Backache

Back pain (synonymous with dorsalgia) is one of the most common reasons for visiting a doctor - the second after acute respiratory illness1. Often, such complaints occur to neurologists, therapists or general practitioners. According to an international study, from 19 to 43% of the adult population surveyed recently, showed pain in the back in the last 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 inhabitant of our planet can experience severe back pain during this time. Their most common localizations are 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 - related to spinal pathology:
   • intervertebral disc pathology, including hernias;
   • narrowing of the spinal canal;
   • joint disease;
   • as a result of injury;
   • congenital malformations and developmental anomalies;
   • metabolic disorders;
   • spondylitis - an inflammatory process of the intervertebral joints.
2. Nonvertebrogenic - not related to spinal space pathology:
   • ligament and muscle sprains associated with heavy loads;
   • myofascial syndrome - chronic muscle pain;
   • inflammation of muscle tissue - myositis;
   • diseases of internal organs;
   • large vessel pathology, for example, aneurysm (sharp development) of the abdominal aorta;
   • arthrosis of the hip joint - inflammatory -dystrophic disease;
   • mental disorders, etc.

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

• Special- associated with specific diseases that can be detected by standard screening methods. This type requires up to 3% 1 of all cases. These can be vertebral fractures, tumors, infectious processes, diseases of the pelvic organs (especially with back pain in women).

  At the same time, there are a number of specific symptoms, called "red flags", which speak of a serious illness and require in -depth examination. This includes:

  • rapid and unreasonable weight loss and / or indications of a history of oncopathology (tumor);
  • weakness in the lower legs, disturbances of sensitivity and function of the pelvic organs (cauda equina syndrome);
  • use of antibiotic therapy, increase in body temperature (infectious process);
  • previous trauma or previous diagnosis of osteoporosis, older than 55 years (vertebral fracture);
  • young age - up to 20 years;
  • long -term preservation of painful sensations and their intensity, even undergoing treatment;
  • combined with general weakness or with walking disturbances, worsens at night, does not change with changes in body position.
• Radicular- next in frequency (up to 27%). It develops as a result of pinching and / or inflammation of the spinal cord roots, which exit through the openings of the spinal space. This type may be indicated by increased pain when coughing, sneezing, physical exercise and other types of activity.
• Not specific- more often acute, it is difficult to immediately determine the specific cause of its development, usually as a result of dystrophic changes in the bones, cartilage tissue of the spine, as well as the muscles and ligaments that form the back support device. In the International Classification of Diseases (ICD -10), there is a special section for the definition of the syndrome - dorsopathy.

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

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

Localization distinguishes:

What is the name	Where it hurts
cervicalgia	pain in the neck
cervicocranilagia	neck + head
cervicobrachialgia	neck and give into the hand
thoraxalgia	pain in the back and thoracic chest, pain under the shoulder blades from behind
lumbodynia	lower back and lumbosacral
sciatica	lower back + legs
sacralgia	sacrum
coccygodynia	coccyx

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

• severe physical exertion, resulting in extreme muscle and ligament;
• uncomfortable or static posture taken by a person for a long time;
• untrained muscles and their excesses, inactive;
• trauma and microtrauma;
• hypothermia;
• non -prolonged movements, such as bed rest;
• alcohol abuse;
• diseases of internal organs;
• joint pathology;
• overweight;
• individual characteristics: curvature of the spine, squatting;
• poor nutrition, diseases of the digestive system, which may be accompanied by disorders of vitamin absorption, mineral metabolism, significant salt intake affecting the joints;
• occupational hazards: thermal effects, temperature fluctuations, vibration, heavy work, etc.

The mechanism of dorsalgia expansion is associated with intervertebral joint restriction, which can be caused by loads, both static and dynamic, microtrauma and non -physiological postures. As a result, in one place the muscles experience cramps and exaggeration, and in other places they inflate excessively. 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 spinal pathology or disease of internal organs. In this case, it is seen as a defensive reaction, but at the same time, it starts a new cycle of pain. In addition, with the maintenance of prolonged spasms, the transmission of nerve impulses to muscle fibers is disrupted, they become more exhilarating, calcium deficiency can occur, and circulatory disorders worsen the condition.

According to the duration of dorsalgia, there are:

• 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 the corresponding disease.

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

• aching or pulling pain, sometimes tightening;
• increased with load or movement 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 back of the back or pain in the lower back;
• when probing, compaction, contour changes, tension are determined, but there is no disturbance of sensitivity in the painful area, decrease in muscle strength, reflexes do not change.

When the nerve root is pressed (radiculopathy), the pain varies in intensity, can shoot, often radiates to the legs, and in the limbs it can be stronger than in the back. During the examination, symptoms of damage to certain nerve roots are observed - muscle weakness, disturbances of sensitivity in certain areas.

Diagnostics

Diagnostic algorithms for acute and chronic dorsalgia are quite different.

Sharp pain

To determine the tactics of treatment, the doctor should, if possible, determine the cause of the pain syndrome: pinched nerve or its root, trauma, tumor, inflammation, infection, osteoporosis, disease of internal organs, etc. As a rule, this type of pain has clear and specific clinical manifestations. After examination and palpation, the patient is referred to the appropriate specialist or for further examination, for example:

• X-ray examination;
• MRI and CT of the spine;
• scintigraphy - a method of visualization using the identification of contrast agents;
• 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 require additional research.

Chronic pain

Since the mechanisms of its development have not been sufficiently studied, it can be problematic to identify its source, especially if the species is dysfunctional 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. However, patient interviews and examinations were conducted thoroughly to determine further treatment tactics.

For pain syndromes that occur against the background of dystrophic changes in the joints, after mechanical stress or under the influence of other factors, it is possible to use magnetic resonance imaging to detect the dynamics of spinal conditions.

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 bed rest and recommend to maintain normal activities;
3. prescribing effective drug and non -drug treatment;
4. monitor dynamics and adjust therapy.

When choosing a drug, attention is paid to its analgesic effect, speed of action and its 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 oral tablets and gels for external use. This drug is indicated as a pain reliever for back pain associated with trauma, overuse, inflammation. It also has anti-inflammatory and antipyretic effects, the duration of its effect can last up to 12 hours. If you do not have the opportunity to immediately see a doctor, 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. Entrance without consulting a doctor is not more than 5 days.

While maintaining the intensity of the pain, it is possible to prescribe painkillers and other sedatives (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 the pain impulse can be identified, then local therapy is used - blockade, intradiscal influence and other procedures. For other patients, treatments such as back and lower back pain were not used, so different treatment methods were used. The main goal is to reduce pain intensity 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 treatment methods were used.

Prophylaxis

For the prevention of 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:

• adequate physical activity and muscle strengthening, including the back;
• timely treatment of chronic diseases of internal organs;
• maintain physiological posture while working;
• quit smoking and alcohol;
• periodic preventive inspections;
• adequate treatment and prevention of infection;
• balanced diet;
• wear comfortable shoes and clothing;
• proper workplace and life organization to protect the back;
• prevention of stress and emotional burden.

Comprehensive treatment and full recovery of back pain patients 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.