Low back pain is one of the most common reasons for forcing a patient to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be a permanent disability, making it impossible to move and take care of yourself. Acute low back pain affects both men and women equally often. With a greater frequency in middle age and old age, low back pain can often be observed in adolescents and young adults. This is due to rapid growth, weakness in the fragile muscles of the lower back, injuries. Thus, lumbosacral back pain is the most pressing problem that anyone can face.
Possible causes of back pain in the lumbar region
Lumbosacral back pain can be associated with processes that occur both inside and outside the spine. . . 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 inclusive age changes in the spine, dystrophy (malnutrition) of the respective 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 narrowing. As a result, severe pain develops in the lumbosacral spine. Osteochondrosis of the lumbosacral region develops much more often in obese people, as well as in patients who have experienced prolonged physical exertion, contributing to the wear of all vertebral structures. Frequent injuries, falling on the back, carrying weights and accompanying osteoporosis worsen the appearance and 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.
- Disc herniation is an equally rare cause, the clinical manifestation of which is pain in the lumbosacral spine. The intervertebral disc (inner core of the nucleus) with prolonged traumatic exposure, as well as with age, loses its elastic properties and elastic capacity. With constant exposure (overweight, trauma, progressive osteoporosis), the annulus fibrosis of the disc becomes thinner and defects are formed in it. Through these weak points in the anal fibrosus, the pulposus nucleus of the disc can be displaced and even protrude.
A herniated disc forms when the fibrosus anulus ruptures and the pulposus nucleus compresses the nerve root elements leaving the spinal cord. Compression leads to the fact that the pain in the lumbar region becomes extremely strong, sometimes unbearable. Lumbosacral back pain with disc herniation may be associated with sensory disturbances and various types of numbness in the respective decompression segments. Low back pain radiates (gives) the lower limb, causing muscle tension due to spasm. With a prolonged course, a herniated disc causes chronic pain in the lumbosacral region. Tension of the muscles in the spine, being constant, further increases the pain syndrome, causing it to become chronic.
- Stenosis (narrowing) of the spinal canal- Lumbosacral back pain is noted in connection with prolonged walking or physical exertion. Acute low back pain may be accompanied by weakness in the legs, convulsive symptoms in the lumbar, gluteal muscles. With significant impairment, there may be sensory dysfunction.
- Tumor lesions of the lumbosacral vertebral segmentsoften manifests itself in varying degrees of pain severity in the lumbar region. Typically, low back pain tends to worsen as the process progresses. The nature of the tumor lesion can be benign (vertebral cysts) and malignant (a spinal tumor, or metastatic lesions from a tumor located far away). By its morphological nature, the tumor may 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 (continuously, without light gaps), increasing in calmness, with oscillations, taps. Lower back pain is associated with 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 different localizations. Osteoporosis develops as a result of accelerated secretion 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 pain, has a moderate degree of pain syndrome. Pain in the lumbar region can give muscle tension, cramps, often combined with a decrease in the patient's height. The most common type of osteoporosis is postmenopause, which develops in women after the disappearance of ovarian function.
- Ankylosing spondylitisoften, along with soreness all over the spine, is characterized by pain in the lumbar and ileosacral joint region. The disease leads over time to stiffness in 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 that are not associated with vertebrogenic defects:
- kidney disease, renal pelvis(exacerbation of chronic pyelonephritis), renal urolithiasis, neoplastic kidney disease and renal tumor metastases. At the same time, the pain in the lumbar region is localized somewhat higher (at the site of renal projection), the pain in the lumbosacral region is not very typical. Pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urine analysis, temperature reaction);
- diseases of the upper floor of the digestive tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) in a certain localization sometimes appear as pain in the lumbosacral region. But back pain is not accompanied by movement, can be combined with other complaints (vomiting, stool discomfort, nausea, burning along the esophagus);
- acute back pain may occur, in some casesfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during menstruation, or just before them. During pregnancy, there may also be aggravation and pain in the lumbar region and in the sacrum;
- deformity of hip arthrosis(coxarthrosis), especially with a deterioration of the process, in addition to walking discomfort, difficulty walking, can give pain in the lumbosacral region, in the muscle area of the gluteal region on the corresponding side of the lesion, tension in the muscles of the lower backand buttocks.
Acute lower 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, computed tomography, MRI) and a neurological examination, he is diagnosed with a disease of the spine.
In the absence of convincing data on spinal pathology (osteochondrosis, herniated disc), additional methods may be required (ultrasound images of internal organs, densitometry, pelvic ultrasound) and consultation with related specialists (oncologist, gynecologist, endocrinologist).
Treatment of back pain in the lumbar region
Acute low back pain, as prescribed by a doctor, is stopped by non-steroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxants, rest, bed rest, applications of anti-inflammatory oils, placement ofcompresses. Treatment in the acute phase can be performed in an inpatient setting, or in a polyclinic.
Prescribe drugs that improve microcirculation, with acute back pain, blockade 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 are used for a long time, in osteoporosis - calcium and vitamin D3 preparations. Physiotherapeutic effects (provided there are no contraindications), physiotherapy exercises and in the rehabilitation phase - subsequent treatment can be used in sanatoriums.