Back pains

Back pain (synonymous with dorsalgia) is one of the most common reasons for visiting a doctor - the second after acute respiratory diseases1. Most often such complaints come to a neurologist, therapist or general practitioner. According to international studies, 19 to 43% of the adult population that was surveyed recently reported 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 are 59-84% 1. Almost every fifth adult inhabitant of our planet may experience severe back pain at this time. Their most common location is the lower back and lower back.

Why do back pains appear?

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

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

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

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

  At the same time, there are a number of specific symptoms, the so-called "red flags", which indicate a serious illness and require a thorough examination. They include:

  • rapid unreasonable weight loss and / or indication of a history of oncopathology (tumors);
  • weakness in the lower extremities, impaired sensitivity and function of the pelvic organs (cauda equina syndrome);
  • the use of antibiotic therapy, fever (infectious processes);
  • previous trauma or previous diagnosis of osteoporosis, age over 55 years (spinal fracture);
  • young age - up to 20 years;
  • long-term preservation of painful sensations and their intensity, despite treatment;
  • in combination with general weakness or gait disturbance, aggravated at night, does not change with a change in body position.
• Radical- next in frequency (up to 27%). It develops as a result of pinching and / or inflammation of the spinal cord root, which exits through the openings of the spine. This type may be indicated by increased pain when coughing, sneezing, exercise and other activities.
• Non-specific- more often acute, it is difficult to immediately determine the specific cause of its development, usually these are the consequences of dystrophic changes in bone, cartilage of the spine, as well as the 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 - dorsopathies.

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

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

The localization distinguishes:

What is the name of	Where it hurts
cervicalgia	neck pain
cervicocranilagia	neck + head
cervicobrachialgia	neck and gives the hand
thoracalgia	chest pain on the back and chest, pain under the shoulder blades of the back
lumbodinia	lower back and lumbosacral area
sciatica	cross + leg
sacralgia	sacrum
coccygodynia	coccyx

In addition to the causes, it is possible to identify factors that may provoke the development of pain syndrome:

• severe physical overload, leading to overstretching of muscles and ligaments;
• awkward or static postures that a person takes for a long time;
• untrained muscles and their overload, inactivity;
• trauma and microtrauma;
• hypothermia;
• prolonged immobilization, such as bed rest;
• alcohol abuse;
• diseases of the internal organs;
• joint pathology;
• Overweight;
• individual characteristics: curvature of the spine, stooping;
• malnutrition, diseases of the digestive system, which may be accompanied by impaired absorption of vitamins, mineral metabolism, significant intake of salts that affect the joints;
• occupational hazards: thermal effects, temperature fluctuations, vibrations, work with weights, etc.

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

Also, muscle spasm can be a reflex reaction to pathology of the spine or diseases of internal organs. In this case, this is seen as a protective reaction, but at the same time a new round of pain begins. In addition, with prolonged spasm, the transmission of nerve impulses to muscle fibers is disrupted, they become more excitable, calcium deficiency may occur and circulatory disorders further aggravate the situation.

Depending on the duration of dorsalgia, there may be:

• acute - lasting up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic - last 12 weeks or more.

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 pain or pulling, sometimes tightness;
• increases with load or movements of the spine, as well as in certain positions, may decrease when kneading or rubbing muscles, as well as after resting in a comfortable position;
• possible pain in the sides of the back or pain in the back;
• when drilling, compaction, changes in the contours is determined tension, but there are no disturbances in the sensitivity 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 in the limb may be stronger than in the back. 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 slightly 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, tumor, inflammation, infection, osteoporosis, diseases of the internal organs and others. As a rule, these types of pain have quite bright 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 using 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 need further testing.

Chronic pain

As the mechanisms of its development have not yet been sufficiently studied, it can be problematic to identify the source, especially if it is a dysfunctional species that reflects the pathology of other organs. This can be a manifestation of diseases such as irritable bowel syndrome, chronic cystitis, chronic pyelonephritis and others. In each case, an in-depth interview and examination of the patient is performed to decide on further treatment tactics.

For pain syndrome, which occurs against 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 condition 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 maintaining normal activity;
3. prescribe effective medical and non-drug treatment;
4. monitor the dynamics and adjust the therapy.

When choosing a drug, attention is paid to its analgesic effect, speed of action and safety. Non-specific anti-inflammatory drugs (NSAIDs) are prescribed in the first place, as their effectiveness has been proven in back pain. One such drug is naproxen.

Naproxen is available as an oral tablet and gel for external use. The drug is indicated as a painkiller for back pain associated with trauma, overload, inflammation. In addition, it has anti-inflammatory and antipyretic effects, the duration of the effect can last up to 12 hours. If you are unable to see a doctor soon and the pain causes significant discomfort, then you can take naproxen as follows: 2 tablets as a starting dose and 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.

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

Non-drug treatments include:

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

Treatment of chronic back pain

If the location of the pain and the source of the pain impulses could be identified, then local therapy is used - blockades, intradiscal influences and other procedures. For other patients, such treatment for back and lower back pain is not used, so a different treatment regimen is used. Its main purpose is to reduce the intensity of pain and maintain 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.

Prevention

For the prevention of dorsalgia it is necessary to identify all possible risk factors and work to eliminate them.

The following will be helpful for all types of pain:

• adequate physical activity and strengthening of muscles, including the back;
• timely treatment of chronic diseases of the internal organs;
• maintaining physiological posture during work;
• quitting smoking and alcohol;
• regular preventive examinations;
• adequate treatment and prevention of infections;
• 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 complete rehabilitation of patients with back pain allows you to maintain quality of life, reduce the number of cases of injury and prevent the transition to a chronic form of the disease.