Lower back painindicates a disease or damage to the spinal column, nerve structures, soft tissues, internal organs, it is observed in febrile conditions of various origins. It happens sharp, dull, constant, periodic, burning, shooting, bursting. Sometimes it is associated with physical activity, weather changes. Pathologies manifested by back pain are diagnosed on the basis of complaints, history, examination data and additional studies: X-ray, MRI, CT. Rest is necessary before the diagnosis is made, sometimes it is permissible to use ointments, and take analgesics.
Why does the lower back hurt
Congenital anomalies and acquired diseases of the spinal column are common causes of back pain. The nature of the pain syndrome varies. The pains caused directly by the pathological process, more often periodic, local, aching or pulling, are associated with the weather, physical exertion, and being in an uncomfortable position.
Due to muscle spasm, lumbago (lumbago) occurs - a sharp pain accompanied by restriction of movement. With many pathologies of the spine, lumboischialgia is observed - aching, burning or shooting pain in the lower back, radiating along the back of the thigh. Painful sensations are often found in the composition of the radicular syndrome. They can be detected in the following diseases of the spinal column:
- Degenerative pathologies: osteochondrosis, protrusion of the intervertebral disc, intervertebral hernia, spondylosis, spondyloarthrosis.
- Congenital anomalies: sacralization, lumbarization.
- Polyethiological conditions: spondylolysis, spondylolisthesis.
- Vascular diseases: disorders of the cerebrospinal circulation.
- Other diseases: Forestier disease.
- Secondary lesions of nerve structures: lumbosacral sciatica, lumbosacral plexitis, myelopathy of various origins.
Curvature of the spine
Slight or moderate aching pains are noted in all types of curvature of the spinal column, which is associated with non-physiological redistribution of the load, overstrain of the muscles and ligaments of the back. Soreness appears due to an uncomfortable position of the body, sleeping on a bed that is too hard or too soft. The symptom is accompanied by:
- flat back syndrome.
Pulling or aching pain in the lumbar and thoracic spine has long been the only symptom of osteoporosis. Pain syndrome is expressed slightly, increases after exercise, before changing weather conditions. The symptom is observed with the following types of osteoporosis:
Similar pains are detected in patients with secondary forms of pathology caused by genetic diseases, endocrine disorders, chronic intoxication, taking certain medications. Secondary osteoporosis can also occur against the background of malabsorption syndrome, liver disease, chronic renal failure, rheumatoid arthritis, SLE.
Increased pain, an increase in the duration of pain may be associated with the development of a pathological fracture. Other signs of trauma are often not pronounced, so the fracture often remains undiagnosed.
The most common injury is contusion of the spinal column. In mild cases, the pathology is manifested by moderate pain in the lower back, aggravated by movement, local edema, and sometimes - hematomas and hemorrhages. In severe bruises, neurological disorders are added to the listed symptoms.
Compression fracture of the lumbar spine occurs as a result of forceful flexion of the trunk. It is characterized by sharp pain, breath holding at the time of injury. Then there is an increase in pain when turning the body, edema of soft tissues is revealed. Palpation of the spinous process is painful. Other possible fractures include damage to the arches, transverse processes, spinous processes.
In addition, lower back pain is found in patients with traumatic spondylolisthesis and vertebral subluxation. Paroxysmal painful sensations, reminiscent of lumbago, are complemented by a feeling of heaviness and numbness of the lower extremities.
Injuries of soft tissues and kidneys
Contusion of soft tissues is accompanied by minor or moderate quickly subsiding local pain, slight edema. Hemorrhage is possible. There is no blood impurity in the urine. Kidney contusions are manifested by soreness and minor short-term hematuria. With kidney injuries of moderate severity, the pain syndrome is intense, the pain radiates to the lower abdomen, groin, and genitals. In the lumbar region, a hematoma is visible. In severe cases, there is severe pain, prolonged gross hematuria. A state of shock develops.
