Back pain: causes, treatment

Back pain is a pressing medical problem. Along with the fact that back pain is one of the most common reasons for seeking medical attention, many aspects of this problem remain poorly understood, and there are very few treatments with a solid evidence base.

During their life, 70-80% of the population suffers back pain at least once. According to epidemiological studies, the prevalence of pain in the lower back reaches 40-80%. In 10-20% of patients of working age, acute back pain is transformed into chronic. This group of patients is characterized by a poor prognosis in terms of recovery, and it accounts for 80% of all health care costs for the treatment of back pain.

Back pain is familiar to everyone. Even those who did not even know about doctors sometimes experience aching sensations that arise both when walking and at rest, on public transport, at work, even while sleeping. As a rule, the first manifestations of back discomfort are attributed to fatigue, overwork, and excessive physical exertion. Indeed, back pain often goes away on its own after a few hours of rest. However, chronic painful sensations are troubling. And for good reason. After all, this can become one of the first signals of diseases of the spine, or other internal organs.

[1], [2], [3]

What Causes Back Pain?

As a rule, injuries, or just injuries, lead to this nature of unpleasant sensations, namely:

• Fractures;
• Scoliosis;
• Cramping;
• Muscle sprains;
• Diseases of the heart, kidneys;
• Hernia;
• Osteochondrosis.

In girls, a nagging back pain, accompanied by fatigue, indicates pregnancy. Back pain is common for people who move a little, work at a computer for a long time, or do physical labor associated with carrying heavy objects. Also contribute to the appearance of painful sensations, unhealthy diet, smoking, excessive alcohol consumption.

How does back pain manifest? 

Clinical manifestations of vertebrogenic pathology are compression-ischemic syndromes, mainly radiculopathy (from 5 to 10%) and muscle-tonic reflex syndromes that accompany radiculopathy or are observed in isolation (90%).

Each local pain stimulus causes, first of all, a reflex in its corresponding segment. In this zone, we observe an area of cutaneous hyperalgesia, muscle tension, painful points of the periosteum, restriction of movement in the corresponding segment of the spine and (possibly) dysfunction of an internal organ. However, the reflex effect is not limited to one segment. Dystrophic changes in one spinal motion segment provoke the reaction of a significant number of segments, which causes tension of the back extensor muscles. Pathology in the periphery produces a central reaction; this leads to a change in the stereotype of movement as a way of protecting the damaged structure. This is how an altered type of movement arises, which can persist even after the elimination of the peripheral process that caused it.

Back pain is characterized not only by local pain syndrome, but also by significant psychological manifestations. At the height of the pain, a pronounced feeling of anxiety develops, up to depression. At the same time, emotional instability in the assessment of pain is noted, as well as an exaggeration of external manifestations of pain, or, conversely, unreasonably excessive caution in movements. At the same time, aspects of health and work are closely combined, their combination with economic indicators, the danger of losing a job. Only a general practitioner can take into account all the variety of factors when treating a patient.

Long-term back pain, which forces you to see a doctor, is caused by damage to the vertebrae themselves, intervertebral discs and joints, the ligamentous or muscular frame of the spine. In this case, the disease that led to the onset of pain can be both relatively favorable in terms of treatment and prognosis (for example, osteochondrosis), and fatal (metastases in the spine, myeloma).

In addition, lower back pain can be accompanied by diseases of the internal organs, such as pyelonephritis, diseases of the internal genital organs, and the lower intestines.

