Lower back pain is one of the most common reasons for a patient to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be permanently crippling, making movement and self-care impossible. Acute low back pain affects both men and women. With higher frequency in people of middle and older age, lower back pain can often be seen in adolescents and young adults. This is due to rapid growth, weakness of the fragile muscles of the lower back, injuries. So, pain in the lumbosacral spine is the most pressing problem that anyone can face.
<1_img_centerxx>Possible causes of back pain in the lumbar region
Pain in the lumbosacral spine can be associated with processes occurring both in the spine itself and outside of it.. . . Consider the main pathological conditions in which acute lower back pain can be observed.
- The most common problem and cause of pain is lumbosacral osteochondrosis. . . It is caused by age-related involutive changes in the spine, dystrophy (malnutrition) of the corresponding segments of the spine and cartilage, and a decrease in the height of the vertebrae. These pathological processes lead to bone growth and damage to the nerve roots at the site of the narrowing. As a result, severe pain develops in the lumbosacral back (spine). Osteochondrosis of the lumbosacral region develops much more often in obese people, as well as in patients who have undergone prolonged physical exertion, contributing to the wear and tear of all structures of the vertebra. Frequent injuries, falls on the back, weight bearing and concomitant osteoporosis worsen the picture and the course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (causing muscle tension) and ligaments in the process.
- Just as rare is a herniated disc, the clinical manifestation of which is pain in the lumbosacral back. The intervertebral disc (inner nucleus pulposus) with prolonged traumatic exposure, as well as with age, loses its elastic properties and elastic capacity. With continuous exposure (overweight, trauma, progressive osteoporosis), the fibrous ring of the disc becomes thinner and defects form in it. Through these weak points of the annulus fibrosus, the nucleus pulposus of the disc can move and even protrude.
A herniated disc is formed when the annulus fibrosus ruptures and the nucleus pulposus compresses parts of the nerve roots leaving the spinal cord. The compression leads to the fact that the pain in the lumbar region becomes extremely intense, sometimes unbearable. Pain in the lumbosacral spine with herniated disc may be accompanied by sensory disturbances and various types of numbness in the corresponding decompression segments (compression). Low back pain radiates (gives) to the lower limb, causing muscle tension due to a spasm. With a prolonged course, a herniated disc causes chronic pain in the lumbosacral region. Muscle tension in the back, being constant, further increases the pain syndrome, making it chronic.
- Spinal stenosis (narrowing)- Lumbosacral back pain is noted in connection with prolonged walking or physical exertion. Acute lower back pain may be accompanied by weakness in the legs, seizure symptoms in the lower back and buttocks muscles. With significant damage, there may be disturbances in sensory functions.
- Tumor lesion of lumbosacral vertebrae segmentsoften manifests itself with varying degrees of severity of pain in the lumbar region. Typically, lower back pain tends to get worse as the process progresses. The nature of the tumor lesion can be both benign (spinal cysts) and malignant (a tumor of the spine, or metastatic lesion by a tumor located at a distance). By its morphological nature, the tumor can be an osteosarcoma, a hemangioma, or develop following a myeloma. Pain in the lumbosacral region with this pathology often bothers the patient both day and night (constantly, without slight gaps), increasing at rest, with jerking, tapping. Lower back pain is accompanied by muscle tension, cramps, sensory disturbances, weight loss, changes in the blood (anemia).
- Osteoporosis (bone loss)- quite often it is the cause of pain in the bones of various locations. Osteoporosis develops as a result of the accelerated excretion of calcium from the bones, as a result of which all the bones become brittle, prone to fractures with little mechanical stress (often of a household nature). Pain in the lumbosacral back in osteoporosis is associated with other bone pain and has a moderate degree of pain syndrome. Pain in the lumbar region can cause muscle tension, cramping, often associated with a decrease in the size of the patient. The most common type of osteoporosis is postmenopause, which develops in women after ovarian function has ceased.
- Ankylosing spondylitisoften, with pain throughout the spine, is characterized by pain in the lumbar region and ileosacral joint. The disease over time leads to stiffness of the spine and the involvement of other peripheral joints in the chronic process.
In addition to these conditions, pain in the lumbar region may be due to the following reasons not associated with vertebrogenic defects:
- kidney disease, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis of the kidneys, neoplastic diseases of the kidneys and metastases of tumors to the kidney. At the same time, the pain in the lumbar region is localized a little higher (instead of the projection of the kidneys), the pain in the lumbosacral region is not very typical. Pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urinalysis, temperature reaction);
- diseases of the upper floor of the digestive tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) at a certain location sometimes manifested by pain in the lumbosacral region. But back pain is not associated with movements, it can be associated with other complaints (vomiting, stool disorders, nausea, burning along the esophagus);
- sharp back pain, in some cases, may occurfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (cancer of the uterus), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during menstruation, or just before. During pregnancy, there may also be heaviness and pain in the lumbar region and the sacrum;
- deforming osteoarthritis of the hip joint(coxarthrosis), especially with an exacerbation of the process, in addition to gait disturbances, difficulty in walking, it can cause pain in the lumbosacral region, in the muscles of the gluteal region on the corresponding side of theinjury, tension in the muscles of the lower back and buttocks.
Acute low back pain: what to do?
If the patient suffers from acute back pain in the lumbar region, it is necessary to immediately seek help from a qualified specialist to diagnose the cause of the pain that has arisen. Most often, the patient goes to a neurologist, where, after a proper diagnosis (X-ray examination, computed tomography, MRI) and neurological examination, he is diagnosed with a disease of the spine.
In the absence of evidence for the pathology of the spine (osteochondrosis, herniated disc), additional methods (ultrasound imaging of internal organs, densitometry, pelvic ultrasound) and consultations of related specialists (oncologist, gynecologist, endocrinologist) maybe necessary.
Treatment of back pain in the lumbar region
Acute low back pain, prescribed by a doctor, is stopped by nonsteroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxants, rest, bed rest, applications of anti-inflammatory ointments, the imposition of compresses. Treatment in the acute phase can be carried out in a stationary environment or in a polyclinic.
Prescribing drugs that improve microcirculation, with acute back pain, blockage is used. Sometimes, with the ineffectiveness of other types of therapeutic effects, they resort to surgical treatment (with compression of the nerve roots). When combined with osteoarthritis, chondroprotectors have been used for a long time, in osteoporosis - preparations of calcium and vitamin D3. Physiotherapeutic effects (provided that there are no contraindications), physiotherapy exercises and at the stage of rehabilitation - follow-up treatment in sanatoria can be used.