Lower back pain: causes and treatment

In most cases, lower back pain is caused by hypothermia or muscle strain due to awkward movement or heavy lifting and can go away on its own. If the pain disrupts the normal rhythm of life, improvement does not occur for too long, or other suspicious symptoms are present, then the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.

Depending on how long the pain has bothered the patient, doctors distinguish:

1. acute pain - less than 4 weeks,
2. subacute pain - from 4 to 12 weeks,
3. chronic pain - more than 12 weeks.

At the appointment, the doctor clarifies with the patient exactly how the back hurts: it can be a sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other unpleasant sensations of varying degrees of intensity. Based on the duration, location and nature of the pain, the doctor assumes what is its source.

Pain in the lumbar spine: causes

Pain in the lumbar region can be associated both with problems of the spine and with other organs and systems in the body. To understand how to cure the lower back, you need to determine what causes the pain.

There are vertebrogenic pain caused by diseases of the spine:

• Osteochondrosis, manifested by problems with intervertebral discs, facet or facet joints. Disorders occur with age in any person: intervertebral discs lose moisture and elasticity, facet joints become denser and become less mobile.
• Overstrain of the muscles and ligaments of the spinal column.
• Compression of the spinal nerve roots - radiculopathies.
• Spinal injury.
• Instability of the spine due to weakness of the ligamentous-muscular system.

Non-vertebral causes include:

1. Neurological disorders

   • Lumbosacral plexopathies are damage to the nerve plexus that gives rise to the peripheral nerves of the lower extremities. Occurs with injuries and metabolic disorders.
   • Dystonia is a violation of the tone of the muscles that support the spine. In this case, pain may be accompanied by poor posture. The disease may be congenital.

2. Systemic diseases

   • Infections affecting the vertebrae, discs, membranes of the spinal cord, or the spinal cord itself, for example, osteomyelitis, epidural abscess.
   • Malignant and benign tumors, metastases.
   • Osteoporosis is a decrease in skeletal bone density, fraught with vertebral fractures.
   • Rheumatological diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.

3. Pain from internal organs.It is caused by causes outside the spine and radiates to the lower back, sometimes in the middle, sometimes to the side - depending on the source organ. These include:

   • Diseases of the gastrointestinal tract - most often pancreatitis.
   • Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pain in the back and side accompanies renal colic when the stone moves along the ureter.
   • Aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body forms a bulge. This may cause a sensation of pulsation in the abdomen.
   • Diseases of the hip joints - injuries, inflammation, degeneration.

4. Psychogenic pain

   Lower back pain may be associated with an anxiety disorder or depression.

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

• disc herniation,
• injury,
• malignant or benign tumor,
• infection.

Compression of the spinal cord is accompanied by extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.

Symptoms

Often low back pain is nonspecific, that is, caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:

• Aching, pulling, or squeezing pain.
• The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, for example, hanging curtains, changing light bulbs in a chandelier, bending down repeatedly and for a long time: when washing floors, vacuuming, removing snow.
• No other symptoms.

The fact that pain can be a symptom of some dangerous condition is indicated by"red flags":

• Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
• Pain at rest and at night, interfering with sleep. Nonspecific pain usually appears with movement or prolonged static load, but goes away after resting in a comfortable position.
• General weakness is also not characteristic of nonspecific pain.
• Unexplained weight loss over the past few months. It may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
• Increased body temperature, chills. Indicates severe inflammation of various origins.
• Severe or increasing decrease in sensitivity or weakness in the leg muscles.
• Impaired bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement combined with acute pain is a sign of compression of a nerve, and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord may be lost forever.
• Lack of effect from treatment and transition of acute pain to chronic.
• Features of the medical history. For example, if lower back pain appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn’t matter how long ago the diagnosis was made. Or pain has appeared in a person who has recently undergone any serious infection, surgery, or has a sharply reduced immune system for any reason, for example, has been taking a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, lower back pain may indicate various complications.

If you have identified at least one of the listed points, immediately consult a doctor for additional examination.

Diagnostics

Pain is a subjective symptom, so a survey and examination by a doctor plays a huge role in diagnosis. The doctor prescribes additional examinations depending on what diagnosis he suggests. For an accurate diagnosis, carry out:

• Laboratory tests— complete blood count, biochemical blood test, general urine test, tests to detect infections, autoimmune diseases.
• Electroneuromyography- study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
• Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spinal column, the presence of hernias, compression of the spinal nerve roots.
• Ultrasonographykidneys and abdominal cavity - carried out if pathology of internal organs is suspected.
• Bone condition assessment: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.

If the doctor is absolutely sure that low back pain is nonspecific, he can prescribe treatment based only on examination, without additional tests.

Often, with lower back pain, a person does not see a doctor, but only comes for an MRI of the spine on his own. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic herniated discs. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person suffers discomfort for a long time, takes painkillers uncontrollably, and develops complications and side effects.

Which doctor should I contact?

First, if you have lower back pain, you can also consult a general practitioner. He will suggest what is causing the pain and, depending on this, will refer you to another specialist. You can skip this step and immediately make an appointment with a neurologist.

If a neurologist, after a specialized examination, suspects a pathology outside the spine, he may refer to:

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

Doctors of all these specialties periodically encounter the symptom of lower back pain, because it has a large number of possible causes.

If a diagnosis of mechanical pain has been established, the patient will be treated by physical therapy specialists, a reflexologist, a physiotherapist, and massage therapists.

How to cure lower back pain

• SurgeryThey are used mainly for signs of compression of the spinal cord or spinal nerve roots, when the patient experiences paresis of a limb or urinary disorder. These symptoms may be caused by an intervertebral hernia, tumor, or injury. Also, consultation with a neurosurgeon may be recommended for the patient in case of chronic pain when conservative treatment is ineffective within 12 weeks. The decision about surgery is made only after visualization of the spine.

  Studies have shown 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 medicinal and non-medicinal methods.

  Drug treatment is carried out using non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.

  Non-drug treatment includes:

  • Physiotherapy— it is aimed at quickly eliminating pain and inflammation, as well as accelerating tissue restoration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
  • Acupuncture- insertion of special sterile needles into biologically active points to reduce pain and relax muscles.
  • Massage— improves the mobility of the spine and joints, promotes proper distribution of the load on the back muscles.
  • Physical therapy- allows you to relax and strengthen your back muscles. Exercises are effective for both acute and chronic back pain.

  If the patient has pain for more than 12 weeks, we are talking about chronic pain. In her treatment, antidepressants with an analgesic effect, as well as cognitive behavioral psychotherapy, are added to all of the above methods.

Bed rest does not provide benefits in the treatment of mechanical low back pain and is not an alternative to the above methods. Moreover, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly slows down recovery.

Consequences

Acute nonspecific low back pain has a favorable prognosis. Of those who seek treatment right away, 70–90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, requiring treatment with antidepressants with an analgesic effect. If the pain is caused by compression of the spinal nerve roots by a hernia, then it may be accompanied by numbness in the limbs, as well as problems with urination and defecation.

Prevention

Help prevent lower back pain:

• Moderate exercise for 150 minutes per week: walking, swimming, exercises for the core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
• Maintaining a healthy weight.
• Warm up every 40-60 minutes with a long static position.
• Thigh muscle stretching exercises.
• Correct body position when lifting weights: you need to squat, not lean forward.
• Prevention of decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis by densitometry. This is especially important for older people and postmenopausal women.
• Maintaining general somatic and psychological health.