Low back pain

Every person is familiar with lumbar pain, there are few who have not encountered it. Sometimes it is enough to spend a long time in a sitting position for lumbar pain to appear. According to statistics, 60-90% of people feel lumbar pain. Lumbar pain is second only to acute respiratory diseases and is a common cause of temporary disability.

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

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Causes of Low Back Pain

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

• Features of professional activity (heavy physical loads, for example, loaders, builders or athletes who lift weights, etc.).
• Sitting for long periods of time, especially every day.
• Sedentary lifestyle.
• Overweight.
• Unbalanced nutrition (lack of calcium, phosphorus, protein, vitamins in the body).
• Bad habits – drinking alcoholic beverages and alcohol.

By reducing or eliminating the above-described factors affecting the body, this is already a huge step towards improving overall health and the condition of the spine, and as a result, eliminating or reducing back pain.

Having dealt with the predisposing factors, let's move directly to the causes of pain in the lumbar region.

The primary causal factors of back pain are associated with degenerative-dystrophic processes in the spine, these include:

1. Osteochondrosis is a degenerative-dystrophic change in the intervertebral discs and cartilage, which leads to deformation of the discs and the occurrence of a hernia.
2. Spondylosis is a degenerative process in which bone growths form on the vertebrae (i.e., bone tissue proliferation) as a compensatory response to excessive loads. Bone tissue proliferation leads to muscle spasms around the spine, limits its mobility, and may cause injury to the radicular nerves in the lumbosacral region and the membranes of the spinal cord.
3. Spondyloarthrosis is a progressive degeneration of the articular surface of the lumbosacral vertebrae with the involvement of ligaments, muscles, joint capsule and the growth of marginal osteophytes in the pathological process. This process leads to deformation of the intervertebral discs, the joint space decreases, the mobility of the spine is limited, pain and muscle tension around the spine are noted. Over time, the spinal roots may be compressed.
4. Spondylolisthesis is characterized by the displacement of the vertebrae relative to each other, as a result of which the lumen of the spinal canal changes and the spinal roots are injured.
5. Herniated discs.

Secondary causal factors arising as a result of concomitant pathology in the body include:

1. Metabolic disorders, deficiency of micro- and macroelements in the body, as a result of which the skeletal system changes (for example, osteomalacia, osteoporosis, hemochromatosis, alkaptonuria).
2. Curvature of the spine (lordosis, kyphosis, scoliosis).
3. Malignant neoplasms located near the spinal column or their metastasis to the spine.
   • Metastases to the vertebrae or epidurals.
   • Lymphogranulomatosis, lymphoma or myeloma.
4. Infectious diseases:
   • Epiduritis (spinal epidural abscess).
   • Spondylitis (osteomyelitis of the spine).
   • Sweat's disease (tuberculous spondylitis).
   • Purulent discitis.
5. Spinal column injuries (eg, vertebral fractures).
6. Autoimmune diseases:
   • Rheumatoid arthritis.
   • Reiter's syndrome (simultaneous damage to the joints, urinary system and conjunctiva of the eyes).
   • Bechterew's disease (ankylosing spondylitis).
7. Back pain of a psychogenic nature (mental disorders), as well as after a stroke.
8. Gastrointestinal diseases (eg, intestinal obstruction, appendicitis).
9. Specific and non-specific diseases of the pelvic organs (renal colic, inflammation of the ovaries, venereal diseases).
10. Lower back pain during physiological processes in women (during menstruation and pregnancy).

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How does lower back pain manifest itself?

How does pain in the lumbar region manifest itself, you ask? In different ways. Pain in the lumbar region can be depending on the degree of its severity:

• Acute, shooting in nature, quite strong, sudden (lumbago).
• Chronic, lasting more than three months. Such pain is often dull and aching (lumbago or lumboschialgia).

In addition, pain in the lumbar region can become recurrent and make itself known from time to time.

