Pain in the back above the waist on the right, left, between the shoulder blades

The modern world is full of various factors capable of causing all kinds of pain. So, widespread hypodynamia, sedentary work and a wrong way of life often lead to the fact that people have pain in the back above the waist: this is the first zone that reacts to excessive loads and lifting of weights. In addition, the pain can irradiate from other areas and organs.

The main task of a person who has developed such an unpleasant symptom is to respond promptly and quickly and consult a doctor.

Causes of the pain in the back above the lower back

There is no single root cause that leads to back pain above the loins. Just like the pain itself can have a variety of character, depending on the reasons. In some patients, the pain intensifies under the influence of physical activity and motor activity, while in others pain can appear at rest - for example, during night rest. Some patients complain only of the appearance of back pains above the loin, and some indicate at once several symptoms - for example, pain can be combined with fever, nausea, dyspnea, etc.

If there is a pain syndrome, it is wrong to immediately "blame" the spine. Pain in the back above the lower back can be caused by diseases of the internal organs - for example, the digestive system, the urogenital system. In some women, this pain can be observed during pregnancy and with the onset of a monthly cycle.

Nevertheless, the most common cause of the physicians consider the pathology and trauma of the spinal column and muscular corset of the back. According to statistics, the pains are often provoked by osteochondrosis, which is accompanied by deterioration of the function of the intervertebral discs.

Sharp pains in the back happen with an attack of radiculitis or with intervertebral hernia. Drawing pains are characteristic for the curvature of the spinal column. Other possible reasons may be:

• inflammatory processes, infections (tuberculosis, rheumatoid arthritis, epidural abscess, brucellosis);
• tumor processes in the spine;
• neuralgia, myalgia.

Risk factors

Factors that can provoke pain in the back above the waist are very heterogeneous:

• hereditary predisposition;
• peculiarities of professional activity (the presence of statodynamic excessive loads, long stay in an uncomfortable position, the action of vibration, etc.);
• hypodynamia, abrupt transitions to physical activity;
• local and general supercoolings;
• incorrect posture;
• frequent infections, diseases of the digestive organs;
• obesity, metabolic disorders;
• bad habits, unhealthy eating;
• elderly age (age-related changes in the musculoskeletal system, the presence of chronic diseases);
• osteomalacia, osteoporosis;
• tumor processes in the body;
• diseases affecting the organs of the small pelvis (kidneys, reproductive sphere).

[1], [2],

Symptoms

For an accurate explanation of the cause of pain, the doctor must decide on its location.

• Pain in the back above the loins along the sides accompany the diseases of the musculoskeletal system. Among such diseases can occur, as usual bruises or other injuries, and severe degenerative processes in the spine. In addition, a similar symptom is observed in rheumatological pathologies (for example, osteoarthritis, Bekhterev's disease ).
• Pain in the back to the right above the lower back is observed when the lungs are affected simultaneously with the spread of the disease to the pleura. As additional symptoms, respiratory movements are limited, dyspnea increases. As well as on the right, the pain in the back on the left above the lower back can appear when the pathological process in the lung tissue is localized.
• A sharp pain in the back above the lower back does not always mean a pathology of the spinal column. Sometimes the problem should be sought in the internal organs - for example, in the kidneys. In some patients, severe back pain became one of the signs of myocardial infarction.
• Pain in the back in the morning above the lower back can accompany spine diseases, such as osteoarthritis, intervertebral hernia, as well as urolithiasis, cardiac pathology.
• Back pain at night above the lower back can indicate a disease of the digestive system: peptic ulcer, stomach tumors, cholecystopancreatitis. Such pains are not uncommon in the defeat of the musculature of the back and spine.
• Pain in the back above the loins during inspiration can be a sign of neurological pathologies, heart disease. But most often this symptom indicates the presence of intercostal neuralgia.
• Back pain during movement above the loins often appears against the background of damage to the mech-vertebra disks, or osteochondrosis. Unpleasant sensations can extend to the lower extremities, in the groin. Increased pain is observed with physical activity.
• The pain of the muscles of the back above the lower back appears with trauma, myositis, after heavy physical work, after severe hypothermia. To clarify the diagnosis it is necessary to conduct a comprehensive diagnosis.

