Back Pain: Treatment, Causes, and Features

Symptoms of a large group of diseases and pathological conditions with similar manifestations, low back pain is one of the most pressing problems in modern healthcare, and the treatment of low back pain is not an easy task.

Although pain syndromes can occur anywhere on the spine, the most common site is the lower back—according to the researchers, the prevalence of low back pain reaches 76 percent in the adult population.

According to statistics, within 1 year, about 80% of people will complain of at least one episode of low back pain, and within the next 12 months, 75% of people will have a recurrence of the pain syndrome.

Types and manifestations of pain syndromes

Pain syndromes are classified as neck pain, mid-back pain (chest pain), lower back pain (lumbar pain), or coccygeal pain (coccygeal or sacral pain), depending on the part of the back affected.

According to the results of a study involving 46, 000 volunteers from several European countries, 24% suffer from chronic pain in various parts of the spine, of which lumbar spine - 18%, and neck pain occurs in 8% of the population.
The duration of pain is acute - lasting up to 12 weeks, or chronic - more than 12 weeks.

The pain may be dull or stabbing, sometimes burning and tingling. Symptoms of some diseases can also extend to the arms and hands, legs or feet, depending on the extent of spinal involvement. Numbness or weakness in the upper and lower extremities is another variant of the accompanying presentation of back pain. Restriction of certain ranges of motion or increased pain in a certain part of the body is also observed in some patients with spinal pain syndromes.

Back Pain: Why is this happening?

Examination may not always be able to identify the immediate cause of back pain, in which case the pain is referred to as "nonspecific" or "mechanical". The cause of this pain is pathological changes in the musculoskeletal system, however, injuries to the cervical, thoracic, lumbar and sacral nerve roots and specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patientsmiddle. Secondary pain in the context of the underlying disease accounts for approximately 2% of cases.

Nonspecific back pain is characterized by:

• tends to get better or worse depending on the position of the body - for example, the patient may feel better when he is sitting or lying down;
• Pain is often aggravated by exercise;
• Attacks can increase suddenly or gradually;
• Sometimes back pain is the result of poor posture or inconvenience in lifting weights, but often for no apparent reason;
• May be caused by minor injuries, such as sprained ligaments or muscles;
• It can happen after stress or overwork and usually starts to get better within a few weeks.

Risk factors for developing nonspecific back pain:

• heavy physical work;
• body bends and leans frequently;
• lifting weights, especially from the wrong position;
• passive lifestyle;
• Industrial influences such as vibration;
• Pregnant;
• Age-related changes in the musculoskeletal system.

Acute pain has physiological significance because it indicates the acute effect of adverse factors.

The most common causes of acute back pain are:

• Trauma to various structures of the spine;
• Spondylolisthesis - displacement of vertebrae relative to each other;
• Sciatica - inflammation of the sciatic nerve (the longest and widest nerve in the body), which runs from the lower back to the feet
• cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
• Intercostal neuralgia - caused by compression or irritation of the nerve roots of the intercostal nerve;

It is important to remember that acute pain heralds the onset of disease, while chronic pain repairs this pathological effect and alerts people to a developing disease.

Conditions that can cause chronic back pain include:

• Displacement or prolapse of the intervertebral disc;
• autoimmune joint disorders, such as ankylosing spondylitis (swelling of the joints in the spine);
• radiculopathy - inflammation and degeneration of nerves from the spinal cord to muscles and joints;
• Arthritis and arthropathy of spinal joints of various origins.

Less commonly, back pain can be a sign of a more serious condition, such as:

• Infectious processes (eg, meningitis, tuberculosis);
• Visceral disease (abdominal aortic aneurysm or gynecological pathology);
• Metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Back Pain Diagnosis

To understand how to deal with severe back pain, you first need to identify its cause. An accurate diagnosis is the key to developing a good treatment plan.

After a thorough examination of the patient's complaint, medical history, and nature of symptoms, doctors may prescribe imaging and functional tests to confirm the diagnosis.

