Back pain

Back pain (synonymous with dorsalgia) is one of the most common reasons for visiting a doctor - second only to acute respiratory illnesses1. Most often, such complaints go to a neurologist, therapist or GP. According to international studies, 19–43% of the recently surveyed adult population experienced back pain in the past month, compared with 27–65% in the past year. Those who have experienced this at least once in their lives are 59-84% 1. Almost one in five adult residents on our planet may experience severe back pain at this moment. Their most common localizations are the lower back and lower back.

Why does back pain occur?

The main causes of back pain are:

1. Causes of vertebrae - related to spinal pathology:
   • pathology of intervertebral discs, including hernias;
   • spinal canal stenosis;
   • joint diseases;
   • consequences of injuries;
   • congenital disorders and developmental disorders;
   • metabolic disorders;
   • spondylitis - inflammatory processes in the intervertebral joints.
2. Nonvertebrogenic - not associated with spinal pathology:
   • sprains of ligaments and muscles that carry a heavy load;
   • myofascial syndrome - chronic muscle pain;
   • inflammation of muscle tissue - myositis;
   • diseases of the internal organs;
   • pathology of large blood vessels, such as abdominal aortic aneurysm (sharp expansion);
   • hip arthrosis - an inflammatory-dystrophic disease;
   • mental disorders, etc.

Depending on the origin, the following types of pain can be distinguished:

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

  However, there are a number of symptoms, the so-called "red flag", which are about serious illnesses and require thorough investigation. These include:

  • rapid unreasonable weight loss and / or a history of oncopathology (tumors);
  • weakness of the lower extremities, deterioration of the sensitivity and function of the pelvic organs (cauda equina syndrome);
  • use of antibiotic therapy, increase in body temperature (infectious processes);
  • previous diagnosis of previous trauma or osteoporosis, older than 55 years (spinal fracture);
  • young age - up to 20 years;
  • long-term preservation of painful feelings and their intensity despite treatment;
  • combined with general weakness or gait disturbances, aggravated at night, does not change with changes in body position.
• Radicularis- next in frequency (up to 27%). It is caused by pinching and / or inflammation of the roots of the spine, which leaves through the openings in the spine. This type may be indicated by increased pain during coughing, sneezing, physical exertion, and other types of activity.
• Not specific- more often acute, it is difficult to immediately determine the specific cause of its formation, usually the consequences of spinal bone, cartilage tissue, and dystrophic changes in muscles and ligaments form the back. There is a special section in the International Classification of Diseases (ICD-10) for the definition of such syndromes, dorsopathies.

Such dorsalgia accounts for up to 85% of cases 1 and mainly involves disruption of the normal functioning of certain structures in the spine, any of which can become a source of pain impulses. Pain can be compression (due to compression of nerve roots) and reflex - from any other tissue, including cramped muscles.

Another type of pain syndrome is described that is not associated with organic lesions of the spine and paravertebral tissues. This is called dysfunctional pain. They can cause psychological problems and chronic stress.

Localization distinguishes:

What is the name	Where does it hurt
cervicalgia	neck pain
cervicocranilagia	neck + head
cervicobrachialgia	gives his neck and hands
thoracalgia	pain in the chest back and chest, pain under the shoulder blades from behind
lumbodynia	the lower back and the lumbosacral region
sciatica	lower back + legs
specialty	sacrum
coccygodynia	coccyx

In addition to the causes, the factors that can trigger the development of pain syndrome can be identified:

• severe physical overload resulting in muscle and ligament strain;
• uncomfortable or static postures that a person lasts for a long time;
• untrained muscles and their overload, their inactivity;
• trauma and microtrauma;
• hypothermia;
• prolonged immobility such as bed rest;
• alcohol abuse;
• diseases of the internal organs;
• joint pathology;
• overweight;
• individual characteristics: curvature of the spine, curvature;
• malnutrition, diseases of the digestive system, which may be accompanied by a decrease in the absorption of vitamins, mineral metabolism, intake of significant salts affecting the joints;
• occupational hazards: heat effects, temperature fluctuations, vibration, working with weights, etc.

The mechanism of dorsalgia development is related to the block of intervertebral joints, which can be caused by both static and dynamic loads, microtrauma, and non-physiological postures. As a result, the muscles in one place are spasmodic and overstretched, and in the other they are overstretched. All this leads to the development of muscle pain, changes in pain sensitivity and the development of abnormal pain impulses.

In addition, muscle cramps may be a reflex reaction to spinal pathology or diseases of internal organs. In this case, it is considered a defensive reaction, but at the same time initiates a new round of pain. In addition, prolonged preservation of the spasm interrupts the transmission of nerve impulses to the muscle fibers, makes them more irritable, calcium deficiency can occur, and circulatory disorders further aggravate the situation.