Spine and spinal cord infections
Osteomyelitis of the spine can be hematogenous, post-traumatic, contact, postoperative. The acute form of the disease is manifested by rapidly growing back pain, combined with chills, fever, intoxication syndrome, and deterioration of the general condition. The pains are twitching, bursting, so intense that they impede any movement, forcing the patient to freeze in bed. In chronic osteomyelitis, the manifestations are smoothed, a fistulous passage with purulent discharge is formed.
Tuberculosis of the spinal column develops gradually. Initially, there are periodic deep pains that intensify after exercise, increased skin sensitivity in the projection of the affected vertebrae. Stiffness of gait is formed. Against the background of significant destruction of bone structures, the nature of the pain changes, since it is caused by compression of the nerve roots. The pains become burning, radiate to the legs, supplemented by paresthesias, numbness.
In patients with spinal epidural abscess, pain is strong, deep, diffuse, combined with chills, hyperthermia, muscle tension. Tapping on the spinous processes of the vertebrae is painful. With the progression of the pathology, a radicular syndrome occurs, then paresis, disorders of the activity of the pelvic organs develop.
Local inflammatory processes
Purulent processes in superficial tissues and perirenal tissue are accompanied by intense pain in the lower back. Possible causes of pain are boils, carbuncles and paranephritis.
In the first two cases, an abscess forms in the skin, looks like a limited, sharply painful lump with a diameter of 1 cm or more of a purple or purple-cyanotic hue with one or more rods in the center. The pain increases rapidly, becomes twitching, throbbing, sleep depriving. General hyperthermia, slight or moderate disturbance of the general condition are noted.
With paranephritis, severe fever occurs in the beginning. Pain syndrome develops in 2-3 days. The pain is very intense, can be given to the abdomen or hypochondrium, aggravated by walking, movements, deep breathing. In some forms of paranephritis, due to pain, the patient takes a forced position. The lumbar muscles are tense. Revealed edema, local hyperemia, hyperthermia. The condition is serious.
Diffuse aching lower back pain, causing a desire to change body position, is characteristic of acute infections accompanied by fever and intoxication syndrome. In most cases, they are caused by myositis, often combined with pain in the muscles of the limbs. Observed with flu, sore throat, ARVI. Sometimes pain is provoked by kidney damage. Infectious diseases accompanied by soreness in the lumbar region include:
- hemorrhagic fevers;
- Japanese mosquito encephalitis;
- Ebola fever;
- foot and mouth disease;
- severe form of coronavirus infection;
- generalized forms of bacterial, fungal, viral infections.
In a number of patients, back pain is observed during a cytokine storm - an inflammatory reaction that develops against the background of severe infectious diseases. Epidemiological myalgia is accompanied by intense paroxysmal pain lasting up to 10 minutes, which appear not only in the lower back, but also in other parts of the back, in the area of the abdominal wall, chest, and extremities. Repeat at intervals of 30-60 minutes. Combined with rhinitis, conjunctivitis, severe hyperthermia.
Other muscle lesions
Aching pain in the muscles of the lumbar region is determined after intense physical exertion - performing strength exercises for the back muscles, prolonged stay in a forced position with a tense lower back. Myalgia subsides at rest, increases with movement, weakens after warming, gentle warm-up, disappears after a few days.
Myositis develops not only in infectious diseases, but also after hypothermia or overload, against the background of exogenous intoxication, metabolic disorders. They are accompanied by prolonged aching pain. There are also special forms of myositis:
- specific infectious myositis in syphilis and tuberculosis;
- idiopathic, juvenile dermatomyositis and polymyositis;
- polymyositis and dermatomyositis in oncological pathologies, systemic diseases of the connective tissue.
Chronic diffuse pain throughout the body, including the lower back, occurs with fibromyalgia. Combined with sleep disorders, asthenia, neurotic disorders.
In addition to the listed pathologies, lower back pain can be troubling in conditions such as:
- Tumors of the spine, spinal cord: sarcoma, hemangioma, metastases, intramedullary and extramedullary neoplasms of the spinal cord.
