Back pain: treatment, causes and characteristics

Back pain, a symptom of a large group of diseases and pathological conditions with similar manifestations, is one of the most pressing problems in modern healthcare, and its treatment is a difficult task.

While pain can occur anywhere in the spine, the most common location is the low back — with a prevalence of 76 percent among adults, according to researchers.

According to statistics, within 1 year, about 80% of people complain of at least one episode of lower back pain, and within the next 12 months, 75% of people will experience a recurrence of the pain syndrome.

Types and manifestations of pain syndromes

Depending on the part of the back affected, pain syndromes are classified as neck pain, mid-back pain (chest pain), lower back pain (lumbar pain), or coccyx pain (coccyx or sacrum pain).

According to the results of a study involving 46,000 volunteers from several European countries, 24% of the population suffered from chronic pain in various parts of the spine, 18% suffered from lower back pain, and 8% suffered from neck pain.
The duration of pain is either acute pain - lasting up to 12 weeks, or chronic pain - more than 12 weeks.

The pain may be dull or stabbing, sometimes burning and stinging.Symptoms of some conditions may also extend to the arms, hands, legs, or feet, depending on the extent of spinal involvement.Numbness or weakness in the upper and lower limbs is another symptom that can accompany back pain.Certain limitations in range of motion or increased pain in certain body positions are also observed in some patients with spinal pain syndromes.

Back Pain: Why Does It Happen?

On examination, it is not always possible to determine the direct cause of back pain, in which case the pain is said to be "nonspecific" or "mechanical."The cause of this pain is pathological changes in the musculoskeletal system, but damage to the cervical, thoracic, lumbar, sacral nerve roots and specific diseases of the spine are not observed - 98% of patients experience this subtype of pain syndrome.Secondary pain caused by underlying disease accounts for approximately 2% of cases.

Nonspecific back pain has the following characteristics:

• The condition tends to improve or worsen depending on the body's position - for example, a patient may feel better while sitting or lying down;
• Pain often worsens with movement;
• Attacks may occur suddenly or gradually increase;
• Sometimes back pain is caused by poor posture or awkwardness when lifting something, but often there is no obvious cause;
• May be caused by a minor injury, such as a sprained ligament or muscle;
• It may occur after stress or overexertion and usually begins to improve within a few weeks.

Risk factors for developing non-specific back pain:

• Heavy physical labor;
• Frequent stooping;
• Lifting heavy objects, especially from an incorrect position;
• sedentary lifestyle;
• Industrial impacts such as vibration;
• Pregnant;
• Age-related changes in the musculoskeletal system.

Acute pain has physiological significance because it indicates the acute impact of an adverse factor.

The most common causes of acute back pain are:

• Injuries to various structures of the spine;
• Spondylolisthesis - displacement of the vertebrae relative to each other;
• Sciatica – Inflammation of the sciatic nerve (the longest and widest nerve in the body), which runs from the lower back to the feet
• Cauda equina syndrome - compression of nerve fibers in the lower part of the spinal canal;
• Intercostal neuralgia - caused by compression or irritation of the nerve roots of the intercostal nerves;

It is important to remember that acute pain marks the onset of disease, whereas chronic pain registers this pathological effect and serves as a reminder that the disease is progressing.

Conditions that may cause chronic back pain include:

• Displacement or prolapse of the intervertebral disc;
• Autoimmune joint diseases such as ankylosing spondylitis (swelling of the joints in the spine);
• Radiculopathy - inflammation and degeneration of nerves from the spinal cord to muscles and joints;
• Arthritis and spinal joints of various origins.

More rarely, back pain may be a sign of a more serious condition, such as:

• infectious processes (e.g., meningitis, tuberculosis);
• Diseases of internal organs (abdominal aortic aneurysm or gynecological pathology);
• Metastasis or certain types of cancer, such as multiple myeloma, a subtype of bone marrow cancer.

Diagnosis of back pain syndrome

To understand how to treat severe back pain, it is recommended to first determine its cause.An accurate diagnosis is key to developing a sound treatment plan.

After carefully examining the patient's complaint, medical history, and the nature of the symptoms, the doctor may order imaging studies and functional tests to confirm the diagnosis.