The occurrence of pain in the lower back is associated with pinched nerve roots, spasms, swelling and irritation of the muscles, ligaments, vertebrae and intervertebral discs of the lumbosacral region.

Pain in the lumbar region can be:

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

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

1. Local (local) pain in the lumbar region. Occurs as a result of damage and irritation of the structures of the lumbar region (joints, musculoskeletal system, ligaments). This pain is clearly localized, constant in nature, usually not strong. It can change 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 and abdominal organs). This pain can radiate to the buttocks and thighs. This pain is deep, pulling and aching, and does not go away at rest.
   • Pain that occurs as a result of damage to the sacrum. It can radiate to the groin area and the buttocks, thighs, and even to the feet. The pain is long-lasting, dull, and diffuse.
3. Radicular pain in the lumbar region. Occurs as a result of irritation of the spinal nerve roots. Radicular pain is more intense than reflex pain and radiates from the spine to the periphery. Such pain is located in the area of innervation of the spinal root and can radiate to the lower limbs to the toes. Coughing, sneezing or other tension intensify radicular pain.
4. Muscle pain (fibromyalgia) is pain that occurs due to protective muscle spasm. It is the most common and occurs with many spinal diseases. Long-term, chronic muscle tension causes aching, sometimes cramping pain.

Dull and aching pain in the lumbar region

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

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Acute back pain in the lumbar region

Acute pain in the lumbar region occurs suddenly, is quite excruciating and causes severe discomfort, significantly limits motor activity. It can occur as a result of sudden movements - turning the body, bending, lifting weights, abruptly rising from a sitting position. Acute pain in the lumbar region can indicate serious diseases of the spine or internal organs. The causes of acute pain in the lumbar region can be:

• spinal injury (eg fracture),
• a sharp stretch of the back muscles,
• intervertebral disc displacement,
• lumbar intervertebral disc herniation,
• arthrosis of the intervertebral joints (facet syndrome),
• arthrosis of the hip joints (coxarthrosis),
• epiduritis,
• genitourinary infections.

In case of acute pain in the lumbar region, bed rest is necessary (take the most comfortable position in which the pain is least noticeable) and call a doctor. It is better not to self-medicate, as this can lead to serious complications up to and including disability.

Diagnosis of back pain in the lumbar region

Diagnosis of pain in the lumbar region is carried out by a neurologist, vertebrologist and is based on the following measures.

1. Collection of anamnesis (medical history) by a doctor. Causal and predisposing factors (possible injuries, concomitant diseases, features of professional activity, etc.) are identified.
2. Examination (including palpation), which is used to assess the general condition, orthopedic and neurological status (assess the mobility of the lower back, sensitivity in the lumbar region, etc.).
3. Additional examination methods:
   • conducting an X-ray of the lumbosacral spine,
   • computed tomography of the spine (assesses the condition of the vertebrae, intervertebral discs, soft tissues, blood vessels, etc.),
   • magnetic resonance imaging of the spine,
   • if necessary, myelography is prescribed (an X-ray contrast study of the spinal cord pathways - a contrast agent is injected into the spinal canal, an X-ray is taken and thus its patency is determined, which may be impaired due to tumors, hernias, stenosis),
   • bone scintigraphy (radionuclide examination), prescribed in case of uninformativeness of previous methods of X-ray examination. With its help it is possible to determine tumors, arthritis, etc.
   • general clinical examinations (general blood and urine tests, biochemical blood tests)
4. Consultation with specialists (if necessary):
   • surgeon,
   • orthopedist,
   • urologist or nephrologist,
   • gynecologist,
   • infectious disease specialist,
   • proctologist,
   • cardiologist,
   • gastroenterologist,
   • 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, the severity of the process and, as a rule, is conservative (surgical treatment is not excluded).

