Backache

Back pain (synonymous with dorsalgia) is one of the most common reasons for visiting a doctor - the second after acute respiratory diseases1. Most often, such complaints come to a neurologist, therapist or general practitioner. According to international studies, from 19 to 43% of the adult population who have been surveyed recently, noted pain in the back during the last month, from 27 to 65% - in the last year. Those who have experienced this at least once in their life, there are 59-84% 1. Almost every fifth adult inhabitant of our planet can experience severe back pain at this 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 pathology of the spine:
   • pathology of intervertebral discs, including hernias;
   • narrowing of the spinal canal;
   • joint diseases;
   • the consequences of injuries;
   • congenital malformations and developmental anomalies;
   • metabolic disorders;
   • spondylitis - inflammatory processes in the intervertebral joints.
2. Nonvertebrogenic - not associated with pathology of the spinal column:
   • sprains of ligaments and muscles 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 expansion) of the abdominal aorta;
   • arthrosis 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 compression 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 illnesses and require in-depth examination. These include:

  • rapid unreasonable 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);
  • the 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, despite treatment;
  • combined with general weakness or with gait disturbance, aggravated at night, does not change with a change in body position.
• Radicular- next in frequency (up to 27%). It develops as a result of pinching and / or inflammation of the spinal cord root, which exits through the openings of the spinal column. This type may be indicated by increased pain when coughing, sneezing, physical exertion and other types of activity.
• Nonspecific- more often acute, it is difficult to immediately determine the specific cause of its development, it is usually the consequences of dystrophic changes in the bone, cartilaginous tissue of the spine, as well as the muscles and ligaments that make up the supporting apparatus of the back. 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 structures of the spine, any of which can become a source of pain impulses. The pain can be compressive (from compression of the 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 lesions of the spine and paravertebral tissues. This is called dysfunctional pain. It can be caused by psychological problems and chronic stress.

Localization distinguishes:

What is the name of	Where does it hurt
cervicalgia	pain in the neck
cervicocranilagia	neck + head
cervicobrachialgia	neck and gives to the hand
thoracalgia	pain in the thoracic back and chest, pain under the shoulder blades from the back
lumbodynia	lower back and lumbosacral region
sciatica	lower back + leg
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 overload, resulting in overstretching 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 internal organs;
• joint pathology;
• overweight;
• individual characteristics: curvature of the spine, stoop;
• poor nutrition, diseases of the digestive system, which may be accompanied by impaired absorption of vitamins, mineral metabolism, a significant intake of salts that affect the joints;
• occupational hazards: thermal effects, temperature fluctuations, vibration, work with weights, etc.

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

According to the duration of dorsalgia, there can be:

• acute - lasting 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, mechanism of development and the presence of concomitant diseases.

For nonspecific pain, the following signs are characteristic:

• aching or pulling pain, sometimes tightening;
• increases with load or movements of the spine, as well as in certain postures, may decrease when kneading or rubbing muscles, as well as after resting in a comfortable position;
• possible pain in the sides of the back or pain in the back of the back;
• when probing, compaction, changes in contours, tension are determined, however, there are 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 differs in its intensity, can be shooting, often radiates to the leg, and in the limb it can be stronger than in the back. On examination, symptoms of damage to a specific nerve root are observed - muscle weakness, impaired sensitivity in a certain area.

Diagnostics

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

Sharp pain

In order to determine the tactics of treatment, the doctor should, if possible, determine the cause of the pain syndrome: pinched nerves or their roots, trauma, tumor, inflammation, infection, osteoporosis, diseases of internal organs, etc. As a rule, these types of pain have rather vivid and specific clinical manifestations. After examination and palpation, patients are referred to the appropriate specialists or for further examination, for example:

• X-ray examination;
• MRI and CT of the spine;
• scintigraphy - a visualization method 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 can 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 any case, a thorough interview and examination of the patient is carried out 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 track the dynamics of the state of the spine.

How to deal with acute back pain

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

1. inform the patient about the causes of the pain syndrome;
2. exclude bed rest and recommend maintaining the usual activity;
3. prescribe effective drug and non-drug treatment;
4. monitor the dynamics and adjust the therapy.

When choosing a medication, attention is paid to its analgesic effect, speed of action and safety. First of all, nonspecific anti-inflammatory drugs (NSAIDs) are prescribed, since 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 pain reliever 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 do not have the opportunity to visit a doctor soon, 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. The course of admission without consulting a doctor is no longer than 5 days.

While maintaining the intensity of pain, it is possible to prescribe other groups of painkillers and sedatives (sedatives).

Non-drug treatments include:

• warming;
• 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 could be identified, then local therapy is used - blockades, intradiscal influences and other procedures. For the rest of the patients, such treatment for back and lower back pain is not used, so a different treatment regimen is used. Its main goal is to reduce the intensity of pain and preserve the quality of life.

Also, as in acute pain, drugs from the NSAID group are prescribed, including naproxen, other analgesics, muscle relaxants, and B3 vitamins. Antidepressants are recommended as needed. Manual therapy should be carried out by a qualified specialist, exercise therapy is prescribed. Psychotherapeutic and physiotherapeutic methods of treatment are used.

Prevention

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 useful:

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

Comprehensive treatment and full-fledged rehabilitation of patients with back pain allows you to preserve the quality of life, reduce the number of cases of disability and prevent the transition to a chronic form of the disease.