Up to 76% of the population experiences back pain during the year; in 7% of cases, patients complain of acute back pain.The hospital's rheumatologists determine the cause of back pain using the latest instrumental and laboratory research methods.To relieve pain and further treat patients, doctors prescribe modern medications that are highly effective and have minimal side effects.Rehabilitation specialists use innovative methods of restorative therapy to speed up the recovery process for patients with back pain.
What types of back pain are there?There are 4 types of back pain: local (local), projection, radicular (radicular) and pain that occurs due to muscle spasm.The most common forms of back pain are combined.Lumboischialgia is characterized by 3 forms of pain: muscular-tonic in the form of syndromes of the piriformis, gastrocnemius, and gluteal muscles, neurovascular, and neurodystrophic.
There are primary and secondary back pain.Primary pain syndrome most often develops between the ages of 20 and 50 years.It is based on the following mechanical factors:
- Spondylosis and intervertebral osteochondrosis;
- Dysfunction of the musculo-ligamentous apparatus of the back;
- Intervertebral disc herniation.
Psychogenic back pain in its pure form is rare.It is difficult to diagnose because the patient who suffers from a mental disorder often has comorbid musculoskeletal and other neurological disorders that can cause pain.In patients under twenty years of age and over fifty years of age, secondary pain syndrome predominates.
Doctors consider pain lasting less than six weeks to be acute, pain lasting six to twelve weeks to be subacute, and pain lasting more than twelve weeks to be chronic.Muscle pain in the back occurs with myositis, osteochondrosis, and after injuries.Patients with acute, subacute and chronic back pain differ in their prognosis for recovery and return to work.Rheumatologists use different approaches to diagnosing the cause of various pain and treating it.
Causes of back pain
One of the most common causes of back pain is traumatic lesions of the spine, which occur as a result of excessive stress during stereotypical physical activity and sports.Such injuries have the following consequences:
- Vertebral fracture;
- Deformation or rupture of intervertebral discs;
- Inflammation and stretching of the joint capsule;
- Rupture of the ligaments of the spinal column.
Microtrauma can occur as a result of an unsuccessful sudden movement during constant physical activity.
The following causes of back pain are also identified:
- Curvature of the spine;
- Neuralgia;
- Osteochondrosis;
- Compression of nerve endings;
- Arthritis and inflammatory diseases;
- Oncological spinal tumors;
- Damage to the fascia;
- Muscle spasm.
The causes of chronic back pain can be diseases of internal organs (heart, lungs, kidneys), burns, cancer pathology, a sedentary lifestyle and emotional overload.Severe back pain can be caused by uncontrolled use of certain medications.If back pain radiates to the leg, you should think about sacral radiculitis.Back pain in the lumbar region is characteristic of diseases of the intestines, kidneys, prostate gland in men and diseases of the reproductive system in women.Pain in the spine in the middle of the back may be a manifestation of myocardial infarction.Pain under the ribs from the back occurs with intercostal neuralgia.
Recently, in clinical guidelines that address the problem of back pain, the term “nonspecific back pain” is often found.It denotes pain associated with musculoskeletal disorders without signs of damage to the cervical, thoracic, lumbar and sacral roots, or specific injuries to the spine.
Determining the cause of back pain
The hospital has unique diagnostic capabilities that allow you to quickly determine the cause of back pain.Doctors establish a connection between the clinical manifestations of the disease and data from additional research methods.The examination program for a patient with back pain includes the following diagnostic measures:
- X-ray examination of the spine;
- Computed tomography;
- Magnetic resonance imaging.
X-ray examination has an important diagnostic value for back pain.Standard diagnostic methods include radiography in anteroposterior and lateral projections, functional spondylograms in the position of maximum flexion and extension.Computed tomography and magnetic resonance imaging make it possible to clarify the localization of the pathological process.
Patients with back pain are prescribed the following types of instrumental studies:
- Electrocardiography (for cardiac dysfunction);
- Magnetic resonance or computed tomography with contrast;
- Optical topography of the skeleton and stabilization diagnostics;
- Ultrasound examination of joints and spine;
- Densitometry (determination of bone tissue density);
- Electroneuromyography;
- Spiroarteriocardiorhythmography.
Patients undergo a complete blood count, urinalysis, tests for C-reactive protein and rheumatoid factor.Differential diagnosis for acute back pain is carried out between the following diseases:
- Potentially dangerous diseases of vertebral and non-vertebral origin (compression of the cauda equina, traumatic, tumor, inflammatory and infectious lesions of the spine, osteoporosis and diseases of internal organs);
- Compression radiculopathy;
- Benign musculoskeletal back pain.
Only after establishing the exact cause of back pain, doctors draw up a treatment plan for the patient.
