Severe lower back pain, right and left: causes

Back pain is a fairly common symptom that was previously considered a privilege of older people. Grandparents bent over, as they say, in three deaths are considered a fairly common phenomenon and this does not surprise anyone, because over the long years of life their back had to endure a lot of stress. Only pain syndrome in the cervical, thoracic and lumbar spine is getting younger every day, despite the fact that severe back pain is an obstacle to normal life and human ability to work.

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Causes of severe back pain

In medical terminology, there is a separate concept for back pain caused by spinal diseases – dorsalgia. This is the name given to a pain syndrome that can be localized in any part of the spine, so there are dorsalgias of the cervical, thoracic and lumbosacral spine. Each type of dorsalgia has its own causes, and most of them are related to the spine and back muscles. Although other pathologies cannot be ruled out, in which radiating pain occurs, which patients also describe as back pain.

Severe back pain, and any spinal pain, regardless of its nature, is perceived by patients as a rather painful symptom, most often a symptom of spinal diseases. Pain syndrome of varying intensity is characteristic of the following diseases:

• Osteochondrosis is a chronic pathology that can affect various parts of the spine. With this disease, degenerative processes occur in the spinal column, leading to compression of the spine and changes in the structure of the intervertebral discs. Most patients with osteochondrosis complain of severe pain in the back, neck or lower back, especially if the disease has been progressing for several years. At the onset of the disease, we are talking more about the appearance of a feeling of fatigue in the back, which gradually transforms into a pain syndrome.
• Spondylosis is another spinal disease that has a degenerative nature. But in this case, it is not the compression of the vertebrae and the disc between them that occurs, but the appearance of bone growths on the tissues of the vertebrae, resembling spikes like a heel spur. The pain syndrome with this pathology can be quite strong if the growths begin to irritate the nerve endings.
• A herniated disc is a serious and rather dangerous disease of the spine, in which the fibrous ring around the disc ruptures with displacement of the disc itself. It begins to squeeze nearby soft tissues, nerve fibers, and blood vessels. Protrusion of the disc beyond the spinal column is accompanied by severe spinal pain at the site of the damaged disc and along the nerve it irritates. Such a displacement can be found in any part of the spine, but it usually occurs against the background of existing pathologies, for example, the same osteochondrosis.
• Disc protrusion, i.e. their protrusion beyond the spinal column without rupture of the fibrous ring. Back pain in the area of the displaced disc is the main symptom of the pathology. The symptom is caused by compression of nearby nerve roots, vessels, muscles, which become inflamed due to constant irritation.
• Spondyloarthrosis of the spine is a fairly common chronic pathology, for which patients consult a doctor only when back pain occurs. We are talking about degenerative changes in the vertebral joints with damage to the cartilage, joint bags, periarticular bones, as well as the appearance of various bone growths that impair the mobility of the spine. Severe aching pain with this pathology is observed mainly in the neck and lower back, i.e. the most mobile parts of the spine.
• Spondylolisthesis is a pathology consisting of the displacement of individual vertebrae forward or backward relative to the axis of the spinal column (ante- and retrolisthesis), as well as to the left or right side (lateralisthesis). Usually, patients complain of aching pain in the back, in the place where the vertebra is displaced. With physical exertion or the need to hold the same position for a long time, the unpleasant symptom intensifies. But depending on which of the vertebrae has changed its position, other types of pain may appear, such as ear pain, neuralgia of various localizations with attacks of acute pain, stabbing pain in the abdomen, etc.
• Spinal instability is a pathological condition in which increased mobility of the vertebrae is observed in various parts of the spine. At the same time, they begin to irritate nearby nerve roots, which causes the appearance of a rather intense pain syndrome, which is even more noticeable during physical exertion, bending, turning the body in one direction or another. Most often, it occurs against the background of the above-described pathologies of the spine, with weakness of the ligamentous apparatus or after an injury. Most often, instability of the vertebrae is diagnosed in the lumbar and cervical spine. With instability of the lumbar spine, pain can radiate to the leg.
• Osteoporosis of the spine. With this disease, the density of bone tissue in the vertebrae decreases. Back pain appears starting from the second stage of the disease, and at first has a nagging character, increasing after physical exertion. But as the pathology develops, they acquire high intensity and a constant character. Moreover, osteoporosis can be complicated by compression fractures of the vertebrae, in which the pain is very strong and appears from the slightest movement or pressure on the back.
