Backache

Back pain (synonymous with dorsalgia) is one of the most common reasons to visit a doctor - second only to acute respiratory illness1. Most often, such complaints come to a neurologist, therapist or general practitioner. According to international studies, from 19 to 43% of the adult population surveyed recently noticed back pain over the past month, from 27 to 65% - in the last year. Those who have experienced this at least once in their lives, there are 59-84% 1. Almost every fifth adult resident of our planet can experience severe back pain at the moment. Their most common localization is the lower back and lower back.

Why does back pain occur?

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

1. Vertebral causes - associated with spinal pathology:
   • intervertebral disc pathology, including hernias;
   • narrowing of the spinal canal;
   • joint diseases;
   • consequences of injuries;
   • congenital malformations and developmental abnormalities;
   • metabolic disorders;
   • spondylitis - inflammatory processes in the intervertebral joints.
2. Nonvertebrogenic - not associated with spinal pathology:
   • ligament and muscle contractions 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 enlargement) of the abdominal aorta;
   • osteoarthritis of the hip joint - an 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 examination methods. This type takes up to 3% 1 of all cases. These can be 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 certain symptoms, the so-called "red flags", which speak of serious diseases and require in-depth examination. This includes:

  • unreasonable rapid loss of body weight and / or an indication of a history of oncopathology (tumors);
  • weakness in the lower extremities, impaired sensitivity and functions of the pelvic organs (cauda equina syndrome);
  • use of antibiotic therapy, an increase in body temperature (infectious processes);
  • previous trauma or previous diagnosis of osteoporosis, age over 55 (spinal fracture);
  • young age - up to 20 years;
  • long-term preservation of painful sensations and their intensity, regardless of treatment;
  • combined with general weakness or gait disturbance, worsening at night, does not change with a change in body position.
• radicular- other in frequency (up to 27%). It develops as a result of the bite and / or inflammation of the spinal cord root, which comes out through the holes of the spine. This type can be indicated by increased pain when coughing, sneezing, physical exertion and other types of activity.
• Not specific- most often acute, it is difficult to immediately determine the specific cause of its development, usually the consequences of dystrophic changes in the bone, cartilaginous tissue of the back, as well as the muscles and ligaments that make up the back support apparatus 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 spinal structures, each of which can become a source of pain impulses. Pain can be oppressive (from compression of nerve roots) and reflex - from all other tissues, including spasmodic muscles.

Another type of pain syndrome is described, which is not associated with any organic damage to the spine and paravertebral tissue. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.

Localization differs:

What is the name of	Where it hurts
cervical pain	neck pain
cervicocranilagia	neck + head
cervicobrachialgia	neck and gives hand
thoracic pain	pain in the back of the chest and chest, pain below the shoulder blades from the back
lumbodinia	lower back and lumbosacral
shiatiku	buttocks + legs
sacralgia	sacrum
kokcygodynia	coke

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

• severe physical overload, resulting in excessive stretching of muscles and ligaments;
• uncomfortable or static postures that a person takes for a long time;
• untrained muscles and their overload, inactivity;
• trauma and microtrauma;
• hypothermia;
• prolonged immobility, such as bed rest;
• alcohol abuse;
• diseases of the internal organs;
• joint pathology;
• mbipesha;
• individual characteristics: back curvature, flexion;
• poor nutrition, diseases of the digestive system, which may be associated with impaired absorption of vitamins, mineral metabolism, a significant intake of salts that affect the joints;
• hazards at work: thermal effects, temperature fluctuations, vibrations, weight work, etc.

The mechanism of dorsalgia development is associated with a block of intervertebral joints, which can be caused by loads, such as static and dynamic postures, microtrauma, and non-physiological postures. As a result, in one place the muscles spasm and enlarge, and in another they overheat. 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 back pathology or diseases of internal organs. In this case, it is seen as a defensive reaction, but at the same time, a new circle of pain begins. In addition, with prolonged storage of the spasm, the transmission of nerve impulses to the muscle fibers breaks down, they become more excited, calcium deficiency can occur, and circulatory disorders further aggravate the situation.

Depending on the duration of the dorsalgia, there may be:

• acute - lasts up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic - last 12 weeks or longer.

Symptoms

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

For non-specific pain, the following signs are characteristic:

• pain or pulling pain, sometimes tightness;
• increases with the load or movements of the spine, as well as in certain positions, can be reduced during kneading or rubbing the muscles, as well as after resting in a comfortable position;
• possible pain in the sides of the back or pain in the back;
• when defined test, compression, changes in contours, tension, but no disturbances in sensitivity in the painful area, a decrease in muscle strength, reflexes do not change.

When the nerve root is compressed (radiculopathy), the pain changes in its intensity, may be shooting, often radiates to the legs, and in the limbs may be stronger than in the back. During the examination, symptoms of damage to a specific nerve root are noticed - muscle weakness, impaired sensitivity in a certain area.

Diagnosing

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

Severe pain

To determine treatment tactics, the doctor should, if possible, determine the cause of the pain syndrome: embedded nerves or their roots, trauma, tumor, inflammation, infection, osteoporosis, diseases of internal organs, etc. As a rule, these types of pain have quite vivid and specific clinical manifestations. After examination and touch, patients are referred to the 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 additional research.

Chronic pain

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

For pain syndrome that 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 follow 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 pain syndrome;
2. exclude the rest of the bed and recommend maintaining normal activity;
3. prescribe effective treatment of drugs and non-drugs;
4. monitor dynamics and adjust therapy.

When choosing a drug, attention is paid to its analgesic effect, speed of action and safety. First of all, nonspecific anti-inflammatory drugs (NSAIDs) are prescribed, as their effectiveness has been proven for back pain. One such drug is naproxen.

Naproxen is available as an oral tablet and a gel for external use. The drug is indicated as a painkiller for back pain associated with trauma, overload, inflammation. It also 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 considerable 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 pain intensity, it is possible to prescribe other groups of sedatives and tranquilizers (sedatives).

Non-drug treatments include:

• heating;
• manual 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, then local therapy is used - blockade, intradiscal impacts and other procedures. For the rest of the patients, such a 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 in acute pain, medications from the NSAID group are prescribed, including naproxen, other analgesics, muscle relaxants, and vitamin B3. Antidepressants are recommended as needed. Manual therapy should be performed by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic methods of treatment are used.

Prophylaxis

To prevent dorsalgia, it is necessary to identify all possible risk factors and work to eliminate them.

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

• proper physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• maintaining a physiological posture at work;
• quitting smoking and alcohol;
• regular preventive examinations;
• adequate treatment and prevention of infections;
• Balanced diet;
• wearing comfortable shoes and clothes;
• accurate organization of workplace and life to protect the back;
• stress prevention 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 disability and prevent the transition to a chronic form of the disease.