Treatment for back pain
The pain syndrome is based on 2 main mechanisms that determine the management of a patient with back pain: damage to the spine and spasm or sprain of muscles and ligaments.From the first day of treatment, patients are prescribed non-steroidal anti-inflammatory drugs (NSAIDs).Their anti-inflammatory effect is due to inhibition of cyclooxygenase-2.NSAIDs not only inhibit the metabolism of this inflammatory mediator, but also actively affect the production of prostaglandins associated with the mobilization of calcium in smooth muscles.For muscle pain in the back, patients are prescribed muscle relaxants.
If there is no effect from analgesics and non-steroidal anti-inflammatory drugs or if there are contraindications to their use, weak opioids (codeine, tramadol) are used to reduce severe back pain.Strong opioids are used in the form of transdermal therapeutic systems with gradual prolonged release of the drug.
Antidepressants are prescribed to treat chronic back pain.They reduce the intensity of pain in patients with chronic back pain.The analgesic effect of antidepressants does not depend on the presence or absence of concomitant depression.For short-term pain relief, pepper patch applications can be used.
Patients with back pain are advised to avoid bed rest and continue with normal daily activities or resume them as soon as possible.For acute pain in the lumbar region, active physical exercise is ineffective during the first two weeks of the disease.
One of the most effective modern treatments for chronic back pain is “pain management.”The method is a targeted effect on the affected areas: painkillers are injected into precisely defined areas using radiography.Blocking pain impulses in combination with a set of individual treatment procedures can relieve the patient of back pain for a long time.
Doctors at the hospital combine drug therapy for back pain with the following types of treatment:
- Physical therapy;
- Massage;
- Acupuncture;
- Kinesiotherapy.
When acute back pain occurs, the doctor may recommend that the patient wear muscle corsets.Their effectiveness in chronic pain syndrome has not been proven.Individually selected physical therapy exercises start the process of tissue restoration and completely restore the motor functions of the spine.Therapeutic massage and myostimulation using the latest equipment that the rehabilitation clinic is equipped with can quickly relieve the patient of back pain.These methods are necessary for the patient's complete recovery.
One of the popular non-drug methods for relieving localized back pain is transcutaneous electrical nerve stimulation.This is a blockade of pain using electrical impulses at the site of its localization.Another effective method of pain relief that is used in the hospital is the biofeedback method.It was created at the intersection of psychology and physiology.A special device reads information that comes from the patient’s body.After this, a computer model of it is formed on the screen.It clearly shows all the processes occurring in the body, including pain.If the patient does not return to normal levels of daily activity four weeks after the onset of acute back pain, it is necessary to refer him to chiropractic therapy.
Which doctor treats back pain?The hospital takes a multidisciplinary approach to treating patients with chronic back pain.It involves programs of drug treatment, patient education, therapeutic exercises and psychotherapeutic interventions, which are carried out regularly with the participation of several specialists (neurologist, vertebrologist, rheumatologist, psychotherapist, rehabilitation specialist, therapist).
Cognitive behavioral psychotherapy reduces the intensity of back pain and improves functional status.Programs that combine behavioral psychotherapy with a gradual increase in physical activity allow the patient to quickly return to normal work.
Physical rehabilitation for back pain
In the physical rehabilitation of patients with back pain, therapeutic exercises play a major role.With the help of individually selected exercises, motor and neurological disorders are corrected, trophism and tissue restoration are improved.Rehabilitation specialists at the hospital use ideomotor and passive exercises for back pain.
Passive exercises are carried out with the maximum possible range of motion in the joint, in one direction, strictly in the same plane, at the same speed.The rehabilitator performs them, starting with large joints, then gradually moves on to small joints.Ideomotor exercises are used to restore damaged pathways of transmission of nerve impulses from the center to the periphery.They are widely used for persistent pain syndrome.
For patients with muscle weakness, rehabilitation therapists prescribe active isometric muscle exercises.Patients perform them without straining and holding their breath, while maintaining tension.These exercises improve blood circulation in spasmodic muscles, prevent muscle wasting, and restore the transmission of nerve impulses.When increasing muscle strength, active dynamic exercises are used from lightweight starting positions.When they are performed, the attachment points of the antagonist muscles are brought closer together, and the attachment points of the trained muscle are separated as much as possible.
In some cases, surgery is used to treat back pain.To avoid surgery, if you have back pain, call the contact center and make an appointment with a neurologist or rheumatologist.After a complete examination and determination of the cause of back pain, the doctor will prescribe a comprehensive treatment.After relieving acute pain in the spine, patients undergo a course of rehabilitation therapy in a rehabilitation clinic using the latest equipment and innovative techniques.