• Ankylosing spondylitis (Bechterew's disease) is a systemic chronic inflammatory-degenerative pathology, mostly affecting young men under 30 years of age. It is characterized by a gradual change in the properties of the intervertebral structures and their progressive ossification. Pain syndrome usually appears at stage 2 of the disease and resembles the symptoms of osteochondrosis of the lumbar spine. Night pain is characteristic, increasing in the morning and decreasing during movement. As the disease progresses, the pain spreads up the spine and is accompanied by constant tension in the back muscles.
• Scoliosis is a curvature of the spine to the right or left side, developing in childhood. In this case, the pain is not constant and occurs mainly after loads on the spine (long periods of sitting, after long walks or standing, carrying heavy objects).
• Kyphosis of the spine is a backward bend of the upper part of the spinal column, which is more typical for the thoracic spine. The first symptoms of the pathology usually appear in adolescence. At first, we are talking about the rapid appearance of back fatigue, but as the stooping manifests itself, the pain syndrome also progresses. Back pain will be accompanied by problems with the functioning of various organs, headaches caused by circulatory disorders in the cervical spine, etc.
• Lordosis of the spine is a similar disease, in which a strong forward curvature of the spine is observed. Such curvature is more typical for the lumbar and cervical spine, much less often for the thoracic spine. One of the signs of the pathology is considered to be pain of varying intensity in the back, lower back and cervical spine, especially under static loads, as well as fatigue of the spine caused by constant muscle tension due to improper load redistribution.
• Tuberculous spondylitis is a bone form of tuberculosis affecting the vertebrae. This is an infectious and inflammatory pathology localized in any part of the spine. It can appear at any age if the tuberculosis mycobacterium enters the human body. A characteristic symptom of the pathology is severe constant back pain that occurs regardless of physical activity.
• Osteomyelitis of the spine (spondylitis) is a severe and dangerous disease with a long course, also having an infectious and inflammatory nature. As a result of the inflammatory process, the vertebrae are destroyed, the density of bone tissue decreases, the spine is deformed. Purulent foci appear in its tissues. The acute form of the disease debuts with back pain and fever. The chronic course of the disease is characterized by radicular syndrome (compression and irritation of the roots of the spinal nerves), one of the main manifestations of which is dorsalgia.
• Radiculitis is an inflammatory pathology characterized by compression of the spinal roots. It usually occurs against the background of other pathologies of the spine with degenerative changes or spinal injuries. We are accustomed to attributing lumbar pain to radiculitis, although in fact the pain syndrome with this disease can also be localized in the back and neck. In fact, doctors use this term not to denote a disease, but a syndrome characteristic of many diseases of the spinal column. A syndrome is a symptom complex that includes back pain, and it can be of a different nature. It can be dull, occasionally occurring pain, acute pain syndrome, or a constant, debilitating symptom of a localized form or with the presence of radiating pain that radiates to the neck, shoulders, limbs along the irritated nerve.
• Neuralgia of the back or compression of the intercostal nerves by the ribs themselves, muscle tissue, and modified vertebrae. The cervical and thoracic regions are affected. The pain syndrome can be either dull aching or sharp, local (in the area of nerve compression) or reflected (along the course of the nerve fibers).
• Spinal arthritis/rheumatoid arthritis is a chronic inflammatory disease of the connective tissue of the spine. Pain in the back, cervical and lumbar regions is one of the main symptoms of the disease, which mainly affects people over 30 years of age. The pain becomes stronger with increased load on the spine or prolonged stay in an uncomfortable position.
• Spinal injuries (fractures, contusions, dislocations). Injuries often cause the development of various diseases and syndromes, including pain in the back. The cause of pain is inflammatory processes and displacement of bones, as a result of which muscles, nerves, and blood vessels are damaged.
• Tumor processes in the spine (benign and malignant, primary and metastatic). Tumors in the spinal cord are characterized by the rapid onset of symptoms, including intense pain that is not relieved by analgesics. Tumor processes outside the spinal cord may not make themselves known for a long time, but as the tumor grows, pain appears that is progressive in nature. Pain usually appears in the middle of the back and lower back, can be localized and reflected, and intensifies after lying on the back, straining the back muscles, coughing, sneezing, etc.
• Spinal stenosis is an age-related disease characterized by narrowing of the spinal canal, lateral pocket and intervertebral openings in the lumbar region. Then, the intervertebral discs shift, resulting in compression of the spinal cord roots, and pain occurs, which is most often localized in the lower back, lower back, and legs.
• Congenital defects of the spine. Some of the above-mentioned diseases are congenital, but back pain usually appears already in the school period, when the load on the spine increases due to prolonged forced sitting. It is in this position that the load on the spine is maximum.

The fact that severe back pain occurs as a result of various spinal pathologies is quite logical and does not surprise anyone. But the appearance of such a symptom can also be provoked by other diseases and conditions. Moreover, the diseases do not necessarily have to be related to the spine.

