Back pain: causes, treatment

The pain in the lumbar region of the spinal column and adjacent areas may disturb the patient at any time of the day, standing, sitting, lying down or in motion, during exercise or in peace. Symptom this is not so specific, meaning that you can get out in this large number of cases, which requires particular attention, in the first place from the part of the patient: it is necessary to contact a doctor immediately.

To what doctor to address?

According to the statistics, up to 25% of patients turn to the doctor is in relationship with the appearance of pain in the lumbar region. 8 of 10 the inhabitants Of the globe have experienced the feeling of pain in the back, at least 1 time in life. More often they are suffering from these symptoms people of working age, a little less people of retirement age, and even more rarely - adolescents (according to various sources, from 8 to 40% in Russia).

Internist, neurologist, rheumatologist

The first doctors to whom most patients with pain in the lower back, become the therapist and the neurologist. But young people with an injury in the recent past, more often turn to a specialist.

And diagnostic, therapeutic, and tactics of these different specialists. Often the therapist will guide the patient to a neurologist, neurologist, defines "your" diagnosis and prescribes a treatment. Specialist often works "individually," and the use of nonsteroidal anti-inflammatory funds, applied techniques of manual therapy and физиолечение. Important for the patient – not to get lost in this situation, not to get involved promises of instant healing during the execution of techniques, not to use him again in the event of a failure or, worse, intense, against the background of such treatment of pain.

When the conservative treatment, i.e. drugs, you must understand that treatment within four weeks without any result - a convincing argument for the revision of the diagnosis, treatment revmatologu, and not for the carrying out of repeated courses of therapy. There are situations, when a patient with complaints of pain in the lower back becomes symptomatic (that is, only a pain reliever) treatment of a kind of model of the schema, without knowing the true causes of this pain.

The causes of back pain

The main causes of pain in the lumbar region is

  • the change of the structures of the spinal column, usually of age (degenerative), osteochondrosis of the spine, a variety of hernia of the intervertebral disc, or inadequate muscle complex. This pain called primary, i.e. directly connected with the spinal column;
  • pathological organs close to the painful area, but directly to the spine are not related (for example, diseases of internal organs, skin). This category of causes refers to inflammation of the joints, lesions, endocrine disorders (e.g., diabetes), - in a word, everything that does not fall in the framework of "natural age-related changes" of the spine. This pain is called secondary.
sore-of-back

The inspection by the doctor

Pain, heavy sensation of mobility or increase the painful tension of muscles in the stretch between the lower ribs and the buttocks, define the term "lyumbalgiya". If these symptoms join pain in the leg, was called lyumbalgiya.

In the first place, it is important to the acuteness of the pain, i.e. the distance of its appearance. The pain prescription for up to 12 weeks (3 months) is called acute, for more than 12 weeks – chronic. The chronic pain syndrome can proceed with exacerbations and periods of improvement.

Of fundamental importance, as the pain is felt. This is the meaning, or at a given point, or the distribution ("projection", "иррадиация") pain during the nerve in the thigh, buttock, knee, foot, or fuzzy, "stupid" the pain. You need to understand, they are limited movements of the spine in the moments of excruciating pain, or movement without hindrance (this can indicate damage of a mechanical nature, for example, the fracture of the vertebra). In such moments there is pain? If it occurs during the load, or at rest, during the night's sleep? An affirmative answer to this last question, in general, is to "red flag" for the specialist, and makes us think about the diagnosis of inflammatory disease of the spinal column of the patient (for them we will stop a little later). If the pain intensifies during movement of the head, walk, jump, we're probably talking about the so-called projection of pain, which is why – damage to neural structures (more often than not sciatica).

Osteochondrosis of the vertebral column, or spondilez – state, in which one observes the seal and the deformation of the vertebrae, with the appearance of small areas of bone-like spines along the edges of the vertebrae. For a long time it was considered spondilez the natural result of the current degenerative aging processes of the body. However, has shown that not only the age may be the cause of degenerative disc disease. Stationary lifestyle, the increase of the load on the lumbar spine during prolonged work at the computer, or prolonged driving (for example, the profession of driver, truck driver) lead to the appearance of degenerative disc disease, even in young people. Under the influence of all these factors, the intervertebral discs-the buffer becomes thinner, and the nerve roots that go from the spinal cord-injured fruit provincial spiked bones. The constant irritation of these roots and causes pain. In Latin the back is called the radix, in such a way that inflammation is usually called radikulit.

The so-called inflammatory diseases of the spine – the area of interest in rheumatology. These mysterious diseases can "smolder" for a few years, especially at a young age and predominantly affects men, and the subsequent end obezdvizhennost' the invalidizatsiyu of the patient. The patients of this group usually "suffers," and the night pain and morning stiffness in the back, and the weakness, and the increasing reduction in performance. Unfortunately, the appearance of the first symptoms of the disease before the correct diagnosis, on average, is approximately seven years. During this time, the changes in the spine can become irreversible, and functional (motor) activity – low. The spine becomes immobile, it changes form, it appears the hump. Meet this disease are not as common as back pain, for example, but the costs of treatment and the total time of the disability of such patients disproportionately higher.

If, in addition to the back of the patient speaks of inflammation of the joints (often the knee, pains in the joints, the joints and stop the pain in the buttocks, unstable chair with unusual impurities, disturbances of vision or eye pain, this is also an urgent reason to send it to a professional to carry out further, specific investigations, and the elimination of the disease from a group of spondiloartritov (for example, seronegative ankylosing spondylitis, or Crohn's disease).

