Lower back pain is one of the most common reasons that forces a patient to seek help from a neurologist or therapist. Lumbosacral spine pain can be permanently disabling, making movement and self-care impossible. Acute low back pain affects both men and women with the same frequency. With a greater frequency in middle and old age, lower back pain can often be observed in adolescents and young adults. This is due to rapid growth, weakness of the fragile muscles of the lower back, injuries. Therefore, lumbosacral spine pain is the most pressing problem anyone can face.
Possible causes of back pain in the lumbar region
Lumbosacral spine pain can be associated with processes occurring both in the spine itself and outside 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 involutional 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 violation of the nerve roots at the site of 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, carrying of weights and concomitant osteoporosis aggravate the picture 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.
- A herniated disc is an equally rare cause, the clinical manifestation of which is lumbosacral back pain. The intervertebral disc (internal nucleus pulposus) with prolonged traumatic exposure, as well as with age, loses its elastic properties and elastic capacity. With continued exposure (overweight, trauma, progressive osteoporosis), the fibrous ring of the disc thins and defects form. Through these weak spots in the fibrous ring, the nucleus pulposus of the disc can move and even protrude.
A herniated disc forms when the fibrous ring ruptures and the nucleus pulposus compresses the nerve root elements that leave 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. Lower back pain radiates (gives) to the lower limb, causing muscle tension due to the spasm. With a prolonged course, a herniated disc causes chronic pain in the lumbosacral region. Being constant, muscle tension in the back further increases the pain syndrome, making it chronic.
- Stenosis (narrowing) of the spinal canal- Lumbosacral back pain is noted in connection with prolonged walking or physical exertion. Acute low back pain can be accompanied by weakness in the legs, convulsive symptoms in the lower back, buttock muscles. With significant damage, there may be disturbances of sensory functions.
- Tumor lesion of the segments of the lumbosacral vertebraeit often manifests itself in 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 (vertebral cyst) and malignant (a tumor of the spine or metastatic lesions from a distant tumor). By its morphological nature, the tumor can be osteosarcoma, hemangioma or develop due to myeloma. Pain in the lumbosacral region with this pathology often disturbs the patient both day and night (constantly, without light interruptions), increasing at rest, with agitation, tapping. Lower back pain is accompanied by muscle tension, cramps, sensory disturbances, weight loss, blood changes (anemia).
- Osteoporosis (bone loss)- quite often it is the cause of pain in the bones of various localizations. Osteoporosis develops due to accelerated excretion of calcium from bones, as a result of which all bones become brittle, subject to fractures with little mechanical stress (often of a domestic nature). Lumbosacral back pain in osteoporosis is combined with other pain in the bones, has an average 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 ovarian function dies down.
- Ankylosing spondylitisoften, along with pain throughout the spine, it is characterized by pain in the lumbar region and ileosacral joint. Over time, the disease 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 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 metastases of kidney tumors. At the same time, pain in the lumbar region is localized slightly higher (in the place of the 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, thermal reaction);
- diseases of the upper floor of the digestive system(peptic ulcer, inflammation of the pancreas, pancreatic cancer) at a certain localization sometimes manifest as pain in the lumbosacral region. But back pain is not associated with movements, it can be combined with other ailments (vomiting, stool disorders, 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 or just before menstruation. Heaviness and pain in the lumbar region and sacrum may also occur during pregnancy;
- deforming osteoarthritis of the hip joint(coxarthrosis), especially with an exacerbation of the process, in addition to gait disturbances, difficulty walking, can give pain in the lumbosacral region, in the area of the muscles of the gluteal region on the corresponding side of the lesion, tension in the muscles of the lower part back and buttocks.
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 diagnostics (X-ray examination, computed tomography, MRI) and neurological examination, he is diagnosed with spinal disease.
In the absence of convincing data 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) may be required.
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 ointments, the imposition of tablets. Treatment in the acute phase can be carried out 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 can be used (provided that there are no contraindications), physiotherapy exercises, and in the rehabilitation stage - follow-up treatment in sanatoriums.