Lower back painindicates disease or damage to the spinal space, nerve structure, soft tissues, internal organs, it is observed in a state of fever of various origins. It can be acute, dull, persistent, periodic, burning, shooting, bursting. Sometimes it is associated with physical activity, weather changes. The pathology indicated by back pain is diagnosed based on complaints, anamnesis, examination data and additional studies: radiography, MRI, CT. Before a diagnosis is made, rest is required, sometimes allowed to use ointments, and take analgesics.
Why does the lower back hurt
Spinal cord disease
Congenital anomalies and diseases acquired from the spine are common causes of back pain. The nature of the pain syndrome varies. Pain caused directly by pathological processes, more often periodic, localized, painful or attractive, associated with weather, physical exercise, and being in an uncomfortable position.
Due to muscle spasms, lumbago (lumbago) occurs - sharp pain accompanied by restriction of movement. With many spinal pathologies, lumboischialgia is observed - pain, burning sensation or shooting pain in the lower back, radiating in the back of the thighs. Painful sensations are often found in the composition of radicular syndrome. They can be detected in the following diseases of the spine:
- Degenerative pathology: osteochondrosis, protrusion of the intervertebral disc, intervertebral hernia, spondylosis, spondyloarthrosis.
- Congenital anomalies: sacralization, lumbarization.
- Polyethylological conditions: spondylolysis, spondylolisthesis.
- Vascular disease: cerebrospinal circulatory disorders.
- Other diseases: Diseases of the forest.
- Secondary lesions of nerve structures: lumbosacral sciatica, lumbosacral plexitis, myelopathy of various origins.
Slight or moderate pain is observed in all types of curvature of the spinal space, which is associated with redistribution of non-physiological loads, muscle and ligament tension. Pain appears due to uncomfortable body position, sleeping on a bed that is too hard or too soft. Symptoms are accompanied by:
- back syndrome.
Pulling or pain in the lumbar and thoracic spine has long been the only symptom of osteoporosis. Pain syndrome is expressed slightly, increasing after exercise, before changing weather conditions. The symptoms are observed with the following types of osteoporosis:
Similar pain is detected in patients with secondary form pathology caused by genetic diseases, endocrine disorders, chronic intoxication, taking certain medications. Secondary osteoporosis can also occur against the background of malabsorption syndrome, liver disease, chronic renal failure, rheumatoid arthritis, SLE.
Increased pain, increase in pain duration may be associated with the development of pathological fractures. Other signs of injury are often unspeakable, so fractures are often undiagnosed.
The most common injury is the spread of the spinal canal. In mild cases, the pathology is manifested by moderate pain in the lower back, exacerbated by movement, local edema, and sometimes hematoma and bleeding. In severe bruising, neurological disorders are added to the listed symptoms.
Compression fractures of the lumbar spine occur as a result of forced stinging. It is characterized by sharp pain, shortness of breath at the time of injury. Then there is an increase in pain when rotating the body, soft tissue edema is revealed. Palpation is a painful rotation process. Other possible cracks include damage to the arch, transverse process, rotating process.
In addition, lower back pain is found in patients with spondylolisthesis trauma and vertebral subluxation. Paroxysmal painful sensation, reminiscent of lumbago, accompanied by heaviness and numbness in the lower part of the foot.
Soft tissue and kidney injuries
Soft tissue contraction is accompanied by small or moderate local pain that quickly subsides, with slight edema. Bleeding is possible. There is no blood stains in the urine. Kidney disease is characterized by short-term pain and hematuria. With kidney injuries of moderate severity, the pain syndrome feels intense, pain radiating to the lower abdomen, groin, and genitals. In the lumbar region, hematomas can be seen. In severe cases, there is severe pain, prolonged gross hematuria. Shock conditions develop.
Spinal and spinal cord infections
Osteomyelitis of the spine can be hematogenous, post-traumatic, contact, after surgery. The acute form of the disease is manifested by rapidly developing back pain, combined with chills, fever, intoxication syndrome, and deterioration of general condition. The pain is wrinkled, ruptured, so strong that it impedes any movement, forcing the patient to freeze in bed. In chronic osteomyelitis, manifestations are launched, fistulous ducts with purulent discharge are formed.
Tuberculosis of the spine develops gradually. Initially, there is periodic deep pain that increases after exercise, increasing skin sensitivity in the projected vertebrae. Walking stiffness is formed. Against the background of significant destruction of bone structure, the nature of the pain changes, as it is caused by compression of the nerve root. The pain becomes burning, radiating to the feet, coupled with paresthesia, numbness.
In patients with spinal epidural abscess, severe pain, deep, diffuse, combined with chills, hyperthermia, muscle tension. Tapping the painful process of rotation of the vertebrae. With the development of pathology, radicular syndrome occurs, then paresis, disruption of pelvic organ activity develops.
Local inflammatory process
Purulent processes in the superficial and perirenal tissues are accompanied by intense pain in the lower back. Possible causes of pain are boils, carbuncles and paranephritis.
In the first two cases, the abscess forms on the skin, appearing like a limited, sharp bump with a diameter of 1 cm or more than a purple or purple-cyanotic color with one or more stems in the middle. The pain increases rapidly, becoming wrinkled, throbbing, and lack of sleep. General hyperthermia, slight or moderate violations of the general condition are observed.
With paranephritis, severe fever occurs at first. Pain syndrome develops in 2-3 days. The pain is very intense, can be given to the stomach or hypochondrium, exacerbated by walking, movement, deep breathing. In some forms of paranephritis, due to pain, the patient takes a forced position. Lumbar muscles tense. Expresses edema, local hyperemia, hyperthermia. The situation is serious.