Back pain in various degenerative-dystrophic lesions of the spine has common pathogenetic features. Three main pathophysiological mechanisms of back pain are currently recognized  . The first mechanism is associated with peripheral sensitization, that is, with an increase in the excitability of peripheral pain receptors (nociceptors) due to trauma, infection, or other factors. The nociceptors responsible for the occurrence of back pain are located in the annulus fibrosus of the intervertebral disc, the posterior longitudinal ligament, the supraspinous, interspinous and intertransverse ligaments, areas of the dura mater, the facet and sacroiliac joints, the roots of the spinal nerves, in the spinal cord, paraspinal ganglia. The vertebrae and ligamentum flavum usually lack nociceptors. The central part of the intervertebral disc contains a large amount of the enzyme phospholipase A ₂, which is involved in the metabolism of arachidonic acid, resulting in the formation of pain mediators such as prostaglandins and leukotrienes. In addition, neurogenic pain mediators such as substance P, vasoactive intestinal peptide (VIP) and peptide regulated by the calcitonin gene, which cause pain, can be released from the sensory fibers surrounding the posterior horn of the spinal cord. Substance P and VIP contribute to an increase in the enzymatic activity of proteases and collagenases and can enhance degenerative processes in the three-articular complex (intervertebral disc, vertebra and facet joint). Sensitization of receptors occurs as a result of damage to the musculoskeletal tissues of the back and the release of the listed pro-inflammatory substances. As a result, even weak mechanical stimuli activate nociceptors and cause pain.

The second pathophysiological mechanism - neural ectopia - is caused by damage to the root, nerve, or spinal ganglion during trauma, compression, or ischemia. The excitability threshold of sensory neurons decreases, ectopic sources of spontaneous impulses appear, resulting in neuropathic or radicular pain that is difficult to treat. Another potential source of radicular pain is the spinal ganglion.

The third mechanism is associated with central sensitization, characterized by an increase in the number of functioning structures in the spinal cord and brain when nociceptive stimulation occurs in the periphery. Whenever painful irritation occurs, it intensifies in the spinal cord, causing the pain to intensify. At the same time, even weak stimulation of afferents contributes to the appearance of the so-called central pain. Direct brain damage (spinal trauma, stroke) can also provoke central sensitization.

[4], [5], [6], [7], [8]

What is the nature of back pain?

As a rule, back pain is aching, pulling, concentrated in a certain part of the spine. However, there are also sharp, unexpected attacks, the so-called lumbago. It is also possible radiating pain in the back with its spread to the limbs, neck, shoulders. Thus, various manifestations of back diseases are possible, which indicates the attention that should be paid to determining the stage of the disease and its type.

How to recognize back pain?

In order to determine the necessary treatment, doctors, as a rule, first talk with the patient, inquiring about the symptoms that caused the back pain, as well as the state of other organs. Blood and urine tests and direct examination may also be required.

Among modern diagnostic methods, the following are used:

• X-ray;
• Magnetic resonance imaging;
• CT scan.

How is back pain treated?

Unfortunately, it is impossible to completely get rid of a condition such as back pain, however, the likelihood of minimizing discomfort is high. To do this, use medical methods, as well as methods of conservative medicine.

So, of the drugs most often used:

1. Anti-inflammatory drugs;
2. Hondoprotectors;
3. Muscle relaxants;
4. Pain relievers.

However, remember that overconsumption of all of these medications can lead to side effects, so only buy and use them with your doctor's advice.

Conservative medicine methods are usually painless and do not cause complications, however, they should also be used as directed by a doctor who will take into account your back pain. For example, with previous heart diseases, hernias, problems with blood vessels and blood circulation, methods of manual therapy can only harm. Among the non-drug methods widely used in various clinics, one can single out:

• Massotherapy;
• Physiotherapy procedures;
• Manual therapy methods;
• Acupuncture;
• Laser therapy;
• Electrophoresis, etc.

Remember that any of these activities should only be conducted by professionals!

The course of treatment, as a rule, lasts about two to three weeks, and to consolidate the result, you can connect treatment in a sanatorium.

How to prevent back pain?

In order for back pain to bother you rarely, follow these rules:

• Maintain posture, do not slouch;
• Do not work in the same position for a long time;
• Try to sit less cross-legged;
• Make fewer jerky movements;
• Sleep on a hard bed;
• Eat right, give up smoking and alcohol;
• Go in for sports, go to the gym or pool, attend aerobics or yoga sections;
• Do not wear high heels for long periods of time.

Back pain is quite unpleasant, especially with its chronic manifestations and sharp attacks, however, proper treatment and an active lifestyle will easily help you cope with this problem!