystrophic processes in bone-cartilage tissue (Arthrofon, Don, Structum).
6. Perhaps the appointment of therapeutic blockade - the introduction of painkillers (novocaine, lidocaine) in the place where the most pain is expressed, the so-called trigger points (most often an epidural blockade with the introduction of an analgesic in the epidural space of the spine). Possible blockade with the combined use of novocaine and a corticosteroid drug (Cortizone, Diprospan). 
7. Physiotherapy treatment: 
   • electrophoresis using calcium, lidase, novocaine. 
   • phonophoresis (use of ultrasound) - improves and speeds up healing processes, has anti-inflammatory and analgesic effect, reduces swelling, 
   • electrostimulation of muscles (relaxes muscles, improves lympho- and blood circulation of muscles around the spine), 
   • amplipulse therapy (analgesic and vascular-trophic effect), 
   • paraffin treatment (restores and improves neuromuscular conduction, metabolic processes, improves lympho- and blood circulation), 
   • reflexotherapy (acupuncture, electroacupuncture, laser therapy), 
   • balneotherapy (application of sulfide, radon, sodium baths, etc.) 
   • mud treatment (use of mud applications of low temperatures). 
8. Therapeutic gymnastics begins with minimal stress and under the strict supervision of a doctor. It is carried out after the removal of acute pain. 
9. Therapeutic massage (strengthens the back muscles and promotes stabilization of the spine) is performed exclusively by a specialist, after an acute period. 
10. It is recommended to wear corsets, half-corsets, bandages, elastic belts, recliners. With their help, treatment and prevention of low back pain are carried out. They limit the amount of movement, reduce pain and muscle spasm. 
11. In the case of ineffectiveness of conservative methods and progression of the process, accompanied by a violation of the functions of internal organs, increased compression of the spinal cord and / or its roots examines the issue of surgical treatment (for example, removal of the intervertebral hernia). 
12. In alternative medicine for the treatment of back pain are used: 
    • horseradish compresses, 
    • rub ointments based on iodine, lemon, birch oil, 
    • Grated black radish and honey.

The complex of therapeutic measures is selected individually by the doctor for each case, depending on the cause of pain in the lumbar region, clinical symptoms, the severity of the process, concomitant diseases and age.

Prevention of pain in the lumbar region

Prevention of pain in the lumbar region consists in carrying out simple activities. 

1. Identification and treatment of concomitant pathology, which can lead to back pain (various infections, tumors). 
2. Balanced nutrition with a sufficient content of micro- and macroelements (especially calcium and phosphorus), protein, vitamins. 
3. Avoid heavy physical exertion, lifting weights. Distribute the load evenly over the body. Do not make sudden movements whenever possible.
4. To lead an active way of life (to go in for sports - swimming, walking, medical gymnastics). 
5. To conduct medical massage. 
6. If the professional activity is associated with a long sitting position, then it is necessary to take a break hourly (walk, do a little exercise). 
7. Comfortable bed with orthopedic mattress. 
8. For the prevention of pain in the lumbar region, it is recommended to wear bandages, corsets, posture correctors, elastic waistband (especially when performing heavy physical exertion, bandages and belts are recommended). 
9. Keep track of weight, tk. Overweight increases the burden on the spine. 
10. Eliminate bad habits - smoking alcohol. 
11. Every year, take preventive examination of the whole body.