Lumbar pain is the most common pain syndrome in outpatient practice.In developed countries, 30-60% of the population suffers from recurrent low back pain, and up to 80% of all back pain occurs in the lumbar region (lumbar).All age groups can suffer from back pain, but the peak incidence occurs between the ages of 30 and 60.
Back pain due to disease
Back pain is a non-specific symptom that can have many causes.Doctors distinguish between primary and secondary back pain syndromes.The majority of back pain is based on morphofunctional changes of the musculoskeletal system (primary back pain syndrome).These are primarily degenerative-dystrophic lesions of the spine:
Possible causes of secondary back pain syndrome:
- Primary and metastatic tumors of vertebrae, spinal cord, retroperitoneal space.
- Fractures of the spine.
- Infectious lesions of vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess).
- Non-infectious inflammatory diseases (ankylosing spondylitis, Reiter's syndrome, rheumatoid arthritis).
- Metabolic bone lesions (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute spinal circulatory disorders (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Referred pain in diseases of the pelvic organs (including infectious gynecological diseases such as renal colic, chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis).
Pain in the lower back can be acute or chronic, and the causes are damage to the spinal cord or nerve roots.Pain radiating from deeper structures:
- kidneys;
- pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumors.
Sharp pain in the lumbar region
Acute sprain.Pain is localized in the region of the long back muscles during spasm, which causes limitations in movements.There is no displacement of pain to the groin or lower limbs.
Fractures of the spine.Usually this is the result of injury from bending or falling on the feet, but if the patient has skeletal disorders, osteoporosis, Cushing's syndrome, hyperparathyroidism, myeloma, bone metastases, Paget's disease, the same result can occur with no injury or minimal trauma.
Displacement of intervertebral discs in the lumbar region.Symptoms of this disease are pain in the lower back, forced body position and limitation of mobility.The involvement of nerve roots in the pathological process is indicated: radicular pain, usually unilateral;sensitivity disorders (paresthesia, hyperesthesia or hypoalgesia);Decreased or absent Achilles or knee reflex.
Facet syndrome.Compression of the root at its exit from the spinal canal causes radicular pain that is not caused by disc damage.Unilateral facet syndrome, most commonly associated with the L5 root, occurs when the superior and inferior sides of the intervertebral joint widen, causing narrowing of the intervertebral canal or foramen.
Epidural abscess.It is most often found in the thoracic spine, and may be accompanied by sharp pain in the back when palpating or tapping the affected area.Symptoms of spinal cord compression require prompt diagnosis and initiation of treatment, including surgery.Pathological processes in the hip joint can be accompanied by pain that spreads to the gluteal region and lower limbs to the level of the knee joint.
Chronic back pain
Spondylosis deformans.Spondylosis deformities are degenerative changes in the lumbar vertebrae with the formation of bony rods that narrow the spinal canal and put pressure on the roots.If lumbosacral pain is accompanied by neurological symptoms (numbness, numbness, or weakness in both lower limbs) while walking, the syndrome of intermittent claudication related to the spine and caused by narrowing of the spinal canal is suspected.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with pain in the lumbar region moving towards the hip.First, there is limited mobility and morning stiffness, decreased respiratory movements of the chest, and progressive curvature and flexion of the thoracic spine.X-ray signs: destruction and reconstruction of the sacroiliac joints, the formation of the so-called "bamboo" spine.Similar symptoms with limited movement in the lower spine can occur with:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.Using radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (breast, lung, prostate, thyroid, kidney, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.Caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;The possibility of these infections should be confirmed or excluded by determining ESR, bone X-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before other neurological symptoms appear.Fluctuating pain in the lower back due to diseases of the internal organs.When the pelvic organs are affected, the pain goes to the sacral region, organs of the lower abdominal cavity - lumbar segments, upper abdominal cavity - lower chest and upper lumbar segments.No local symptoms or stiffness in the back;full back movements do not increase pain.
Treatment
A patient with lumbar osteochondrosis feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Back pain sometimes spreads to the leg.In this case, you should urgently contact a neurologist.
Do not delay to consult a doctor in the following cases:
- Experiencing severe lower back pain for more than 3 days;
- pain occurred after the injury;
- at the same time you feel pain in the back, lower leg and foot;
- pain in the lower back is combined with numbness in the hips, thighs, legs, feet and groin.
Back pain is a very common symptom, especially in older people.Rheumatism, lumbar osteochondrosis and radiculitis - all these diseases cause acute pain in the lumbar region.Only a proper examination of the body can show the results and give an accurate answer about the causes of back pain.