1. Elimination of the cause of lower back pain (treatment of concomitant diseases, osteochondrosis, hernias, etc.).
2. Bed rest, the bed should be hard (usually a shield is placed under the mattress).
3. A balanced diet with sufficient amounts of vitamins, protein, micro- and macroelements (especially calcium and phosphorus).
4. Symptomatic therapy:
   • non-steroidal anti-inflammatory drugs - dicloberl, movalis, ibuprofen - effectively relieve inflammation and pain,
   • it is possible to use analgesics such as analgin, baralgin,
   • the use of muscle relaxants that reduce muscle spasm and tension (mydocalm, tizanidine),
   • prescribe B vitamins (improves metabolic processes in the cell) and vitamin C (strengthens blood vessels and increases immunity),
   • use of local remedies (ointments, gels or compresses) - finalgon, fastum gel, ketonal, indomethacin or orthophene ointments. Compresses with dimexide or novocaine.
   • antiviral drugs and immunomodulators (Anaferon, echinacea),
5. Use of drugs that reduce degenerative-dystrophic processes in bone and cartilage tissue (Artrofon, Dona, Structum).
6. It is possible to prescribe therapeutic blockades – the introduction of painkillers (novocaine, lidocaine) into the place where the pain is most pronounced, the so-called trigger points (most often, an epidural blockade is performed with the introduction of an analgesic into the epidural space of the spine). A blockade with the combined use of novocaine and a corticosteroid drug (Cortisone, Diprospan) is possible.
7. Physiotherapy treatment:
   • electrophoresis using calcium, lidase, novocaine.
   • phonophoresis (use of ultrasound) – improves and accelerates healing processes, has anti-inflammatory and analgesic effects, reduces swelling,
   • electrical muscle stimulation (relaxes muscles, improves lymph and blood circulation of muscles around the spine),
   • amplipulse therapy (has an analgesic and vascular-trophic effect),
   • paraffin treatment (restores and improves neuromuscular conduction, metabolic processes, improves lymph and blood circulation),
   • reflexology (acupuncture, electroacupuncture, laser therapy),
   • balneotherapy (use of sulphide, radon, sodium baths, etc.),
   • mud therapy (use of low-temperature mud applications).
8. Therapeutic gymnastics begins with minimal loads and under strict supervision of a doctor. It is carried out after the removal of acute pain.
9. Therapeutic massage (strengthens the back muscles and helps stabilize the spine) is performed exclusively by a specialist, after the acute period.
10. It is recommended to wear corsets, semi-corsets, bandages, elastic belts, recliners. They are used to treat and prevent lower back pain, as they limit the range of motion, reduce pain and muscle spasm.
11. If conservative methods are ineffective and the process progresses, accompanied by dysfunction of internal organs, increased compression of the spinal cord and/or its roots, the issue of surgical treatment is considered (for example, removal of an intervertebral hernia).
12. In folk medicine, the following are used to treat back pain:
    • horseradish compresses,
    • ointments based on iodine, lemon, birch oil are rubbed in,
    • rubbing with black radish and honey is done.

A set of treatment measures is selected individually by a 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 low back pain

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

1. Identification and treatment of concomitant pathology that can lead to lower back pain (various infections, tumors).
2. A balanced diet with sufficient micro- and macroelements (especially calcium and phosphorus), protein, and vitamins.
3. Avoid heavy physical exertion, lifting weights. Distribute the load evenly over the body. Avoid sudden movements if possible.
4. Lead an active lifestyle (play sports – swimming, walking, therapeutic exercises).
5. Conduct therapeutic massage.
6. If your professional activity involves sitting for long periods of time, you need to take a break every hour (walk, do some light exercise).
7. Comfortable bed with orthopedic mattress.
8. To prevent pain in the lumbar region, it is recommended to wear bandages, corsets, posture correctors, and elastic belts (especially when performing heavy physical activity; bandages and belts are also recommended for pregnant women).
9. Monitor your weight, as excess weight increases the load on the spine.
10. Eliminate bad habits – smoking, alcohol.
11. Every year, undergo a preventive examination of the entire body.