The nature of pain

The nature of the pain syndrome is also taken into account in the diagnosis.

• Aching in the back above the lower back can talk about lumbar osteochondrosis, spondylosis and other pathological processes in the spinal column. If such pain occurs after hypothermia, then we can assume the development of inflammation of the lumbar musculature (myositis).
• Drawing pain in the back above the lower back can be a temporary phenomenon that occurs after a strong physical strain, after a prolonged stay in an uncomfortable position. Drawing sensations are not uncommon for people who previously had back injuries and are now experiencing so-called "weather" pain.
• Tinea pain in the back above the loin often indicates the presence of pyelonephritis, exacerbation of pancreatitis, cholelithiasis, less often - problems with the heart muscle.
• A severe back pain above the loin can occur due to the movement of stones in the kidneys, as well as exacerbation of intestinal inflammatory diseases, inflammation of the ureter, and rupture of cystic education in women.
• Acute pain in the back above the loins is often called "lumbago". It can act as a complication of scoliosis, when the nerve is jammed due to dislocation of the discs. No less often there is an osteochondrosis vertebra deformation with compression of the nerve of the intervertebral hernia.
• Dull pain in the back above the lower back sometimes indicates a kidney problem. In addition, such pain can also arise as a result of overtraining, after lifting heavy objects or sharp motor activity in the body, which could cause muscle spasms.
• Shooting pain in the back above the lower back is detected when the nerve roots are jammed, with intercostal neuralgia. As a differentiation should also be considered an attack of acute cholecystitis or pancreatitis.

Back pain above the loin during pregnancy

The organism of a pregnant woman works with an ever-increasing load, because he needs to ensure the full development of a future child. Sometimes, because of these loads, the body of the woman herself may suffer: for example, as a result of an increase in the weight of the fetus, the center of gravity in the body of the expectant mother shifts, which can cause back pain above the loin and between the shoulder blades.

Especially often women in the situation complain of back pain, if they have problems with the musculoskeletal system before pregnancy. For example, if the pregnant woman had a curvature of the spinal column, the lumbar musculature was weakly developed, or there were signs of osteochondrosis, then she automatically falls into the risk group for back pain, including the upper back. Also at risk are the ladies with excess weight: their spine experiences an even greater daily load.

Pain syndrome usually does not occur until the second trimester, but it is possible and early appearance of discomfort. Much depends on the lifestyle of the pregnant woman, on the degree of physical activity and on other factors.

According to statistics, pain in the back above the waist in women waiting for the baby, appear in about 40% of cases, and after childbirth - in 68% of cases.

[3], [4]

Diagnostics of the pain in the back above the lower back

The first stage of diagnosis is a conversation with the doctor, during which the patient should, as far as possible, tell in detail about the features of pain in the back above the waist. Consideration of the doctor is also very important. Already at this stage the doctor can make a preliminary diagnosis. For the final diagnosis to be made, further diagnosis is necessary.

Analyzes are prescribed only when it is necessary to make sure there is no infection or to confirm the presence of an inflammatory process. For this purpose, a general and biochemical blood test is prescribed. If kidney disease is suspected, then mandatory urine analysis is performed, according to which the kidney function is evaluated.

If there are suggestions that back pains are higher than the lower back caused by the underlying pathology, or if pain is present for a long time, further instrumental diagnostics is prescribed.

If the problem is presumably hidden in discs, nerves, tendons, then an x-ray study, a computer tomography or magnetic resonance imaging is prescribed.

If suspected of kidney damage, ultrasound is indicated.

