Shingles in the lower back

A sensation of sharp, attack-like or prolonged pain that encompasses the torso in the lower back - at the level of the lumbar spine - is defined as shingles low back pain. [1]

Causes of the shingles in the lower back

Shingles pain in the lumbar region (regio lumbalis) - below the thoracic vertebrae and above the sacrum (five fused vertebrae connected to the last lumbar vertebra) - is a non-specific symptom, as it occurs in different diseases and pathological conditions.

The most likely causes of this symptom that are directly related to the spine, i.e. Vertebrogenic, include:

• compression of spinal nerve roots - radicular or radicular syndrome of the lumbar spine (L1-L5), which is called radiculitis;
• deforming osteoarthritis of the spinal joints - spondyloarthritis;
• Spondylolisthesis - lumbar vertebrae displacement;
• Intervertebral herniation of the lumbosacral spine, leading to stenosis (narrowing) of the lumbar spinal canal and compression of spinal nerves;
• aboutsteochondrosis of the lumbosacral spine.

Shingling low back pain - lumbalgia - can also be manifested by some internal organ diseases, including:

• acute cholecystitis;
• Nephrolithiasis (kidney stone disease), pyelonephritis, nephrotuberculosis, polycystic or hydronephrosis of the kidney;
• Ulcerative colitis and other inflammatory bowel disease;
• Abdominal aortic aneurysm.

Such pain may be due to malignant tumors or metastasis of tumors of various localizations.

In addition to all of the above, shingles lower back pain in men can be caused by chronic inflammation of the prostate gland (prostatitis) or prostate adenocarcinoma.

Shingles lumbar pain in women is often etiologically related:

• algodysmenorrhea;
• ectopic pregnancy;
• uterine prolapse;
• endometriosis;
• Polycystic ovarian polycystic or their malignant tumors.

Although colic in pregnancy with pain radiating to different places is not uncommon, shingles low back pain in pregnancy - in the absence of other symptoms - is not considered by obstetricians as a pathological symptom, but as a sign of physiological changes, such as increased mobility of the joints and relaxation of the pelvic ligaments. Read more in the publication - Low back pain in pregnancy

There are different types of pain according to their intensity and predominant localization. For example, acute shingling pain in the lower back is caused by renal colic, acute cholecystitis, and hepatic colic.

The symptom of lumbago or an attack of pancreatitis is a sharp, severe, shingling pain in the lower back. But in fibromyalgia or myofascial pain syndrome, which can be a consequence of spinal ligament and muscle strain, there is most often a nagging, pulling, shingling pain in the lower back.

If there is shingles pain in the lower back and stomach (more precisely in the stomach and lower back), then gastroenterologists immediately suspect that the patient has gastritis, gastroduodenitis or an exacerbation of peptic ulcer disease.

Ovarian cysts, pelvic adhesions, retroperitoneal neoplasms (retroperitoneal tumors) cause shingles of abdominal and low back pain.

Inflammation of the appendix (appendicitis), gallstones and cirrhosis of the liver are characterized by shingles pain on the right side of the lower back. And with problems with the spine, as well as with diseases of visceral organs, in particular, inflammation of the pancreas, unilateral inflammation of the kidney or inflammation of the uterine appendages, women may feel a shingling pain on the left side of the lower back.

Shingles back pain above the lumbar (at the level of the first lumbar vertebra L1 and lower thoracic vertebrae T10-T12) may indicate diseases of abdominal organs such as the stomach, pancreas, and duodenum, as well as diaphragmatic hernia - a hernia of the esophageal opening of the diaphragm.

In cases of postherpetic neuralgia in shingles (caused by human herpes virus type 3); in acute pyelonephritis; in spinal subdural and epidural abscess; in patients with pelvic purulent inflammatory diseases combined symptoms such as shingles low back pain and fever. [2]

Pathogenesis

The onset of the sensation of pain is caused by pain sensory neurons known as nociceptors, which are activated by tissue damage. The process begins when nociceptors detect a potentially damaging stimulus and send a signal to other neurons via afferent fibers in the form of an action potential using excitatory neurotransmitters (glutamate and the neuropeptide substance P).

Depending on the underlying mechanisms, three types of pain are distinguished: nociceptive (receptive), neuropathic (neuralgia) and mixed forms.

Shingles pain in the lumbar region can be of all types. If the source of pain impulses entering the spinal cord (with the formation of synapses on the neurons of its posterior horns) are visceral organs, the pain is nociceptive.

And the pathogenesis of neuralgia, arising from axonal damage - direct alteration and/or dysfunction of the nerve fiber, is due to excessive excitability of nerve cells that continuously transmit pain impulses to the brain. This is what happens when spinal nerves are compressed and their roots are compressed.

The lumbar nerve plexus (plexus lumbalis) and the lumbar sympathetic chain play an important role in the development of shingles pain. The plexus lumbalis lies within the large lumbar muscle (m. Psoas major) and is formed by the anterior portions of the four lumbar spinal nerves and the outgrowth of the last thoracic nerve (T12). And in front and on the sides of the lumbar vertebral bodies (deep in the large lumbar muscle) is the lumbar segment of the sympathetic chain (trunk of the sympathetic nervous system), including four interconnected ganglia (clusters of nerve bodies). From the ganglia, located along the spinal cord at the dorsal and ventral roots of the spinal nerve, lumbar nerves L1L4, each of which (depending on the localization) branches off to the ventral, renal, inferior mesenteric, intermesenteric and superior subcostal nerve plexuses. Each lumbar nerve has sensory (sensitive) branches, and all lumbar spinal ganglia also contain cells of afferent (sensory) nerve fibers that transmit impulses to the CNS. Therefore, the convergence and connection of visceral afferent nerve fibers entering the spinal cord at the same level as fibers from nerve plexuses explains the peculiarities of interpretation of incoming signals by neurons of the lateral horns of the spinal cord and brain centers.

Also read - Neuropathic pain

Diagnostics of the shingles in the lower back

Given the wide range of causes of shingles in the lumbar region and the presence of other symptoms, diagnosis, in most cases, is carried out by doctors of different specializations: vertebrologists, gastroenterologists, nephrologists, gynecologists, neurologists.

For this purpose, patients are examined, including anamnesis, physical examination, laboratory tests (various blood tests, urinalysis, coprogram), if necessary - biopsy and histologic examination.

Appropriate instrumental diagnostics is carried out: X-ray, ultrasound of internal organs, computer and magnetic resonance tomography.

And differential diagnosis is designed to accurately determine the true cause of the shingles pain that is gripping the lower back.

Treatment of the shingles in the lower back

The treatment methods and medications used depend on the etiology of the symptom. Some of them are discussed in separate publications:

• Treatment for low back pain
• Medication treatment of osteochondrosis of the spine
• Treatment of osteoarthritis
• Spinal hernia treatment
• Neuralgia pills
• Ointments for sciatica
• Pills for muscle and joint pain
• Shingles treatment
• Treatment of kidney inflammation
• Acute cholecystitis - Treatment
• Treatment of ovarian cysts
• Prostatitis treatment

Most often physiotherapy is used for vertebrogenic causes of shingles lumbalgia, but physiotherapy treatment is also possible for other conditions, for example:

• Physiotherapy for peptic ulcer disease
• Physical therapy for chronic colitis

In some conditions - appendicitis, abdominal aortic aneurysm, cystic ovaries, pelvic adhesions, retroperitoneal neoplasms, adenocarcinoma of the prostate gland, etc. - surgical treatment is required. - surgical treatment is required.