There are diseases that occur pain in the lower back and completely undisturbed vertebrate or structures. One of these disease – myofascial pain syndrome. The patient (often a young patient) point to a long stay in an uncomfortable position, or physical overload, anticipating the development of headaches. When the medical examination is worthy of note a sharp pain sensitive to pressure on specific points located near the spine. This condition greatly reduces the quality of life of the patient, but small changes in the muscle tissue (the local overvoltage) is not a hazard, nor for the nerve roots, nor for the internal organs. Usually the therapeutic effect can achieve with the help of the target muscle relaxants, low doses of nonsteroidal anti-inflammatory drugs, local administration (injection) in the "sore point" of steroid anti-inflammatory medication.

Examination

It is believed that if a patient with pain in the low back has not "worrying signs" (see below), a further examination does not need, and the treatment can be carried out by a therapist without the analysis and also the x-ray. But, as practice shows, almost every one who is sick of these "signs" can be detected, and therefore there is the need to donate blood, at least in the common (and better – and immunological) analysis, and to perform an x-ray of the lumbar spine in two projections (ideally – with the "capture" of the bones of the pelvis).

  • - Blood tests may reveal an increase in the velocity of erythrocyte sedimentation (ESR), which indicates inflammation, possibly of the source of immune system or infection. Increase the level of white blood cells, also speaks of infection or inflammation, and severe anemia – about the possible presence of a tumor in the process.
  • - Analysis of the urine, to surrender to the suspicion of renal disease. Pain in the lumbar region in this way, intermittent, often "spread" to the top, to the bottom fins. When there are changes in the urine analysis pass ULTRASOUND of the kidney, and the further tactic is discussed in detail with a therapist or a urologist.
  • - X-ray – the most economic investigations, is the method of choice when the diagnostic search in this case. On the x-ray you can see the breach of the structures of the vertebral column, signs of inflammation of the vertebral joints, the circumstantial evidence to determine the place of compression of the nerve. The "transparency" of the vertebrae on the x-ray will lead to the thought of osteoporosis (fragile) skeleton bone. As is well known, on the background of osteoporosis, the most frequent such complication such as fracture of a vertebra. If the fracture is, alas, took place, will also be visible on x-ray. The features of this research method are huge, but if the disease is found, it is necessary to clarify how severe the damage, is not in need of a patient in a surgery to the spine. For this it is necessary a more precise research – послойное (computerized tomography). There are two types of computed tomography – computer x-ray and magnetic resonance imaging.
  • - Computed tomography (CT). The method of survey that allows you to literally look inside the spinal column. All the bone structures that are not visible with a normal x-ray, dental tomogram will be perfectly visible. If necessary, with the help of the received data and a special computer program it is possible to reconstruct the 3D model of any type of structure.
  • - Magnetic resonance imaging (MRI). Not x-ray method of study. Different from computed tomography, is also the one that allows the physician to more carefully assess the status of "soft" structures of the spine (CT visible only the bony elements): the spinal cord, roots. More details in this survey saw the vertebrates hernia, vascular changes and muscle. It is usually an expert in magnetic RESONANCE imaging remains the last word when the research diagnosis and definition of further tactics.

The signs, to which attention must be given

Secondary back pain, which do not have relationships with остеохондрозом – a symptom that alarming, causing as soon as possible to start the basic research of the pathological process that causes the pain. To dwell briefly on the symptoms that may indicate a possible secondary (i.e. not directly connected with the spine) pain and require increased vigilance, as from the doctor and the patient:

  • detail the sudden loss of body mass (you may suspect a tumor);
  • infections of the kidney and of the bladder (in this case, the pain can be a symptom of pyelonephritis);
  • increased pain at rest or after a night of sleep (this symptom has a special interest in rheumatology, as well as can be a sign of the evolution of ankylosing Spondylitis (as);
  • increase of the body temperature;
  • changes in blood tests (increased coagulation of the blood, detected during the execution coagulogram, increase the level of white blood cells or decrease in hemoglobin, and also the increase of ESR (erythrocyte sedimentation rate) in general, the analysis, increase the level of c-reactive protein in the analysis);
  • a diagnosis of "osteoporosis", or taking medications that reduce the amount of calcium in the bones;
  • age over 50 years of age (the risk of osteoporosis in menopausal women) or less than 20 years, this is especially true for young people;
  • link to the trauma, regardless of its prescription (for example, a fall from a height of over 2 metres, and for the elderly, significant trauma is already a fall from a height of the body);
  • signs of neurological disorders deviations (violation of the sensitivity of the skin, urination or defecation is usually a sign of a profound defeat of the spinal cord);
  • the inefficiency is "routine" treatment for 4 weeks.
pain

Maintain activity and mobility

A common mistake – the observance of rest in bed with acute back pain. The movement of this disease, the muscle-skeletal is not only necessary, but it is necessary. In all cases, except compression radicular syndrome (this diagnosis will install a neurologist), finding in a horizontal position increases the cost of the treatment and tightens the healing time. Yes, and when radicular syndrome of time, total bed rest should not be more than two days.

In inflammatory diseases of the spine and sacro-iliac joint physical activity – the main tool of the struggle advances, with disabilities. Recall that the group of diseases has been gradually progressive in nature, and exercises aimed at maintaining flexibility and developing and strengthening the muscular "corset" of the spine, can be considered to be an effective method of treatment, such as special therapy, nonsteroidal anti-inflammatory drugs of different groups, assigned by the experts.