[5]

Differential diagnosis

Differential diagnosis is aimed at assessing the possibility of developing vertebral and non-vertebral somatic diseases. Details of such differentiation can be briefly described in the table:

Disease	Symptoms
Dissecting aortic aneurysm	Tendency to high blood pressure, chest pain, giving to the area above the waist and between the shoulder blades, violation of the heart rhythm, signs of aortic regurgitation.
Acute attack of renal colic	Pain in the back above the lower back caused by dehydration, intense physical exertion, can be accompanied by nausea (before vomiting), hematuria.
Acute attack of pancreatitis	The pain above the lumbar region can be given to the scapula or clavicle on the left side. Often there is vomiting without relief, increased gas formation.
Infectious and inflammatory process in the spine	An increase in body temperature, the presence of local soreness and local hyperthermia, the presence of signs of an inflammatory process in the analysis of blood.
Tumor process in the spine	Lowering of body weight for no apparent reason, the presence of constant pain, independent of the load, the lack of the effect of taking conventional analgesic drugs.
Compression injury of the spine	Injuries, excessive physical activity in the anamnesis, prolonged treatment with glucocorticoids, numbness of the limbs, local pain during palpation.
Spondyloarthritis	Pain in the back above the waist in the morning, at rest, decreases during movements. Presence of morning stiffness, inflammatory signs in the analysis of blood.

[6], [7], [8]

Treatment of the pain in the back above the lower back

No doctor dares to prescribe the treatment of pain in the back above the waist, if he does not know the original cause of such a symptom. Only after careful diagnosis and after studying its results, adequate therapy can be prescribed.

Symptomatic pain treatment may include such medications:

• Paracetamol is the most affordable and common drug that is used for moderate back pain above the loins. Tablets should be taken at regular intervals of 500 mg to four times a day. The maximum possible daily dosage is 4 g, and the total duration of the treatment course is up to five days. The proposed dosage is safe and almost never accompanied by the development of side effects (provided there is no hypersensitivity to Paracetamol).
• Nonsteroidal anti-inflammatory drugs help to significantly reduce even relatively intense back pain. The analgesic capacity of such drugs is higher than that of Paracetamol. A specific non-steroid drug is selected taking into account possible side effects: thus, because of the high probability of damage to the digestive system, such drugs should not be used for stomach ulcer and duodenal ulcer. In addition, you need to remember that such a group of drugs can not relieve the pain in the back of radicular origin.

Experts advise using pain in the back above the lower back to apply such NSAIDs:

1. a class of nonselective inhibitors of cyclooxygenase 2 (Diclofenac 75 to 150 mg per day for two doses, Ketoprofen 100 to 300 mg per day for two doses, Dexketoprofen 25 to 75 mg per day for several doses, Ketorolac 20 mg per day for two admission, Lornoxicam from 8 to 16 mg per day for two doses);
2. class of selective inhibitors of cyclooxygenase 2 (Nimesulide 200 mg per day for two doses, celecoxib 200 to 400 mg per day for two doses).

• Miorelaxing drugs - are prescribed if the pain in the back above the lower back is caused by a muscle spasm, and also in the absence of the effect of taking Paracetamol or non-steroid agents. The course of taking muscle relaxants is usually short - up to one week. The doctor may prescribe a benzodiazepine drug (Tetrazepam, Diazepam) or a non-benzodiazepine series (Baclofen, Flupirtine, Tizanidine, etc.). The dose of drugs is set individually, taking into account possible side effects (dizziness, lowering of blood pressure, fatigue). The recommended doses may be:
  • Tizanidine - from 2 to 4 mg to three times a day;
  • Tolperisone - 150 mg three times a day.

If monotherapy with paracetamol or non-steroidal drugs was not effective, then a combination treatment is prescribed:

• one of the non-steroid preparations + opiate soft action (Tramadol);
• Paracetamol + opiate soft action (for example, combined preparation Zaldiar one tablet up to 3 times a day);
• nonsteroidal drug + muscle relaxant.