• Spine X-rayUsed to detect degenerative diseases and fractures.
• CT scanProvides detailed cross-sectional images of the spine, showing subtle changes in the bones.
• Magnetic resonance imagingDisplays tissue and bone structure for detection of slipped or herniated discs, pinched nerves or spinal cords.
• in progressmyelographyA special biologic, a dye injected into the area around the spine, was used to better visualize the spinal canal and discs, as well as the condition of the nerve fibers inside and around the spine.
• Electrical diagnostic testsAllows you to assess electrical activity in upper and lower extremity nerves.
• Positron emission bone scanFirst, the tumor pathology of the bone was revealed.
• Densitometry - Bone Densitometry - IndicationIn diseases and conditions that result in decreased bone mineral density.

Ways to Treat Back Pain

The complex structure and stage of pathological changes in pain syndromes in various parts of the back determine the necessity of a combination of pharmacological and non-pharmacological treatments.

Evidence-based principles of care for people with chronic back pain mean:

1. Explain to the patient the cause of the pain, and usually its benign origin;
2. ensure adequate daily physical activity;
3. Prescribe effective and safe treatment, primarily for pain relief;
4. If treatment fails, correct treatment after 1-3 months.

Clinical recommendations from international physicians provide a general algorithm for how to cure chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), nonsurgical treatments, physical therapy, manual therapy, and antidepressants and psychotherapy are considered the most effective treatments for chronic pain.

Non-drug treatments for back pain

In most cases, people with back pain will improve within 2-6 weeks. The main goal of nonspecific treatment is to reduce exercise restriction and minimize relapse, and while good physical condition cannot prevent all pain episodes, it can help relieve them.

The development of correct motor stereotypes and exercise therapy are important areas for nonpharmacological correction of pain syndromes.

Nonpharmacological treatment of low back pain can be divided into three stages based on duration.

i stage- Passive physiotherapy in the acute phase (6 weeks).

Phase II- Active exercise during the subacute phase (6-12 weeks).

The third phase- Rehabilitation physiotherapy effects.

Bed rest is prescribed for acute back pain only for a limited time.

Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:

1. Non-specific physical activity, such as daily walking, cycling, swimming. For simple back pain, regular physical activity and mild stretching are recommended to improve long-term outcomes. Physical therapy may also be recommended to strengthen the muscles of the abdomen and spine;
2. Therapeutic massage is used for short-term pain relief but does not lead to long-term functional improvement;
3. Methods such as acupuncture, manual therapy and spinal traction were used.

Regardless of the conservative approach used, it is important to remember that patients may not feel immediate relief and will improve within a few weeks or months.

medical treatment of pain

The most common medications for back pain are:

1. Nonsteroidal anti-inflammatory drugs and muscle relaxants.
2. Steroid hormones are injected into the joint or epidural space of the spine to reduce inflammation and pain in the back. However, this therapy is not suitable for long-term use due to the side effects of the drug.

When is surgery used?

While the vast majority of people with back or neck pain recover over time without medication or non-surgical treatment, some patients may require surgery to correct their spinal disease. In general, people with spinal pain can undergo surgery if the following criteria are met:

• Structural problems have been diagnosed and confirmed by imaging (such as X-ray or MRI);
• Conservative treatments, such as physical therapy or drugs, do not provide adequate pain relief;
• Debilitating back pain - it interferes with daily activities or participation in physical activity;
• Symptoms that adversely affect physical or emotional health;
• There are objective, diagnostically proven reasons to believe that spine surgery will be beneficial;
• have nerve damage.

Prevention of low back pain

Maintaining a healthy lifestyle is the key to preventing low back pain. Being overweight can put stress on your back, so maintaining a healthy weight is important. Regular exercise strengthens the abdominal and back muscles. Smoking accelerates the aging of blood vessels and many tissues in the body, including the spine, so refusing tobacco products is another step toward a healthy back. Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.