• Spine X-rayFor detecting degenerative diseases and fractures.
• computed tomographyProvides detailed cross-sectional images of the spine, showing even subtle changes in the bones.
• magnetic resonance imagingShows tissue and bone structure to identify slipped or herniated discs, nerve or spinal cord compression.
• ongoingmyelographyA special biological dye is injected into the area around the spine to better visualize the spinal canal and discs, as well as the condition of the nerve fibers in and around the spine.
• electrodiagnostic testingAllows you to evaluate the electrical activity of nerves in the upper and lower limbs.
• Positron emission scan of boneTumor pathology of bone was first revealed.
• Densitometry - Determine Bone Density - DisplayFor diseases and conditions that cause reduced bone mineral density.

Ways to Fight Back Pain

The complex structure and stage of pathological changes in pain in various parts of the back determine the need for a combination of drug and non-drug treatments.

Evidence-based principles for the treatment of patients with chronic back pain mean:

1. Explain to the patient the cause of pain, usually its benign origin;
2. Ensure adequate daily physical activity levels;
3. Prescribe effective and safe treatments primarily for pain relief;
4. If ineffective after 1-3 months, corrective treatment will be given.

International clinical recommendations from doctors provide a common algorithm for how to treat chronic back pain.The most effective treatments for long-term pain are believed to be nonsteroidal anti-inflammatory drugs (NSAIDs), non-surgical treatments, physical therapy, manual therapy, as well as antidepressants and psychotherapy.

Non-drug treatments for back pain

In most cases, people with back pain will improve within 2-6 weeks.The main goals of non-specific treatment are to reduce movement restrictions and minimize recurrence, and while good physical fitness cannot prevent all episodes of pain, it does help resolve them.

Establishing correct movement stereotypes and physical therapy are important areas for non-pharmacological pain correction.

Non-pharmacological treatment of back pain can be divided into three phases based on duration.

first stage- Passive physiotherapy in the acute phase (6 weeks).

second stage– Active exercise in the subacute phase (6-12 weeks).

The third stage- Rehabilitation physiotherapy effect.

Acute back pain requires only limited time bed rest.

Various physical activities and forms of complementary and alternative medicine can help relieve pain, such as:

1. Non-specific physical exercise such as daily walking, biking, swimming.For simple back pain, regular physical activity and gentle stretching are recommended to improve long-term results.Physical therapy may also be recommended to strengthen the abdominal and spinal muscles;
2. Therapeutic massage is used for short-term pain relief but does not lead to long-term functional improvements;
3. Methods such as acupuncture, manual therapy and spinal traction are used.

Regardless of which conservative treatment method is used, it is important to remember that patients may not experience immediate relief and may experience improvement over several weeks or months.

Medications to Treat Pain

The most common medical treatments for back pain are:

1. Non-steroidal anti-inflammatory drugs and muscle relaxants.
2. Steroid hormone injections into the joint or epidural spaces of the spine can reduce inflammation and pain in the back.However, this treatment is not suitable for long-term use due to the side effects of the drug.

When to use surgery?

While the vast majority of people with back or neck pain recover over time without the need for medications or non-surgical treatments, some patients may require surgery to correct spinal conditions.Generally speaking, patients with spinal pain can undergo surgery if:

• The structural problem has been diagnosed and confirmed with imaging (such as X-ray or MRI);
• Conservative treatments such as physical therapy or medications do not provide adequate pain relief;
• Back pain can be debilitating and prevent you from participating in daily activities or physical activity;
• Symptoms negatively impact physical or emotional health;
• There is objective reason to believe that spinal surgery will be beneficial, substantiated by diagnostic methods;
• Nerve damage occurs.

Prevent back pain

Maintaining a healthy lifestyle is key to preventing back pain.Being overweight can put stress on your back, so it's important to maintain a healthy weight.Regular exercise can strengthen your abdominal and back muscles.Smoking accelerates the aging of blood vessels and many tissues in the body, including the spine, so stopping the use of tobacco-containing products is another step toward a healthy back.Proper posture, workplace ergonomics and avoiding a sedentary lifestyle are effective ways to prevent back pain.