Back pain: treatment, causes and characteristics

Back pain is a symptom of a large group of diseases and pathological conditions with similar manifestations, and one of the most pressing problems of modern health care, and the treatment of 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 lower back pain reaches 76% among the adult population.

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

Types and manifestations of pain syndrome

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

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

The pain may be dull or throbbing, sometimes there is a burning and tingling sensation.Symptoms of some diseases also extend to the arms, hands, legs or feet, depending on the level of spinal involvement.Numbness or weakness in the upper and lower limbs is another option to accompany the manifestations of back pain.A restriction in the range of certain movements or an increase in pain in certain body positions is also seen in some patients with spinal pain syndrome.

Back pain: why does it happen?

During the examination, it is not always possible to determine the direct cause of the back pain, in which case the pain is called “non-specific” or “mechanical”.The cause of this pain is pathological changes in the musculoskeletal system, but no damage to the cervical, thoracic, lumbar and sacral nerve roots or specific diseases of the spine are observed - this subtype of pain syndrome occurs in 98% of patients.Secondary pain due to the underlying disease represents approximately 2% of cases.

Nonspecific back pain has the following characteristics:

• tends to improve or worsen depending on body position – for example, the patient may feel better when sitting or lying down;
• pain often worsens with movement;
• the attack may develop suddenly or intensify gradually;
• Sometimes back pain is the result of poor posture or lifting something awkwardly, but often appears for no apparent reason;
• may be caused by a minor injury, such as a ligament or muscle sprain;
• can occur after stress or overwork and usually begins to improve within a few weeks.

Risk factors for developing non-specific back pain:

• heavy physical labor;
• frequent bending and bending of the body;
• lifting heavy objects, especially from an incorrect position;
• sedentary lifestyle;
• industrial impacts such as vibration;
• pregnancy;
• age-related changes in the musculoskeletal system.

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

The most common causes of acute back pain are:

• injuries 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), running 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 recalls the evolution of a 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 joints of the spine);
• radiculopathy – inflammation and degeneration of the nerves running from the spinal cord to muscles and joints;
• arthritis and osteoarthritis of the vertebral joints of various origins.

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

• infectious processes (eg, 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 in case of severe back pain, it is first necessary to establish the cause.Un diagnostic précis est la clé d’un plan de traitement bien élaboré.

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

• Spinal X-rayused to detect degenerative diseases and fractures.
• CT scanprovides 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 identify herniated discs, pinched nerves or spinal cord.
• When drivingmyelogramsA special biological dye is used and injected into the area around the spine to better visualize the spinal canal and intervertebral discs, as well as the condition of the nerve fibers in and around the spine.
• Electrodiagnostic testsallows you to evaluate the electrical activity of the nerves of the upper and lower limbs.
• Positron emission scan of bonesfirst of all reveals the oncopathology of the bones.
• Densitometry - determination of bone density - illustratedfor diseases and conditions resulting in decreased bone mineral density.

Methods to combat back pain

The complex structure of pain in various parts of the back and the stages of pathological changes dictate the need for a combination of drug and non-drug treatment.

Therapeutic principles for a patient with chronic back pain, based on evidence-based medicine, involve:

1. explain to the patient the causes of the pain and, as a general rule, its benign origin;
2. ensuring sufficient levels of daily physical activity;
3. prescribe effective and safe treatment, primarily to relieve pain;
4. correction of treatment if it is ineffective after 1 to 3 months.

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

Non-drug treatment for back pain

In most cases, a patient suffering from back pain improves within 2 to 6 weeks.The main goal of non-specific treatment is to reduce movement restrictions, minimize relapses and, although good physical fitness cannot prevent all painful episodes, it facilitates the resolution of these episodes.

Development of the correct motor stereotype and physical therapy are important areas of non-pharmacological pain correction.

Depending on the duration, non-drug treatment of back pain can be divided into three phases.

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

Stage II– active exercises during the subacute period (6 to 12 weeks).

Stage III- physiotherapeutic effects of rehabilitation.

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

Various physical activities and 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 are recommended to improve long-term results.Physical therapy may also be recommended to strengthen the abdominal and spinal muscles;
2. therapeutic massage is used to relieve pain in the short term, but does not lead to long-term functional improvement;
3. the use of methods of acupuncture, manual therapy and spinal traction.

Regardless of the method of conservative treatment used, it is important to remember that the patient may not experience immediate relief and that improvement will occur over several weeks or months.

Drug treatment of pain

The most common methods of drug treatment for back pain are:

1. Non-steroidal anti-inflammatories and muscle relaxants.
2. Injections of steroid hormones into the joint socket or epidural space of the spine, which reduces 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 medications.

When is surgical treatment used?

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

• the structural problem has been diagnosed and confirmed by imaging (e.g., X-ray or MRI);
• Conservative treatments such as physiotherapy or medication have failed to provide adequate pain relief;
• back pain is debilitating and prevents you from participating in daily activities or physical activity;
• symptoms negatively affect physical or emotional health;
• there are objective reasons, confirmed by diagnostic methods, to believe that spinal surgery will be beneficial;
• neurological damage occurs.

Preventing back pain

Maintaining a healthy lifestyle is the key to preventing back pain.Excess weight puts pressure 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, particularly contributing to the aging of the spine.Stopping consuming products containing tobacco is therefore another step towards a healthy back.Correct posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.