Low back pain is one of the most common reasons forcing a patient to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be permanently disabling, making movement and self-care impossible. Acute low back pain affects men and women equally often. Most often in middle and old age, low back pain can often be seen in adolescents and young adults. This is due to rapid growth, weakness in the fragile muscles of the lower back, injuries. Therefore, pain in the lumbosacral spine is the most urgent problem that anyone can face.
Possible causes of back pain in the lumbar region
Pain in the lumbosacral spine can be associated with processes that occur both in the spine and outside of it.. . . Consider the main pathological conditions in which acute low 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 growths and nerve root infringement 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 experienced prolonged physical exertion, which contributes to the wear and tear of all structures of the vertebra. Frequent injuries, back falls, weight-bearing, and concomitant osteoporosis aggravate the condition and course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (which cause muscle tension) and ligaments in the process.
- Herniated disc is an equally rare cause, whose clinical manifestation is pain in the lumbosacral back. The intervertebral disc (internal 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 in the annulus fibrosus, the nucleus pulposus of the disc can shift and even protrude.
A herniated disc forms when the annulus fibrosus ruptures and the nucleus pulposus compresses the elements of the nerve roots that exit the spinal cord. Compression leads to the fact that the pain in the lumbar region becomes extremely intense, sometimes unbearable. Lumbosacral spine pain with herniated disc may be accompanied by sensory disturbances and various types of numbness in the corresponding decompression (compression) segments. Low back pain radiates (gives way) to the lower limb, causing muscle tension due to spasm. With a prolonged course, a herniated disc causes chronic pain in the lumbosacral region. The muscular tension in the back, being constant, further increases the pain syndrome, causing it to become chronic.
- Stenosis (narrowing) of the spinal canal- Pain in the lumbosacral back is observed in relation to prolonged walking or physical exertion. Acute low back pain can be accompanied by leg weakness, seizure symptoms in the lumbar and gluteal muscles. With significant damage, there may be disturbances of sensory functions.
- Tumor lesion of the lumbosacral vertebrae segmentsit often manifests itself in varying degrees of severity of pain in the lumbar region. Low back pain generally tends to get worse as the process progresses. The nature of the tumor lesion can be both benign (vertebral cysts) and malignant (a tumor of the spine or metastatic lesions from a tumor located at a distance). By its morphological nature, the tumor can be osteosarcoma, hemangioma, or develop as a result of myeloma. Pain in the lumbosacral region with this pathology often bothers the patient both day and night (constantly, without light gaps), increasing at rest, with tremors, bumps. Low back pain is accompanied by muscle tension, cramps, sensory disturbances, weight loss, changes in the blood (anemia).
- Osteoporosis (loss of bone mass)- 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 bones become brittle, prone to fractures with little mechanical stress (often of a domestic nature). Lumbosacral back pain in osteoporosis is combined with other bone pains, it has a medium degree of pain syndrome. Pain in the lumbar region can lead to muscle tension, cramps, often combined with a decrease in the patient's height. The most common type of osteoporosis is postmenopausal, which develops in women after the extinction of ovarian function.
- Ankylosing spondyloarthritisoften, along with pain throughout the spine, it is characterized by pain in the lumbar region and the ileosacral joint. The disease eventually leads to stiffness in the spine and the involvement of other peripheral joints in the chronic process.
In addition to these conditions, pain in the lower back may be due to the following reasons not associated with vertebrogenic defects:
- diseases of the kidneys, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis of the kidneys, neoplastic diseases of the kidneys and metastasis of tumors in the kidney. At the same time, pain in the lumbar region is localized somewhat higher (in the place of projection of the kidneys), 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) in a certain location sometimes manifest as pain in the lumbosacral region. But back pain is not associated with movements, it can be combined with other discomforts (vomiting, stool alteration, nausea, burning along the esophagus);
- acute back pain, in some cases, can occurfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Low back pain in women sometimes occurs during or just before menstruation. During pregnancy, there may also be heaviness and pain in the lower back and sacrum;
- osteoarthritis deformation of the hip joint(coxarthrosis), especially with an exacerbation of the process, in addition to gait disturbance, difficulty in walking, can give pain in the lumbosacral region, in the area of the muscles of the gluteal region on the corresponding side of the injury, tension in the muscles of the lower back and glutes.
Acute low back pain: what to do?
If the patient has acute back pain in the lumbar region, it is necessary to immediately seek the help of a qualified specialist to diagnose the cause of the pain that has appeared. Most often, the patient goes to a neurologist, where, after proper diagnosis (X-ray examination, CT scan, MRI) and a neurological examination, he is diagnosed with a disease of the spine.
In the absence of convincing data for the pathology of the spine (osteochondrosis, herniated disc), additional methods (ultrasound images of internal organs, densitometry, pelvic ultrasound) and consultations of related specialists (oncologist, gynecologist, endocrinologist) may be required.
Treatment of back pain in the lumbar region.
Acute low back pain, as prescribed by a doctor, is stopped with non-steroidal 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 performed in a stationary environment or in a polyclinic.
Prescribe drugs that improve microcirculation, with acute back pain, blockade is used. Sometimes, due to the ineffectiveness of other types of therapeutic effects, they resort to surgical treatment (with compression of the nerve roots). When combined with osteoarthritis, chondroprotectors are used for a long time, in osteoporosis - calcium and vitamin D3 preparations. Physiotherapeutic effects (provided there are no contraindications), physical therapy exercises, and in the rehabilitation stage, follow-up treatment can be used in sanatoriums.