Vitamins

For the treatment of back pain above the loin, doctors are advised to use drugs that contain B vitamins. These drugs successfully combat neurological problems and eliminate painful sensations.

• Thiamin, or vitamin B ₁  improves the properties of the nerve tissue, relieves pain;
• Pyridoxine, or vitamin B _6,  potentiates the function of the nervous system, improves the conductivity of nerve impulses;
• Vitamin D normalizes the absorption of calcium, phosphorus, magnesium, improves the composition of bone tissue;
• Ascorbic acid stops oxidative processes in tissues, removes inflammation, activates metabolism, promotes the production of collagen fibers, increases the elasticity of vertebral discs.
• Vitamins A and E are taken in tandem. They contribute to the restoration of damaged tissue, increase its elasticity and elasticity.

Physiotherapeutic treatment

It is difficult to imagine a treatment for back pain above the loin without the use of physiotherapy methods. Physioprocedures have analgesic, anti-inflammatory effect, relieve tension of spasmodic muscles, improve the tone of weakened muscles.

With back pain, the following are considered basic methods:

• electrostimulation - impact on the muscles with a weak current to improve muscle tone and tone;
• electrophoresis - the introduction of medicinal substances directly into the affected tissue, without additional toxic load on the body;
• phonophoresis - a procedure similar to electrophoresis (ultrasound is used instead of current);
• UHF - the impact of ultra high frequency electric field pulses (40.68 MHz);
• parafinoterapiya - the formulation of paraffin applications, which allow improving blood and lymph circulation in tissues, stimulating metabolic processes;
• detensor therapy - the procedure of stretching and unloading the spine (can be prescribed for the treatment of compression and traumatic injuries of the spinal column);
• shock-wave treatment - used for degenerative-dystrophic diseases of the spine;
• laser therapy - stimulates metabolism in degenerative-dystrophic pathologies of the spine and joints;
• magnetotherapy - activates compensatory-adaptive reactions, stimulates the body's internal reserves to combat pathology.

Alternative treatment

The strength of alternative treatments is explained by their naturalness. However, they need to be used, knowing the real cause of pain in the back above the lower back, and also after preliminary consultation with the doctor.

• A mixture of oils of birch leaves and St. John's wort will help to ease back pain. This mixture rubs the affected area once a day before bedtime.
• To improve blood circulation and relieve pain, rub the area above the loin with garlic tincture. Garlic teeth are crushed and poured with vodka, kept in a dark place for 10 days. Compresses based on this tincture are also good, but they can be placed only for 30-40 minutes, so as not to cause irritation of the skin.
• Apply fresh crushed Kalanchoe leaves to the diseased area above the loin. It is especially good if such attachments are performed after a preliminary back massage.
• Compresses based on horse fat have a good effect. Fat is distributed thinly into one layer, covered with a film and fixed with adhesive plaster. Patients claim that the pain in the back above the lower back passes after 1.5 hours.
• Fir in the back area fir essential oil.

[9], [10], [11], [12]

Herbal Treatment

• The plant jaunty (comfrey) has proven itself in the treatment of back pain associated with osteochondrosis and intervertebral hernias. Screw through a meat grinder fresh rhizome of a plant and mix with an equal share of honey. The resulting mass is used for 1 tsp. Daily on an empty stomach. Duration of therapy is 10 days, after which they make the same break and continue treatment. Usually spend 2-4 such courses.
• There is also an external method of treatment by the lascivious. Soak 50 g of rhizome in the water, pour 0.7 liters of vodka and stand for two weeks. The obtained tincture is filtered and used to set the compresses to the place of pain in the back (above the waist). Duration of treatment - 10 days, after that do the same break. A total of 2-4 courses.
• Fill 300 grams of crushed rhizome of the saber with so much vodka to cover the raw material completely. Next, put the container in a dark place and stand for 21 days, after which the tincture is filtered and drunk at 1 tbsp. L. Three times a day (you can drink it with a sip of water). So drink all the tincture, take a break in treatment for 4 weeks and spend a second course.
• Fresh pine buds are scrolled through a meat grinder in such a quantity that a 3-liter jar is full. There, 200 g of sugar are also covered, mixed, covered with a lid and placed in a refrigerator. When the mass becomes brown, the drug is ready. Take it inside 30 minutes before meals, up to 4 times a day, 1 tsp. The course of treatment ends when all the medicine is eaten.