Painful lower back pain, causing a desire to change body position, is a characteristic of acute infections accompanied by fever and intoxication syndrome. In most cases, it is caused by myositis, often combined with pain in the muscles of the limbs. Observed with flu, sore throat, ARVI. Sometimes the pain is caused by kidney damage. Infectious diseases accompanied by pain in the lumbar region include:
- dengue fever;
- Japanese mosquito encephalitis;
- Ebola Fever;
- foot and mouth disease;
- severe form of coronavirus infection;
- forms of bacterial, fungal, viral infections in general.
In some patients, lower back pain is observed during cytokine storms - an inflammatory reaction that develops against a background of severe infectious disease. Epidemiological myalgia is accompanied by intense paroxysmal pain for up to 10 minutes, appearing not only in the lower back, but also in the other back, in the abdominal wall area, chest, and legs. Repeat at intervals of 30-60 minutes. Combined with rhinitis, conjunctivitis, severe hyperthermia.
Other muscle lesions
Painful pain in the muscles of the lumbar region is determined after intense physical exercise - doing strength exercises for the back muscles, prolonged in a forced state with a tense lower back. Myalgia subsides at rest, increases with movement, weakens after warming, gentle warming, disappears after a few days.
Myositis develops not only in infectious diseases, but also after hypothermia or excessive, with a background of exogenous poisoning, metabolic disorders. They are accompanied by prolonged pain. There are also special forms of myositis:
- specific infectious myositis in syphilis and tuberculosis;
- idiopathic dermatomyositis, adolescence and polymyositis;
- polymyositis and dermatomyositis in oncological pathology, systemic diseases of connective tissue.
Chronic diffuse pain throughout the body, including the lower back, occurs with fibromyalgia. Combined with sleep disorders, asthenia, neurotic disorders.
In addition to the pathologies listed, back pain can be interrupted in conditions such as:
- Tumors of the spine, spinal cord: sarcoma, hemangioma, metastasis, intramedullary and extramedullary neoplasms of the spinal cord.
- Kidney disease: pielonefritis, glomerulonephritis, urolitiasis, renal infarction, renal vein thrombosis, renal cysts, kidney cancer, purulent processes.
- Hereditary diseases: Pierre-Marie hereditary cerebellar ataxia.
- Exogenous poisoning: abuse of phenylpropanolamine.
- Pathology of the heart and blood vessels: Leffler endocarditis, abdominal aortic aneurysm.
- Emergency: blood travel shock.
In small pelvic pain, sometimes the pain syndrome radiates to the lower back. The onset of symptoms may be accompanied by a number of female diseases, prostate cancer, proctitis, sigmoiditis.
Primary diagnosis is performed by an orthopedic traumatologist. If there are neurological symptoms, the patient is examined by a neurologist. The doctor interviews the patient, performs an objective examination. According to the instructions, consult a surgeon, rheumatologist, urologist, and other specialists. Diagnostic programs may include:
- Neurological examination.During the examination, the specialist assesses reflexes, muscle strength, coordination of movements, deep and shallow sensitivity.
- Radiography.X-rays of the lumbar spine indicate fractures, decreased intervertebral disc height, other degenerative changes, mass, signs of inflammation, spondylolisthesis. If necessary, standard radiographs are equipped with functional examinations.
- Other neuroimaging techniques. CT and MRI are used to clarify X-ray data. Computed tomography examines the structure of the solid structure in detail, MRI examines the condition of the ligaments and intervertebral discs. To exclude stenosis, myelography is performed.
- Functional study. Muscle conditions and nerve conduction were assessed using electromyography, electroneurography, and evoked potential studies.
- Laboratory analysis. To confirm the infectious nature of the disease, pathogen determination, blood tests and microbiological research are performed. Serological tests are used to detect nerve infections.
According to the instructions, ultrasound of the kidneys, prostate, pelvic organs, urinalysis, abdominal aortic ultrasound, and other studies were performed.
Back Pain Treatment
In the event of a traumatic spine injury, the patient must be placed in a shield and immediately taken to a medical facility. If the pain is not traumatic, the load on the back should be reduced, body position should be optimized while working and resting. Acute pain syndrome is an indication to consult a neurologist.
One dose of analgesic can be done until a specialist examination. With lumbago, lumboischialgia caused by a previously diagnosed spinal degenerative disease, it is permissible to use local warming and analgesic drugs. If infectious processes are suspected, local medications are not indicated.
Physiotherapy and drug therapy are the basis of treatment. The patient is given a mode of protection. The following methods are used:
- NSAID. Effective for acute and chronic pain in muscles and spine. Used in tablet form, topical agent.
- Neurotropic vitamins. Patients are injected with group B vitamins, which enhance the effects of other group drugs, helping to reduce pain.
- Local Anesthetics. For persistent and acute pain, restriction of therapy with anesthetics is performed. To improve treatment outcomes, painkillers are combined with glucocorticosteroids.
- Physiotherapy. Ultrasound, magnetotherapy, percutaneous electrical stimulation, laser therapy, and drug electrophoresis are used. Maybe massage appointments, manual therapy, acupuncture.
Taking into account the specificity of pathology, the following surgical interventions are performed:
- Instability: inter-body unity, transpedicular fixation, plate mounting
- Tumors, osteoporosis, osteomyelitis, tuberculosis: sequestrectomy, vertebroplasty, kyphoplasty, corporectomy.
- Intervertebral hernia: discectomy, microdiscectomy, nucleoplasty.
- Spinal cord narrowing: laminectomy, facetectomy, puncture disc compression.
In the postoperative period, analgesics, antibiotics are prescribed. Rehabilitation activities include exercise therapy, massage, physiotherapy.