Depending on the duration of dorsalgia, they may include:

• acute - lasts up to 6 weeks;
• subakut - from 6 to 12 weeks;
• chronic - last 12 weeks or more.

Symptoms

Symptoms of dorsalgia depend on the cause, the mechanism of development, and the presence of concomitant diseases.

In the case of non-specific pain, the following signs are typical:

• aching or pulling pain, sometimes tightening;
• increases with load or movement of the spine and in certain positions, may decrease after kneading or rubbing the muscles and resting in a comfortable position;
• possible pain in the back or pain in the back;
• during palpation we determine compression, contour changes, tension, but there are no sensitivity disturbances in the painful area, muscle strength decreases, reflexes do not change.

When the nerve root is compressed (radiculopathy), the intensity of the pain varies, it can shoot, it often radiates towards the foot, and it can be stronger in the limb than in the back. During the examination, symptoms of damage to a given nerve root can be observed - muscle weakness, deterioration of sensitivity in a certain area.

Diagnostics

The diagnostic algorithm for acute and chronic dorsalgia is somewhat different.

Sharp pain

In order to determine the tactics of treatment, the physician 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 so on. As a general rule, these types of pain have fairly vivid and specific clinical manifestations. After examination and palpation, patients are referred to appropriate specialists or for further examination, such as:

• X-ray examination;
• Spinal MRI and CT;
• scintigraphy - visualization method with the introduction of contrast material;
• densitometry - determination of bone density;
• laboratory tests for tumor markers, rheumatic tests, biochemical blood tests, etc.

Patients with non-specific acute pain generally do not require further research.

Chronic pain

As the mechanisms of its development have not yet been adequately studied, identification of the source may be problematic, 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 any case, a thorough interview and examination of the patient is performed to decide on further treatment tactics.

In the case of pain syndrome underlying dystrophic changes in the joints, it is possible to monitor the dynamics of the state of the spine by magnetic resonance imaging under the influence of any mechanical stress or other factors.

How to treat acute back pain

Physicians who adhere to the principles of evidence-based medicine use the following tactics to treat patients with acute dorsalgia:

1. inform the patient of the causes of the pain syndrome;
2. exclude bed rest and recommend maintaining normal activity;
3. prescribes effective drug and non-drug treatment;
4. monitors dynamics and adjusts therapy.

When selecting a drug, attention should be paid to its analgesic effect, speed of action and safety. First, non-specific anti-inflammatory drugs (NSAIDs) are prescribed because they have been shown to be effective against back pain. One such drug is naproxen.

Naproxen is available as an oral tablet and gel for external use. The drug is indicated as an analgesic for back pain associated with trauma, overload, inflammation. It also has anti-inflammatory and antipyretic effects, lasting up to 12 hours. If you do not have the opportunity to see a doctor soon and the pain causes significant discomfort, you can take naproxen as an initial dose of 2 tablets, then 2 tablets every 12 hours or 1 tablet every 8 hours. The process of admission without consulting a doctor is up to 5 days.

In addition to maintaining the intensity of pain, it is also possible to prescribe other analgesics and sedatives (sedatives).

Non-drug treatments include:

• heating;
• hand therapy;
• physiotherapy;
• massage;
• physiotherapy;
• acupuncture and other alternative methods.

Treatment of chronic back pain

If the localization of pain and the source of pain impulses can be identified, topical therapy should be used - blockades, intradisk effects, and other procedures. The rest of the patients do not use this treatment for back and low back pain, so a different treatment regimen is used. Its main goal is to reduce the intensity of pain and maintain quality of life.

Furthermore, as with acute pain, medications belonging to the NSAID group are prescribed, including naproxen, other painkillers, muscle relaxants, and vitamins B3. Antidepressants are recommended as needed. Hand therapy should be performed by a trained professional and exercise should be prescribed. Psychotherapeutic and physiotherapeutic methods of treatment are used.

Prophylaxis

To prevent dorsalgia, all possible risk factors should be identified and efforts made to eliminate them.

For all types of pain, the following will be helpful:

• adequate physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• maintaining physiological posture at work;
• quitting smoking and alcohol;
• regular preventive examinations;
• proper treatment and prevention of infections;
• balanced diet;
• wearing comfortable shoes and clothes;
• proper organization of work and life to protect the back;
• prevention of stress and emotional overload.

Comprehensive treatment and complete rehabilitation of patients with back pain allows for the preservation of quality of life, the reduction of cases of disability, and the prevention of the transition to a chronic form of the disease.