Pathologies that can lead to severe back pain:

• Stretching of muscles and ligaments of the back. Pathology, which is classified as an injury, most often occurs during strength training and lifting weights by untrained people. Although sometimes the cause of such a situation is poor posture and prolonged immobilization, accompanied by muscle atrophy. The main symptoms of the pathology are considered to be severe back pain and limited mobility, because any movement and load on the affected muscle or ligament cause piercing, tearing pain. The cause of pain is considered to be micro-tears of soft tissue fibers and their inflammation.
• Inflammation of the back muscles (myositis) with the formation of painful seals on the muscles. The pathology is characterized by swelling of tissues and aching pain of weak and medium intensity that does not go away after rest, but with muscle tension, sudden movements, pressure on painful seals, lying on the back on a hard surface, with a change in weather, under the influence of cold, they can significantly increase and affect the quality of life of patients.
• Fibromyalgia is a disease whose causes are not fully known to doctors. The pathology is characterized by symmetrical chronic muscle, tendon and joint pain in the back and body. The pain is diffuse (that is, the patient feels that his entire back, including the spine, hurts) and of varying intensity, and tends to intensify with changes in the weather, under the influence of cold and stress.
• Myofascial syndrome, which is characterized by muscle spasms with the formation of painful point seals (trigger points). The development of pathology is facilitated by injuries, sudden movements, stress, low physical activity, chronic muscle fatigue due to monotonous movements, etc. Pain in this syndrome can be very intense, especially when trigger points are affected. Reflective pain is characteristic.
• Muscular-tonic syndrome caused by degenerative changes in the spine and increased load on the back muscles. The pain is aching and moderate in intensity, and can worsen with movement and exposure to cold. Most often, we are talking about pain limited to a specific area of the back.
• Inflammatory kidney diseases (pyelonephritis, glomerulonephritis), in which patients may experience quite severe pain in the lower back. Renal colic in kidney stone disease is considered especially painful.
• Diseases of the liver and gallbladder, when there is reflected pain in the back.
• Problems with the intestines, which often cause pain in the lower back, and sometimes the entire lower half of the back hurts.
• Cardiac pathologies, pain in which can be noted both behind the sternum on the left and in the area of the shoulder blades on the back.
• Gastric ulcer and duodenal ulcer, the pain of which, when exacerbated, often radiates to the back.
• Pancreatitis or inflammation of the pancreas with its characteristic girdle pains, which, when the pathology worsens, have a fairly high intensity.
• Diseases of the lungs and pleura (pneumonia, pleurisy, pulmonary tuberculosis). They are characterized by pain in the thoracic region of the back and especially between the shoulder blades.

If we are talking about diseases of internal organs and reflected back pain, their characteristic feature can be considered the fact that they practically do not depend on changes in body position, physical activity, temperature effects. Back pain in this case is an additional symptom that may or may not appear.

When it comes to diseases of the spine and back muscles, various factors can contribute to the occurrence of pain syndrome. Let's consider the main risk factors for the occurrence of spinal pain:

• Hypothermia of the body, which contributes to a decrease in immunity and the development of infectious and inflammatory diseases, including diseases of the soft tissues and bones of the back.
• Bacterial and viral infections (patients may complain of noticeable back pain even with respiratory infections: flu, acute respiratory viral infections, tonsillitis, etc.).
• Any chronic diseases that weaken the body and negatively affect many processes in it.
• Heavy physical labor that puts stress on the spine.
• Weightlifting classes.
• Lifting and carrying heavy objects, especially by untrained people.
• Sudden movements in the spine that can lead to pinching of the spinal nerve roots.
• Diseases of the pelvic organs, which can provoke the appearance of quite severe aching pain in the lumbar region.
• Diseases of the digestive system (isophagitis, esophagospasm) and heart diseases (cardiac ischemia, aortic aneurysm, inflammation of the pericardium of the heart, pulmonary embolism, etc.)
• Intensive training in the gym without prior preparation or an unauthorized increase in loads by the trainer.
• Work activities that involve prolonged periods of sitting or standing.
• Excessive computer use, as a result of which a person sits for hours in front of the monitor, forgetting to relieve tension in the back muscles and monitor their posture. This factor is especially relevant in our time and is one of the main reasons for the occurrence of severe back pain in teenagers and young people.
• An uncomfortable bed that promotes muscle tension rather than relaxation can be a factor in the curvature of the spine.
• Unprofessional back massage.
• Epidural anesthesia, i.e. injection of painkillers into the space between the vertebrae, which is practiced to relieve severe pain during childbirth and various surgeries.
• Pregnancy, during which back pain can be caused by both physiological (the growth of the abdomen changes the woman's posture, which leads to an incorrect distribution of the load on the spine and its rapid fatigue) and pathological reasons (for example, pyelonephritis, which is popular during pregnancy).
• Excess weight, which creates increased stress not only on the legs, but also on the spine.
• Metabolic disorders that make bones weaker and muscles and ligaments less elastic.
• Stress, which is considered a risk factor for the development of most human diseases and significantly increases their number during periods of psycho-emotional shocks.

