According to the statistics, 70-80% of the population of our country at least once in their life collides with the back pain in the lumbar region, or, to put it in medical language, pain in the lower back. Its prevalence in the united kingdom was 59%, Denmark 70%, in Finland 75%. Between all issued "hospital" in our third country in cases of back pain.
Causes of back pain can be very different from psychogenic factors in cancer metastasis. Fortunately, serious illnesses, and not more than 5% of cases of pain in the lower back, the main reason — overvoltage or muscle spasm and other problems of the musculoskeletal system.
The types of back pain in the lumbar region
The pain in the back, as in any other organ, which is diverse. Most often it is the pain — the first sign that the doctor may make assumptions about the nature of the disease.
In the origin of the back pain can be:
- primary — this is called chronic functional or degenerative changes in the tissues of the spine and of the muscles, sometimes, with the full involvement of adjacent structures — of the roots of the spinal nerves.
- secondary — caused by injury, inflammation, arthritis or osteoarthritis of the intervertebral, the defeat of the internal organs.
Duration of the pain can be:
- acute — occurs because of a new corruption or re sort of pathological condition, is inextricably linked to him, lasts up to 6 weeks;
- subacute — lasts for 6-12 weeks;
- chronic — duration more than 12 weeks.
Typical clinical manifestations depend on the source of pain.
Muscle-tonic and other pain syndromes
Hypothermia, constant uncomfortable posture during work or relaxation, the errors from incorrect motor stereotypes, degenerative diseases of the spine, change the height and elasticity of intervertebral discs, lead to the fact that the load on the muscles is distributed non-uniformly. Some of them become overloaded, which, on the contrary, you do not get the amount of work required. Accordingly, in some muscles starts to spasm, the caller's pain. Appear the so-called trigger points, the impact that strengthens cramps and soreness. The specific characteristics of the pain:
- clearly limited the plot (local pain);
- feels deep in the muscle layer;
- in the muscle, discoverable tight plot or additives, which found it particularly painful points;
- if exposed on these points the pain is greatly amplified, forcing the patient to shiver (a symptom of jump);
- limitation of mobility;
- if you can stretch the muscle — the pain decreases.
On this type of pain is perfectly valid ointments that heat up or popular services. However, their effect is of short duration, because the cause which causes a muscle spasm, they do not eliminate it. The most reliable method of injection of the analgesic medication directly into the start point, and also the therapeutic exercise, physiotherapy, manual therapy.
Compression radiculopathy
Caused compression or stretching of the spinal nerve roots due to a herniated disc or the reduction of its height and, accordingly, the distance between the vertebrae. This pain often feels like "surface" that is spreading more into the skin, and deep tissue. Is greatly enhanced when you sneeze, you cough, the load on the spine. This pain feels like the classic "back pain", giving the movement the nerve root.
Canal stenosis
Occurs due to disc herniation, protrusion (protrusion) into the spinal canal or the appearance of seizure — detached disk. However, squeezed into the formation under the name of "horse-tail" — the roots of lower spinal nerves, which Innervate the lower limbs. The pain when this extends along the stroke of the root of the nerve, from the waist to the foot, appears and in peace, and when you walk, increases with spine extension and decreases when you lean forward.
Particular syndrome
It is called pathology, small intervertebral (the joints of facets). The pain may be local, but also radiate (give) in the groin, the tailbone, the back of the thigh. Intensifies when bending and back wheel.
All of these types of pain syndrome appear to be marked, sometimes the patient may also say, on which day, and after an impact (which is raised, not so he turned, and so on). The pain intensified in the evening and after physical activity, decreases after rest. Often this type of pain is typical for middle-aged people and the elderly.
Inflammatory pain
Caused the defeat of the joints of the vertebral column — the different types of arthritis: rheumatoid, Reiter's disease, ankylosing spondylitis, etc Inflammatory pain occurs more frequently in people relatively young, it gradually develops. She is maximum at the beginning of the day and decreases at night, or after physical activity. Often accompanied by morning stiffness.
Other possible causes of lower back pain — the pathology of internal organs, such as kidney stones, or inflammation of the adnexa in women. Since many diseases can manifest themselves in a similar way, at least as far as the pain, it is better not to make diagnoses and to consult with the doctor.
Immediate consultation of a specialist is necessary in cases where:
- the pain appeared after the injury, especially in older women;
- in history we are the cancer;
- the pain is accompanied by an increase of the temperature;
- sharply and for no apparent reason loss of weight;
- change the pace or lose the legs;
- appear difficulty during urination and defecation.
These signs may be the manifestation of serious diseases that require immediate treatment.
The diagnosis of pathology
For the back pain and the lumbar area doctor, first of all, it is necessary to exclude hazardous to the life of the state, fortunately, are quite rare.
Common and biochemical analysis of blood able to identify the inflammatory changes, to detect a high level of calcium, a characteristic of the metastasis of malignant tumors in bony structures, change the number of blood cells multiple myeloma of the disease, and so on. Men in age may assign the analysis of the prostate-specific antigen for the elimination of a possible prostate cancer.
X-ray examination, detects the change of height of the intervertebral disc and possible osteophytes — proliferation of the bone, caused properly distributed, the load on the vertebrae, the shape change of the same vertebrae.
Computerized tomography and magnetic RESONANCE imaging will show the protruding intervertebral disc calcification (areas of calcification), stenosis of the spinal canal.
Today is the turn of these two studies gradually is ULTRASOUND of the spine, which helps to detect similar changes, without exposing the patient to excess radiation load.
You need to consult a neurologist, according to the testimony of a chiropractor.
After a complete examination, it becomes clear the treatment strategy. As a general rule, to deal with the back pain can be therapeutic techniques, is indicated surgery relatively rare.
The pharmacological treatment of pain in the lumbar area of the back
In 95% of cases, the patient has no reason to worry — usually the back pain is not a threat to the health and may be treatable. The myofascial syndrome is adjusted faster to resolve radicular pain may require several months. In one way or another, in most of the cases is required medical treatment. Use nonsteroidal anti-inflammatory drugs (NSAIDS) to relieve pain and reduce swelling, medicines to maintain the intervertebral cartilage. Sometimes, in order to reduce the pain and oedema prescribed hormonal drugs — act more quickly on anti-inflammatory drugs, their administered in the form of blocks and intravenous infusion under the supervision of a doctor.
The drugs can be in the form of ointments and gels — this method of treatment of back pain popular spot. But as a method of introduction into the body of the active substance, the use of external funds — the another was must, that it is possible to predict, because the most part of means also does not penetrate through the skin.
Another popular method — oral intake of drugs, or, more simply, tablets and capsules. The pill is not difficult, the effect occurs quite quickly — usually within half an hour-an hour, but the long-term use of drugs can affect the degree of the gastro-intestinal tract.
Therefore, the method more quickly and more effectively to relieve the pain — injection directly into the muscle or the affected area back, the so-called block. Their only flaw — a requirement hard for high qualified doctor who will perform this manipulation.
Drug therapy
Usually the medicinal treatment is completed methods of drug-free. Which physiotherapy need, decides the doctor. This may be the classic massage or manipulative therapy, and osteopathic procedures, as well as acupuncture. Is gaining popularity, and therapeutic exercise — special exercises in the form of special lessons in decompression simulators that help to relieve tense muscles, to train the new motor stereotypes, thus eliminating the cause of back pain.
So, the best option therapy of pain in the back — a combination of medication technical and non-drug approach. Such a complex work in several directions allows to cope quickly with the disease, to eliminate the pain completely or to get a long-lasting effect.