Back pain

Back pain (synonymous with dorsalgia) is one of the most common reasons to see a doctor - the second after acute respiratory illness1. Such complaints most commonly come to a neurologist, therapist, or general practitioner. According to international studies, 19 to 43% of the adult population recently surveyed have noticed back pain in the last month, and 27 to 65% in the last year. Those who have experienced this at least once in their life, have 59-84% 1. Almost every fifth adult inhabitant of our planet at this time can feel severe back pain. Their most common localization is the lower back and lower back.

Why do back pains occur?

Among the main reasons for the development of back pain are:

1. Vertebral causes - related to spinal pathology:
   • pathology of intervertebral discs, including hernias;
   • narrowing of the spinal canal;
   • joint diseases;
   • consequences of injuries;
   • congenital malformations and developmental anomalies;
   • metabolic disorders;
   • spondylitis - inflammatory processes in the intervertebral joints.
2. Nonvertebrogens - not associated with spinal pathology:
   • sprains of ligaments and muscles associated with heavy loads;
   • myofascial syndrome - chronic muscle pain;
   • inflammation of muscle tissue - myositis;
   • diseases of internal organs;
   • pathology of large vessels, for example, aneurysm (sharp dilation) of the abdominal aorta;
   • arthrosis of the hip joint - inflammatory-dystrophic disease;
   • mental disorders, etc.

Depending on the origin, the following types of pain are distinguished:

• Specifically- is associated with a specific disease that can be detected by standard examination methods. This type lasts up to 3% 1 of all cases. These can be compression fractures of the spine, tumors, infectious processes, diseases of the pelvic organs (especially with back pain in women).

  At the same time, there are a number of certain symptoms, the so-called "red flags", which speak of serious diseases and require in-depth examination. These include:

  • rapid unreasonable weight loss and / or indications of a history of oncopathology (tumors);
  • weakness of the lower extremities, impaired sensitivity and function of the pelvic organs (cauda equina syndrome);
  • use of antibiotic therapy, increase in body temperature (infectious processes);
  • previous trauma or previous diagnosis of osteoporosis, older than 55 years (spinal fracture);
  • young age - up to 20 years;
  • long-term preservation of painful sensations and their intensity, despite treatment;
  • combined with general weakness or gait disturbance, exacerbated at night, does not change with a change in body position.
• Radicular- next in frequency (up to 27%). It develops as a result of constriction and / or inflammation of the spinal cord root that exits through the openings of the spinal column. This type may be indicated by increased pain when coughing, sneezing, physical exertion and other types of activities.
• Nonspecific- more often acute, it is difficult to immediately determine the specific cause of its development, these are usually the consequences of dystrophic changes in bone, cartilaginous tissue of the spine, as well as muscles and ligaments that make up the supporting apparatus of the back. In the International Classification of Diseases (ICD-10) there is a special section for the definition of such syndromes - dorsopathy.

Such dorsalgia accounts for up to 85% 1 of all cases and is mainly associated with a disturbance in the normal functioning of certain structures of the spine, any of which can become a source of pain impulses. Pain can be compressive (from the compression of nerve roots) and reflex - from all other tissues, including spasmodic muscles.

Another type of pain syndrome has been described, which is not associated with organic lesions of the spine and paravertebral tissues. This is called dysfunctional pain. This can be caused by psychological problems and chronic stress.

Localization distinguishes:

What's his name	Where it hurts
cervicalgia	neck pain
cervicocranilagia	neck + head
cervicobrachialgia	neck and gives a hand
thoracalgia	pain in the thoracic back and chest, pain under the shoulder blades from the back
lumbodynia	lower back and lumbosacral region
sciatica	lower back + leg
sacralgia	sacrum
coccygodynia	tailbone

In addition to the reasons, it is possible to identify factors that can cause the development of pain syndrome:

• severe physical overload, resulting in excessive stretching of muscles and ligaments;
• uncomfortable or static positions that a person occupies for a long time;
• untrained muscles and their overload, inactivity;
• trauma and microtrauma;
• hypothermia;
• prolonged immobility, such as bed rest;
• alcohol abuse;
• diseases of internal organs;
• joint pathology;
• overweight;
• individual characteristics: curvature of the spine, bending;
• poor nutrition, diseases of the digestive system, which may be accompanied by impaired absorption of vitamins, mineral metabolism, significant intake of salts affecting the joints;
• occupational hazards: thermal effects, temperature fluctuations, vibrations, work with weights, etc.

The mechanism of development of dorsalgia is related to the block of intervertebral joints, which can be caused by loads, both static and dynamic, microtraumas and non-physiological positions. As a result, in one place the muscles spasm and stretch excessively, and in another they stretch excessively. All this leads to the development of muscle pain, changes in pain sensitivity and the creation of pathological pain impulses.