If you look closely at the factors and causes that provoke the appearance of back pain, it becomes clear that our entire life contributes to this. It is not surprising that the prevalence of such a symptom as severe back pain is approaching such disorders as headaches and increased fatigue, which can be called almost characteristics of a modern person.

Pathogenesis

Regardless of the location of the pain syndrome, it always affects the quality of life of a person. Usually we notice even minor pain sensations, let alone severe pain that can restrict movement and put a person into a stupor. According to various estimates, 80 to 90% of patients with spinal pathologies suffer from back pain of varying intensity. Almost half of apparently healthy people also complain of spinal pain. But do they know why such a symptom occurs at all?

The occurrence of severe back pain is associated with the development of various pain syndromes: radicular, myofascial, muscular-tonic. It is thanks to pain that we learn about various disorders in the body, i.e. it can be considered as a conditioned reflex of a protective nature.

When tissues are damaged, for example, when they become inflamed by aggressive mechanical action, causing hematomas (blows), fiber ruptures (excessive physical exertion), areas of chronic irritation (bone fragments, spiky growths, protruding vertebrae, infections), pain receptors are activated, sending a signal about the problem to the brain. It is not surprising that any inflammatory processes are accompanied by pain of greater or lesser intensity, and the greater the inflammation, the more we feel it.

We are talking about physiological pain, which can be dealt with using medications and removing the cause of irritation. Pains caused by disorders in the nervous system are of a slightly different nature. Such pains can be provoked by serious diseases of the brain or spinal cord, but they can also be caused by a negative impact on the peripheral nerves. A type of such pain is radicular syndrome, which occurs when the spinal cord roots are damaged (compressed or irritated) in the lumen of the spinal column when the vertebrae are displaced.

Severe back pain can also be caused by increased muscle tone. Muscle spasm disrupts the blood supply to soft tissues, which leads to trophic disorders that the body regards as trauma. In addition, tense back muscles, which become dense and inelastic, are more susceptible to micro-tears of fibers.

Moreover, they, like protruding bones and cartilages, can compress nearby nerve fibers. Which will be accompanied by pain and decreased tissue sensitivity.

Muscle pain is well relieved by massage. But it must be performed by a specialist. If your back hurts a lot after a massage, it means it was done incorrectly. Perhaps, due to the careless, unprofessional actions of the massage therapist, even some structures in the back area were damaged. A proper massage helps to relax the back muscles and relieve pain, and not vice versa. The pain can only increase during the procedure, and relief should come at the end of the session.

Of interest is also the pain after anesthetic procedures. From the outside, this looks like some kind of an anomaly. However, patients often complain that their back hurts a lot after epidural anesthesia. The pain appears after the anesthetic wears off. It should gradually weaken and go away within a few days. If this does not happen, then there were some violations during the procedure: an infection was introduced or the puncture was made carelessly or in the wrong place, as a result of which the needle damaged muscles and nerve fibers. Although in this case, the patient's psycho-emotional mood cannot be ruled out.

In some cases, severe back pain can be psychogenic. This is what they call a pain syndrome that occurs due to strong emotions and stress. Unlike physiological and neuropathic pain, such sensations are not associated with organic lesions of the back tissue. It's just that in overly sensitive people, strong emotions cause disturbances in the nervous system, which begins to incorrectly interpret the impulses coming to it, perceiving most of them as painful. In this case, analgesics can do little to help, unlike sedatives and psychotherapy sessions.

Statistics

Statistics show that the most common cause of back pain is osteochondrosis, which affects about 80 percent of the population. Scoliosis, which is diagnosed to varying degrees in most schoolchildren and students, as well as regular sitting at computer games are the most common causes of spinal pain in the younger generation. But most often, back pain affects old people, who have accumulated a decent amount of various diseases over their lives and have begun physiological changes in the body that do not contribute to the health of the back.

It is important to understand that people often simply do not suspect that they have pathologies. Therefore, the appearance of pain in the back is a kind of surprise for them. Even if the pain was caused by an uncomfortable body position or sleeping on a bed that is too hard or too soft, the fact that it does not go away for two or more days indicates that there is something wrong with the person's back.