Low Back Pain: Causes and Treatment

In most cases, low back pain is caused by hypothermia or muscle strain from improper movement or heavy lifting, and can resolve on its own. If the pain disrupts the normal rhythm of life, persists for too long without getting better, or appears with other suspicious symptoms, you should entrust a doctor to diagnose and treat low back pain.Depending on how long the pain has bothered the patient, doctors distinguish between:

1. Acute pain - less than 4 weeks,
2. Subacute pain - 4 to 12 weeks,
3. Chronic pain - more than 12 weeks.

When making an appointment, the doctor will clarify the specific conditions of back pain to the patient: it can be severe pain in the waist during activity, cyclic pain in the waist, persistent dull pain, sharp stabbing pain, and other discomforts of varying degrees. Strength of. Based on the duration, location, and nature of the pain, doctors speculate on the source of the pain.

Lumbar Pain: Causes

Lower back pain can be related to spinal problems as well as other organs and systems in the body. To understand how to treat your lower back, you need to determine what's causing your pain.Vertebral pain caused by spinal disorders include:

• Osteochondrosis, which presents with problems with the discs, facet joints, or facet joints. Conditions that can happen to anyone as they age: The discs lose moisture and elasticity, and the facet joints become denser and less mobile.
• Excessive tension in the muscles and ligaments of the spine.
• Spinal nerve root compression - radiculopathy.
• Spinal injury.
• Spinal instability due to weakness of the ligamentous musculature.

Non-spinal causes include:

1. Nervous system disease
   • Lumbosacral plexopathy is an injury to the nerve plexuses that give rise to the peripheral nerves in the lower extremities. Occurs due to injury and metabolic disorders.
   • Dystonia is an attack on the tone of the muscles that support the spine. In this case, pain may accompany poor posture. The disease may be congenital.
2. systemic disease
   • Infections affecting the vertebrae, discs, spinal cord membranes, or the spinal cord itself, such as osteomyelitis, epidural abscess.
   • Malignant tumors, benign tumors, and metastases.
   • Osteoporosis is a decrease in bone density associated with vertebral fractures.
   • Rheumatic diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.
3. Pain from internal organs.It is caused by causes outside the spine and radiates into the lower back, sometimes in the middle and sometimes to the sides - depending on the source organ. These include:
   • Gastrointestinal disorders - the most common is pancreatitis.
   • Urinary tract disorders - infections such as pyelonephritis and urolithiasis. Renal colic is accompanied by sharp, stabbing pains in the back and sides as the stone moves along the ureter.
   • Aortic aneurysm is a rare and dangerous pathology in which a bulge forms in the wall of the largest artery in the body. This may cause a pulsating sensation in the abdomen.
   • Hip Disorders - Injury, Inflammation, Degeneration.
4. psychogenic painLower back pain may be related to anxiety or depression.

Injury to the spinal cord or lower spinal cord roots (called the cauda equina) is a medical emergency. Compression of these structures can be caused by:

• disc herniation,
• Injuried,
• malignant or benign tumors,
• Infect.

Spinal cord compression is accompanied by extremely severe bilateral low back pain, leg muscle weakness, and even paralysis, numbness of the lower limbs, and incontinence, making it difficult to confuse it with other conditions.

symptom

Low back pain is often nonspecific, meaning it is caused by harmless musculoskeletal conditions. The patient in this case described the following symptoms:

• Pain, pulling, or squeezing pain.
• Pain occurs or worsens when a person stands or sits for long periods of time, lifts heavy objects, raises arms and performs physical tasks such as hanging curtains, changing chandelier bulbs, repeatedly bending over for long periods of time: when washing floors, vacuuming, removing snow.
• There are no other symptoms.

In fact, pain can be a symptom of certain dangerous conditions, as shown by the fact that:"red flag":

• Aged over 50 years old. People in this age group are at higher risk for osteoporosis and tumors.
• Pain at rest and at night, affecting sleep. Nonspecific pain usually occurs during exercise or prolonged static loading but disappears after resting in a comfortable position.
• Generalized weakness is also not characteristic of nonspecific pain.
• Unexplained weight loss over the past few months. This may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
• Increased body temperature and chills. Indicates severe inflammation from various sources.
• Severe or ongoing decrease in sensitivity or weakness in the leg muscles.
• Impaired bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves in the lower part of the spinal cord reach the pelvic organs and lower limbs. They contain sensory and motor fibers. Loss of sensation or movement accompanied by acute pain is a sign of compression of a nerve (and possibly the spinal cord). If this condition is not treated by a doctor, the function of the nerve or part of the spinal cord may be permanently lost.
• Treatment lacks effectiveness and acute pain turns into chronic pain.
• Medical history characteristics. For example, if a patient previously diagnosed with osteoporosis or malignancy presents with low back pain. It doesn’t matter how long ago the diagnosis was made. or pain in people who have recently experienced a severe infection, surgery, or whose immune system has been drastically reduced for any reason, such as long-term use of corticosteroids or poorly controlled diabetes. In these cases, low back pain may indicate various complications.

