Low back pain is the most common pain syndrome in outpatient practice.In developed countries, 30-60% of the population suffers from recurrent back pain, and up to 80% of back pain occurs in the lumbar region (behind the waist).All age groups can suffer from low back pain, but the peak incidence occurs between the ages of 30 and 60.
Pain in the lower back due to illness
Back pain is a non-specific symptom that can be caused by many reasons.Doctors distinguish between primary and secondary low back pain syndrome.Most low back pain is based on musculoskeletal morphofunctional changes (primary low back pain syndrome).These are mainly degenerative-dystrophic lesions of the spine:
Possible causes of secondary back pain syndrome:
- Primary and metastatic tumors of the spine, spinal cord, retroperitoneal space.
- Vertebral fractures.
- Infectious lesions of the spine and intervertebral discs (tuberculosis, brucellosis, epidural abscess).
- Non-infectious inflammatory diseases (ankylosing spondylitis, Reiter's syndrome, rheumatoid arthritis).
- Metabolic bone damage (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute spinal blood circulation disorders (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Pains in diseases of the pelvic organs (including renal colic, infectious gynecological diseases such as chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis) are indicated.
Pain in the lower back can also be acute or chronic, and the cause is damage to the spine or nerve roots.Possible transfer of pain from deep structures:
- kidneys;
- pancreas;
- large intestine;
- pelvic organs;
- Retroperitoneal tumors.
Acute pain in the lower back
acute strain.The pain is localized in the area of the long muscles of the back during their spasm, which causes limitation of movement.There is no radiating pain to the groin or lower extremities.
Vertebral fractures.As a rule, this is the result of injury when bending or falling on the legs, but the same result can be without injury or with minimal injury, if the patient has a damaged bone system, osteoporosis, Cushing's syndrome, hyperparathyroidism, myeloma, metastases of malignant tumors in the bones, Paget's disease.
Displacement of the intervertebral discs in the lumbar region.Symptoms of this disease include pain in the lower back, forced body position and restriction of movement.The involvement of nerve roots in the pathological process is indicated by: radicular pain, usually unilateral;sensitivity disorders (paresthesia, hyperesthesia or hypalgesia);Decreased or absent Achilles or knee reflexes.
Facet syndrome.Compression of the root at its exit from the spinal canal causes radicular pain that is not caused by disc damage.Unilateral facet syndrome, most commonly associated with the L5 root, occurs when the upper and lower sides of the intervertebral joint are enlarged, causing narrowing of the intervertebral canal or foramen.
Epidural abscess.Most often found in the thoracic spine, it can be accompanied by sharp pain in the back when palpating or pressing the affected area.Requires rapid diagnosis and initiation of treatment measures, including surgical intervention, if there are signs of spinal cord compression.Pathological processes in the hip joint may be accompanied by pain that radiates to the buttock region and lower limbs at the level of the knee joint.
Chronic back pain
Deformative spondylosis.Spondylosis deformans is a degenerative change in the lumbar vertebrae with the formation of bony spurs that narrow the spinal canal and put pressure on the roots.If lumbosacral pain occurs with neurological symptoms while walking (loss of sensitivity, sensory disturbances or weakness in both lower limbs), there is a suspicion of intermittent claudication syndrome, which is associated with the spine and is caused by narrowing of the spinal canal.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people who have lower back pain that radiates to the hips.First, there is limited mobility and morning stiffness, decreased respiratory movements of the chest, and progressive curvature and flexion of the thoracic spine.X-ray signs: destruction and restructuring of the sacral joints, formation of the so-called "bamboo" spine.Similar symptoms can occur with limited movement in the lower part of the spine:
- psoriatic arthritis;
- Reiter's syndrome;
- Chronic colitis.
Tumors and their metastases, metabolic diseases.Using radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (breast, lung, prostate, thyroid gland, kidney, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;The possibility of these infections should be confirmed or excluded by determination of ESR, bone X-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- Lipoma
The aforementioned tumors can cause chronic pain even before other neurological symptoms appear.Displacement of pain in the lower back due to diseases of internal organs.With damage to the organs of the pelvic cavity, the pain is transferred to the sacral region, the organs of the lower abdominal cavity - to the lumbar segments, the upper abdominal cavity - to the lower thoracic and upper lumbar segments.No local symptoms or stiffness in the back;Full range of motion of the back does not increase pain.
treatment
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Back pain sometimes radiates to the leg.In this case, you should immediately consult a neurologist.
Do not delay the visit to the doctor if:
- experience severe back pain for more than 3 days;
- The pain occurred after the injury;
- At the same time, you feel pain in the waist, lower leg and foot;
- Low back pain combined with numbness in the buttocks, thighs, legs, feet and groin.
Back pain is a very common symptom, especially among the elderly.Rheumatism, lumbar osteochondrosis and sciatica - all these diseases cause acute pain in the lower back.Only a proper examination of the body can show the results and give a clear answer to the causes of lower back pain.