Lumbar pain is one of the most common reasons why a patient is forced to seek the help of a neurologist or therapist. Pain in the lumbosacral spine can permanently disable, making movement and self-care impossible. Acute low back pain affects men and women equally often. With a higher incidence in middle and old age, lower back pain can often be noticed in adolescents and young adults. This is due to rapid growth, weakness of the fragile muscles of the lower back, injuries. Therefore, pain in the lumbosacral spine is the most important problem anyone can face.
Possible causes of back pain in the lumbar region
Pain in the lumbosacral spine may be associated with processes that occur both inside and outside the spine. . . Consider the main pathological conditions in which acute lower back pain can be observed.
- The most common problem and cause of pain is lumbosacral osteochondrosis. . . They are caused by age-related involuntary 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 growth and disruption of 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 experienced prolonged physical exertion, contributing to the wear of all vertebral structures. Frequent injuries, falling on the back, carrying weights and simultaneous osteoporosis worsen the picture and the course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (which causes muscle tension) and ligaments in the process.
- Disc herniation is an equally rare causewhose clinical manifestation is lumbosacral back pain. The intervertebral disc (inner nucleus pulposus) loses its elastic properties and elastic capacity with prolonged traumatic exposure, as well as with aging. With constant exposure (overweight, trauma, progressive osteoporosis), the annular fibrosus of the disc becomes thinner and defects occur in it. Through these weak points in the annular fibrosus, the nucleus pulposus of the disc can move and even protrude.
A disc herniation occurs when the annular fibrosus ruptures and the nucleus pulposus compresses the nerve root elements leaving the spinal cord. Compression causes the pain in the lumbar region to become extremely intense, sometimes unbearable. Pain in the lumbosacral spine with a herniated disc can be accompanied by sensory disorders and various types of numbness in the corresponding segments of decompression (compression). Pain in the lower back radiates (gives) to the lower limb, causing muscle tension due to cramps. With prolonged flow, a herniated disc causes chronic pain in the lumbosacral region. The tension of the muscles in the back, which is constant, additionally increases the pain syndrome, which causes it to become chronic.
- Spinal canal stenosis- Lumbosacral back pain associated with prolonged walking or physical exertion has been reported. Acute lower back pain may be accompanied by weakness in the legs, convulsive symptoms in the lumbar, gluteal muscle. With significant damage, sensory functions can be disturbed.
- Tumor lesion of lumbosacral vertebral segmentsit often manifests itself in varying degrees of pain in the lumbar region. Lower back pain usually worsens as the process progresses. The nature of the tumor lesion can be both benign (vertebral cysts) and malignant (spinal tumor or metastatic tumor lesion 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 torments the patient both day and night (constantly, without light gaps), intensifying at rest, with trembling and tapping. Lower back pain is accompanied by muscle tension, cramps, sensory disorders, weight loss, changes in the blood (anemia).
- Osteoporosis (bone loss)- very often the cause of bone pain is of different localizations. Osteoporosis develops as a result of the accelerated excretion of calcium from the bones, as a result of which all the 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 an average degree of pain syndrome. Pain in the lumbar region can cause 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 extinction of ovarian function.
- Ankylosing spondylitisoften, along with pain in 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 lumbar region may be due to the following reasons that are not related to vertebrogenic defects:
- kidney disease, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis, renal neoplastic disease, and renal tumor metastasis. At the same time, pain in the lumbar region is localized somewhat more strongly (at the site of renal projection), and 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) at a particular localization sometimes manifest as pain in the lumbosacral region. But back pain is not associated with movement, it can be combined with other ailments (vomiting, stool disorders, nausea, burning along the esophagus);
- in some cases, acute back pain may occurfor 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 it. There may be heaviness and pain in the lumbar region and sacrum during pregnancy;
- deforming osteoarthritis of the hip joint(coxarthrosis), especially with worsening of the process, in addition to gait disorders, difficulty walking, can cause pain in the lumbosacral area, in the area of the gluteal area on the appropriate side of the lesion, muscle tension of the lower back and 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. The patient more often goes to a neurologist, where he is diagnosed with a spinal disease after an appropriate diagnosis (X-ray examination, computed tomography, MRI) and neurological examination.
In the absence of convincing data on the pathology of the spine (osteochondrosis, herniated disc), additional methods may be needed (ultrasound imaging of internal organs, densitometry, pelvic ultrasound) and consultation with related experts (oncologist, gynecologist, endocrinologist).
Treatment of back pain in the lumbar region
Acute lower back pain, as prescribed by a doctor, is stopped by nonsteroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxants, rest, bed rest, application of anti-inflammatory ointments, the imposition of compresses. Treatment in the acute phase can be carried out in an inpatient setting or in a polyclinic.
Prescribe drugs that improve microcirculation, along with acute back pain, blockade is used. Sometimes, with the ineffectiveness of other types of therapeutic effects, they resort to surgical treatment (compression of nerve roots). In combination with osteoarthritis, chondroprotectors have been used for a long time, in osteoporosis - preparations of calcium and vitamin D3. Physiotherapeutic effects can be used (provided that there are no contraindications), physiotherapeutic exercises and in the rehabilitation phase - further treatment in sanatoriums.