If you notice at least one of the listed points, consult your doctor immediately for further examination.

diagnosis

Pain is a subjective symptom, so a doctor's investigation and examination play a huge role in diagnosis. The doctor performs additional tests based on his recommended diagnosis. For accurate diagnosis, do:

• lab testing— Complete blood count, blood chemistry panel, general urine panel, infection panel, autoimmune disease panel.
• Neuroelectromyography- Study of impulse conduction along nerve fibers, which makes it possible to accurately determine the location of lesions in neurological diseases.
• Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spine, the presence of hernias, and compression of spinal nerve roots.
• UltrasonographyKidneys and Abdomen - Examination is performed if pathology of internal organs is suspected.
• Bone condition assessment: Densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.

If the doctor is absolutely certain that the low back pain is nonspecific, he or she can prescribe treatment based on the examination alone, without the need for additional tests.Often, people with low back pain don't see a doctor and just get themselves a spinal MRI. This approach can be confusing for patients: Studies show that most adults have asymptomatic disc herniations. The patient attributed the pain to this MRI finding and did not seek further medical care. As a result, a person becomes chronically ill, takes painkillers uncontrollably, and experiences complications and side effects.

Which doctor should I contact?

First, if you have lower back pain, you can also consult your GP. He will suggest the cause of your pain and refer you to another specialist if appropriate. You can skip this step and make an appointment with a neurologist immediately.If a neurologist suspects a lesion outside the spine after specialized examination, he may refer to:

• rheumatologist,
• surgeon,
• urologist,
• gastroenterologist,
• endocrinologist,
• Oncologist.

Doctors in all of these specialties encounter symptoms of low back pain on a regular basis, as it has many possible causes.If mechanical pain is diagnosed, the patient will receive treatment from a physical therapist, reflexologist, physiotherapist, and massage therapist.

How to Treat Lower Back Pain

• SurgeryThey are mainly used when patients suffer from limb paralysis or urinary tract disease with symptoms of spinal cord or spinal nerve root compression. These symptoms may be caused by an intervertebral hernia, tumor, or injury. Additionally, patients should be advised to consult a neurosurgeon if they develop chronic pain despite conservative treatment within 12 weeks. A surgical decision can only be made after observing the spine. Research shows that uncomplicated disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.
• Conservative treatmentIncludes pharmaceutical and non-pharmacological methods.Medical treatment uses nonsteroidal anti-inflammatory drugs to relieve pain and inflammation, and muscle relaxants to relax muscles.Non-drug treatments include:
  • physiotherapy— It is designed to quickly eliminate pain and inflammation, as well as accelerate tissue recovery and muscle relaxation. The most effective methods: magnet therapy, laser therapy and shock wave therapy.
  • acupuncture- Special sterile needles are inserted into bioactive points to relieve pain and relax muscles.
  • massage— Improves flexibility of the spine and joints and promotes proper distribution of load on the back muscles.
  • physical therapy- Allows you to relax and strengthen your back muscles. Exercise is effective for both acute and chronic back pain.
  If a patient has pain for more than 12 weeks, we are talking about chronic pain. In addition to all of the above, antidepressants with analgesic properties and cognitive behavioral psychotherapy were added to her treatment.

Bed rest is not beneficial in treating mechanical low back pain and is not a substitute for the above methods. Furthermore, it should be avoided as much as possible for patients. Prolonged bed rest can cause joint stiffness, muscle tension, and significantly slow recovery.

result

The prognosis for acute nonspecific low back pain is good. Of those who seek treatment immediately, 70-90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, pain becomes chronic and lasts for more than 12 weeks, requiring treatment with analgesic antidepressants. If the pain is caused by the hernia compressing a spinal nerve root, it may be accompanied by numbness in the extremities and difficulty urinating and defecating.

prevention

Help prevent low back pain:

• 150 minutes of moderate exercise per week: walking, swimming, core muscles: abdominals, lower back, pelvic floor, thighs and buttocks.
• Maintain a healthy weight.
• Perform a long static warm-up every 40-60 minutes.
• Thigh muscle stretching exercises.
• Proper body posture when lifting weights: You need to squat, not lean forward.
• Prevent bone density loss by taking calcium and vitamin D, and diagnose osteoporosis early with bone densitometry. This is especially important for older adults and postmenopausal women.
• Maintain general physical and mental health.