Homeopathy

You can expect a noticeable improvement in the patient's condition with back pain above the lower back, if the treatment includes several treatment methods. This includes taking medications, exercise therapy, reflexotherapy, and homeopathic treatment.

For the treatment of the lumbar spine, as well as areas above the lower back, injections with such drugs are used:

• The purpose of T is administered intramuscularly or subcutaneously, one ampoule twice a week.
• Traumeel C is administered intramuscularly or segmentally (biopuncture) one ampoule daily in the acute phase of back pain. After a normalization of a condition it is possible to pass to reception of tablets Traumel With.
• Diskus compositum injected intramuscularly or subcutaneously on one ampoule 2.2 ml from one to three times a week. The duration of therapy is 1-1.5 months.

The above funds remove the inflammatory reaction, stabilize metabolic processes, trigger a restorative reaction at the level of cellular structures. The risk of side effects in this case reaches a minimum: homeopathic preparations are safe and rarely cause any additional negative symptoms.

Surgery

The most common diseases, accompanied by pain in the back and requiring surgical intervention - is the intervertebral hernia and stenosis of the lumbar vertebral column. These pathologies cause pain at or above the lower back, with possible irradiation in the lower limbs. Individual patients complain of difficulty walking or urinating, and sometimes muscle paralysis develops.

Indications for surgical treatment may include:

• spondylolisthesis (displacement of vertebrae);
• tumors of the spine, kidneys.

The question of conducting an operative intervention is decided on an individual basis.

Complications and consequences

Since the causes of back pain above the loin can be very different, it is difficult to talk about any specific consequences or complications. Pathologies that caused pain syndrome can be localized directly in the lumbar region (in the spine, musculoskeletal apparatus, nerve roots, etc.), and in other organs. Often soreness is the result of certain diseases of the central nervous system, neuroses, abnormalities of the blood flow in the abdominal aorta, pathologies of organs located in the small pelvis and abdominal cavity. In no case at the first signs of pain in the back above the lower back, "immediately diagnose" radiculitis and proceed to self-medication. Even a doctor, not having the results of diagnosis on hand, can not pinpoint the cause of such pains.

If it is wrong to heal, or completely ignore the treatment, then a variety of complications can develop:

• chronic pain syndrome, associated with the defeat of the nerve roots and back musculature;
• radiculopathy, myositis;
• pyelonephritis, kidney failure;
• chronic pancreatitis;
• hernia and other diseases of the spinal column.

[13], [14], [15], [16]

Prevention

To avoid the appearance of pain in the back above the waist, or other pathologies associated with pain in the back, you need to listen to the following recommendations:

• sleep in comfortable conditions, using an orthopedic mattress;
• to exercise caution and safety rules in sports, not to overload the musculoskeletal apparatus, to avoid injury;
• follow the position of the back, learn to keep the posture;
• avoid hypodynamia, practice mild physical activity;
• Do not neglect walking tours;
• Do not overeat, follow the body weight;
• drink enough fluid;
• sleep, adhere to adequate sleep and rest;
• do not engage in self-treatment and, if necessary, go to the doctors.

[17], [18], [19], [20], [21]

Forecast

In most patients, back pain above the loin refers to a benign condition, which generally has a favorable prognosis. In the future, upon completion of the treatment, it is necessary to determine the belonging of the patient to the appropriate risk group in order to prevent relapse and chronic pain. Particular attention should be paid to the characteristics of professional activity, psychosocial factors, lifestyle and nutrition of the patient.

[22], [23], [24],