Back pain: treatment, causes and characteristics

Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations and is one of the most pressing problems in modern health care, and treating back pain is a difficult task.

Although pain can occur in any part of the spine, the most common location is the lower back - according to researchers, the prevalence of lumbar pain in the adult population is 76%.

According to statistics, about 80% of people complain of at least one attack of pain in the lower back within a year, and in the next 12 months, 75% of them experience a relapse of the pain syndrome.

Types and manifestations of pain syndrome

Depending on the back segment affected, the pain syndrome is divided into pain in the neck, in the middle of the back (chest pain), in the lower back (lumbar pain) or in the coccyx (pain in the tailbone or sacrum).

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

The pain can be dull or stabbing, sometimes there is a burning and tingling feeling.The symptoms of some diseases also extend to the arms and hands, legs or feet, depending on the degree of spinal involvement.Numbness or weakness in the upper and lower extremities is another possible side effect of back pain.Some patients with spinal pain syndrome also experience limitations in the range of certain movements or increased pain in certain body positions.

Back pain: why does it happen?

During examination, it is not always possible to determine the direct cause of back pain.In this case one speaks of “non-specific” or “mechanical” pain.The cause of this pain is pathological changes in the musculoskeletal system, but damage to the roots of the cervical, thoracic, lumbar and sacral nerves, as well as specific diseases of the spine are not observed - this subtype of pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease accounts for approximately 2% of cases.

Non-specific back pain is characterized by the following features:

• tends to improve or worsen depending on posture - for example, the patient may feel better sitting or lying down;
• The pain often worsens with movement.
• the attack may develop suddenly or increase gradually;
• Sometimes back pain is the result of poor posture or awkward lifting of something, but often occurs for no apparent reason;
• may be caused by a minor injury, such as a ligament or muscle strain;
• can occur after stress or overwork and usually improves within a few weeks.

Risk factors for the development of non-specific back pain:

• heavy physical work;
• frequent bending and bending of the body;
• lifting heavy objects, especially from an incorrect position;
• sedentary lifestyle;
• industrial influences such as vibrations;
• Pregnancy;
• age-related changes in the musculoskeletal system.

Acute pain has physiological significance because it indicates the acute influence of an unfavorable factor.

The most common causes of acute back pain are:

• Injury to various structures of the spine;
• Spondylolisthesis – displacement of the vertebrae relative to each other;
• Sciatica – Inflammation of the sciatic nerve (the longest and widest nerve in the human 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 nerves;

It is important to remember that acute pain signals the onset of a disorder, while chronic pain records this pathological effect and is reminiscent of a developing disorder.

Conditions that can cause chronic back pain include:

• Displacement or prolapse of an intervertebral disc;
• Autoimmune joint diseases such as ankylosing spondylitis (swelling of the spinal joints);
• Radiculopathy – Inflammation and degeneration of the nerves that run from the spinal cord to the muscles and joints;
• Arthritis and arthrosis of the spinal joints of different origins.

Much less commonly, back pain can be a sign of more serious illnesses, such as:

• infectious process (e.g. meningitis, tuberculosis);
• Diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
• Metastases or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Diagnosis of back pain syndrome

To understand what to do if you have severe back pain, it is advisable to first determine the cause.An accurate diagnosis is the key to a well-developed treatment plan.

After carefully examining the patient's complaints, medical history, and type of symptoms, the doctor may order imaging studies and functional tests to confirm the diagnosis.

• X-ray of the spineis used to detect degenerative diseases and fractures.
• Computed tomographyprovides detailed cross-sectional images of the spine, showing even subtle changes in the bones.
• Magnetic resonance imagingshows both tissue and bone structures and is used to detect herniated discs, pinched nerves or the spinal cord.
• When conductingMyelogramsTo better visualize the spinal canal and discs, as well as the condition of the nerve fibers in and around the spine, a special biological dye is used that is injected into the area around the spine.
• Electrodiagnostic testsallows assessment of electrical activity of nerves in the upper and lower extremities.
• Positron emission scan of bonesreveals primarily the oncopathology of the bones.
• Densitometry – determination of bone density – shownfor diseases and conditions that lead to a decrease in bone mineral density.

Methods to combat back pain

The complex structure of pain in different parts of the back and the stages of pathological changes require a combination of drug and non-drug treatment.

The principles of therapy based on evidence-based medicine for a patient with chronic back pain include:

1. explain to the patient the causes of the pain and, as a rule, its benign origin;
2. Ensuring adequate daily physical activity;
3. Prescribing effective and safe treatment, particularly for pain relief;
4. Correction of therapy if it is ineffective after 1-3 months.

International clinical recommendations of doctors provide a general algorithm for curing chronic back pain.It is believed that the most effective methods for treating long-term pain are drugs from the group of nonsteroidal anti-inflammatory drugs (NSAIDs), non-surgical treatment, physiotherapy, manual therapy, as well as antidepressants and psychotherapy.

Non-drug treatment of back pain

In most cases, a patient with back pain will improve within 2-6 weeks.The main goal of non-specific treatment is to reduce movement restrictions and minimize relapses.Although good physical fitness cannot prevent all painful episodes, it does make resolution of these episodes easier.

The development of correct motor stereotypes and physical therapy are important areas of non-pharmacological pain correction.

Based on duration, non-drug treatment for back pain can be divided into three phases.

Stage I- passive physiotherapy during the acute phase (6 weeks).

Stage II– active exercises during the subacute phase (6-12 weeks).

Stage III- physiotherapeutic rehabilitation effects.

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

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

1. non-specific physical exercises such as daily walking, cycling, swimming.For uncomplicated back pain, regular physical activity and gentle stretching exercises are recommended to improve long-term results.Physiotherapy may also be recommended to strengthen the abdominal and spinal muscles;
2. therapeutic massage provides short-term pain relief but does not result in long-term functional improvement;
3. the use of acupuncture, manual therapy and spinal traction methods.

Regardless of which method of conservative treatment is used, it is important to remember that the patient may not feel immediate relief and improvement may occur only after several weeks or months.

Drug pain treatment

The most common methods of treating back pain with medication are:

1. Nonsteroidal anti-inflammatory drugs and muscle relaxants.
2. Injections of steroid hormones into the joint cavity or epidural space of the spine, reducing inflammation and pain in the back.However, this type of therapy is not intended for long-term use due to the side effects of the medication.

When is surgical treatment used?

While the vast majority of people with back or neck pain recover over time without medication or nonsurgical treatment, some patients may require surgical correction of spinal conditions.In general, a patient with spinal pain can undergo surgery if the following criteria are met:

• the structural problem was diagnosed and confirmed by imaging (e.g., X-ray or MRI);
• Conservative treatments such as physical therapy or medications did not adequately relieve the pain;
• Back pain is debilitating and prevents you from participating in everyday activities or exercising.
• Symptoms negatively impact physical or emotional health;
• There are objective reasons confirmed by diagnostic methods to believe that spinal surgery will be beneficial.
• neurological damage occurs.

Prevent back pain

A healthy lifestyle is the key to preventing back pain.Excess weight puts strain on your back, so it's important to maintain a healthy weight.Regular exercise strengthens the abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues in the body and, among other things, contributes to the aging of the spine.Therefore, avoiding products containing tobacco is another step towards a healthy back.Proper posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.