- Kidney disease: pyelonephritis, glomerulonephritis, urolithiasis, kidney infarction, renal vein thrombosis, kidney cyst, kidney cancer, purulent processes.
- Hereditary diseases: Pierre-Marie's hereditary cerebellar ataxia.
- Exogenous intoxication: abuse of phenylpropanolamine.
- Pathology of the heart and blood vessels: Leffler's endocarditis, abdominal aortic aneurysm.
- Emergencies: blood transfusion shock.
In diseases of the small pelvis, sometimes the pain syndrome radiates to the lower back. The appearance of a symptom is possible with a number of female diseases, prostate cancer, proctitis, sigmoiditis.
Primary diagnosis is performed by an orthopedic traumatologist. In the presence of neurological symptoms, the patient is examined by a neurologist. The doctor interviews the patient, carries out an objective examination. According to the indications, consultations of a surgeon, rheumatologist, urologist, and other specialists are prescribed. The diagnostic program may include:
- Neurological examination.During the examination, the specialist evaluates reflexes, muscle strength, coordination of movements, deep and superficial sensitivity.
- Radiography.X-rays of the lumbar spine show fractures, a decrease in the height of the intervertebral discs, other degenerative changes, masses, signs of inflammation, spondylolisthesis. If necessary, standard radiographs are supplemented with functional examinations.
- Other neuroimaging techniques. CT and MRI are used to clarify X-ray data. Computed tomography examines the structure of solid structures in detail, MRI examines the state of the ligaments and intervertebral discs. To exclude stenosis, myelography is performed.
- Functional studies. The condition of muscles and nerve conduction is assessed using electromyography, electroneurography, and evoked potential studies.
- Laboratory analyzes. To confirm the infectious nature of the disease, determine the pathogen, blood tests and microbiological research are done. Serological tests are used to detect neuroinfections.
According to indications, ultrasound of the kidneys, prostate, pelvic organs, urinalysis, ultrasound of the abdominal aorta, and other studies are performed.
Back Pain Treatment
In case of traumatic spinal injury, the patient must be placed on the shield and immediately taken to a medical facility. In case of non-traumatic pain, the load on the back should be reduced, the position of the body should be optimized during work and rest. Acute pain syndrome is an indication for consulting a neurologist.
A single dose of analgesics is possible until a specialist examination. With lumbago, lumboischialgia caused by previously diagnosed degenerative diseases of the spine, it is allowed to use local warming and anesthetic drugs. If an infectious process is suspected, local remedies are not indicated.
Physiotherapy and drug therapy are the basis of treatment. The patient is assigned a protective mode. The following methods are used:
- NSAIDs. Effective for acute and chronic pain in muscles and spine. Used in the form of tablets, topical agents.
- Neurotropic vitamins. Patients are injected with B vitamins, which enhance the effect of drugs of other groups, help reduce pain.
- Local Anesthetics. For persistent and acute pain, therapeutic blockade with anesthetics is performed. To improve the result of treatment, pain relievers are combined with glucocorticosteroids.
- Physiotherapy. Ultrasound, magnetotherapy, percutaneous electrical stimulation, laser therapy, and drug electrophoresis are used. Perhaps the appointment of massage, manual therapy, acupuncture.
Taking into account the peculiarities of the pathology, the following surgical interventions are performed:
- Instability: interbody fusion, transpedicular fixation, plate fixation.
- Tumors, osteoporosis, osteomyelitis, tuberculosis: sequestrectomy, vertebroplasty, kyphoplasty, corporectomy.
- Intervertebral hernias: discectomy, microdiscectomy, nucleoplasty.
- Narrowing of the spinal canal: laminectomy, facetectomy, puncture disk decompression.
In the postoperative period, analgesics, antibiotics are prescribed. Rehabilitation activities include exercise therapy, massage, physiotherapy.