Also, muscle spasms can be a reflex reaction to the pathology of the spine or diseases of internal organs. In this case, it is seen as a defensive reaction, but at the same time it starts a new round of pain. In addition, with prolonged preservation of cramps, there is a disorder in the transmission of nerve impulses to muscle fibers, they become more irritable, calcium deficiency can occur, and circulatory disorders further worsen the situation.

According to the duration of dorsalgia, they can be:

• acute - lasts up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic - lasts 12 weeks or longer.

Symptoms

The symptoms of dorsalgia depend on the cause, the mechanism of development and the presence of concomitant diseases.

The following signs are characteristic of non-specific pain:

• aching or dragging pain, sometimes tightening;
• it increases with load or movements of the spine, as well as in certain positions, it can decrease when kneading or rubbing muscles, as well as after resting in a comfortable position;
• possible back pain or back pain;
• when probing, compaction, changes in contours, tension are determined, but there is no sensitivity disorder in the painful area, a decrease in muscle strength, reflexes do not change.

When the nerve root is compressed (radiculopathy), the pain varies in intensity, can be shooting, often radiating to the leg, and can be stronger in the limb than in the back. The examination shows symptoms of damage to a certain nerve root - muscle weakness, impaired sensitivity in a certain area.

Diagnosis

The diagnostic algorithm for acute and chronic dorsalgia is somewhat different.

Sharp pain

To determine the tactics of treatment, the doctor should, if possible, determine the cause of the pain syndrome: pinched nerves or their roots, trauma, tumors, inflammation, infections, osteoporosis, diseases of internal organs, etc. As a rule, these types of pain have quite vivid and specific clinical manifestations. After examination and palpation, patients are referred to appropriate specialists or for further examination, for example:

• X-ray examination;
• MRI and CT of the spine;
• scintigraphy - a method of visualization that uses the introduction of a contrast agent;
• densitometry - determination of bone density;
• laboratory tests to determine tumor markers, rheumatic tests, biochemical blood tests, etc.

Patients with nonspecific acute pain usually do not require additional research.

Chronic pain

Since the mechanisms of its development have not yet been sufficiently studied, it can be problematic to identify the source, especially if it is a non-functional species that reflects the pathology of other organs. It can be a manifestation of diseases such as irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and others. In either case, a thorough interview and examination of the patient is conducted to decide on further treatment tactics.

For pain syndrome that occurs in the background of dystrophic changes in the joints, after any mechanical stress or under the influence of other factors, it is possible to use magnetic resonance imaging to monitor the dynamics of the spine.

How to deal with acute back pain

Physicians who adhere to the principles of evidence-based medicine use the following tactics to manage patients with acute dorsalgia:

1. inform the patient about the causes of the pain syndrome;
2. exclude bed rest and recommend regular activities;
3. prescribe effective drug and drug-free treatment;
4. monitor dynamics and adjust therapy.

When choosing a drug, attention is paid to its analgesic effect, speed of action and safety. First of all, nonspecific anti-inflammatory drugs (NSAIDs) have been prescribed because their effectiveness has been proven in back pain. One such drug is naproxen.

Naproxen is available in the form of an oral tablet and gel for external use. The drug is indicated as a means of relieving pain in back pain associated with trauma, overload, inflammation. It also has anti-inflammatory and antipyretic action, the duration of the effect can last up to 12 hours. If you do not have the opportunity to see a doctor soon and the pain is causing significant discomfort, you can take naproxen as follows: 2 tablets as a starting dose, then 2 tablets every 12 hours or 1 tablet every 8 hours. The course of admission without consulting a doctor is not longer than 5 days.

By maintaining the intensity of pain, it is possible to prescribe other groups of painkillers and sedatives (sedatives).

Drug-free treatments include:

• warming up;
• manual therapy;
• physiotherapy;
• massage;
• physiotherapy;
• acupuncture and other alternative methods.

Treatment of chronic back pain

If the localization of pain and the source of the pain impulse could be identified, then local therapy is used - blockades, intradiscal influences and other procedures. For the rest of the patients, such treatment of back and lower back pain is not used, so a different treatment regimen is used. Its main goal is to reduce the intensity of pain and preserve the quality of life.

Also, as with acute pain, NSAIDs are prescribed, including naproxen, other analgesics, muscle relaxants, and vitamin B3. If necessary, antidepressants are recommended. Manual therapy should be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic methods of treatment are used.

Prophylaxis

To prevent dorsalgia, it is necessary to identify all possible risk factors and work on their elimination.

The following will be helpful for all types of pain:

• appropriate physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• maintaining physiological posture during work;
• quitting smoking and alcohol;
• regular preventive examinations;
• adequate treatment and prevention of infection;
• balanced diet;
• wearing comfortable shoes and clothes;
• proper organization of the workplace and life to protect the back;
• prevention of stress and emotional overload.

Comprehensive treatment and full rehabilitation of patients with back pain allows you to preserve the quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.