Up to 76% of the population experiences back pain throughout the year;in 7% of cases, patients complain of sharp back pain.The hospital's rheumatologists determine the cause of back pain using the latest instrumental and laboratory research methods.To alleviate pain and further treat patients, doctors prescribe modern medicines that are highly effective and have minimal side effects.Rehabilitation specialists use innovative restorative therapy methods 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.It is based on the following mechanical factors:
- Intervertebral spondylosis and osteochondrosis;
- Dysfunction of the musculoligamentous apparatus of the back;
- Intervertebral disc herniation.
Psychogenic back pain in its pure form is rare.It is difficult to diagnose because a patient suffering from a mental disorder usually has musculoskeletal comorbidities and other neurological diseases that can cause pain.In patients under twenty years of age and over fifty years of age, secondary pain syndrome predominates.
Doctors consider pain that lasts less than six weeks to be acute, pain that lasts six to twelve weeks to be subacute, and pain that lasts 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 low back pain differ in their prognosis for recovery and return to work.Rheumatologists use different approaches to diagnose the cause of various pains and treat them.
Causes of back pain
One of the most common causes of back pain is traumatic spinal injuries, which occur as a result of excessive stress during stereotypical physical activities and sports.Such injuries have the following consequences:
- Vertebral fracture;
- Deformation or rupture of intervertebral discs;
- Inflammation and distension of the joint capsule;
- Rupture of spinal ligaments.
Microtrauma can occur as a result of a sudden unsuccessful movement during constant physical activity.
The following causes of back pain are also identified:
- Spine curvature;
- 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, oncological pathology, physical inactivity and emotional overload.Severe back pain can be caused by the uncontrolled use of certain medications.If your back pain radiates down your leg, you should think about sacral radiculitis.Back pain in the lumbar region is characteristic of diseases of the intestine, kidneys, prostate 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 in the back occurs with intercostal neuralgia.
Recently, in clinical guidelines addressing the problem of back pain, the term “nonspecific back pain” is often found.Denotes pain associated with musculoskeletal disorders without signs of damage to the cervical, thoracic, lumbar and sacral roots, or specific spinal injuries.
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:
- Radiographic examination of the spine;
- Computed tomography;
- Magnetic resonance imaging.
Radiographic examination has an important diagnostic value for back pain.Standard diagnostic methods include radiographs 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 imaging or computed tomography with contrast;
- Optical topography of the skeleton and stabilization diagnosis;
- Ultrasound examination of joints and spine;
- Densitometry (determination of bone tissue density);
- Electroneuromyography;
- Spiroarteriocardiorrhythmography.
Patients undergo a complete blood count, urinalysis, C-reactive protein and rheumatoid factor tests.Differential diagnosis of 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, tumoral, inflammatory and infectious injuries of the spine, osteoporosis and diseases of internal organs);
- Compressive radiculopathy;
- Benign musculoskeletal back pain.
Only after establishing the exact cause of back pain do doctors draw up a treatment plan for the patient.
Back pain treatment
Pain syndrome is based on 2 main mechanisms that determine the management of a patient with back pain: spinal injury and spasm or sprain of muscles and ligaments.From the first day of treatment, patients are prescribed non-steroidal anti-inflammatory drugs (NSAIDs).Its anti-inflammatory effect is due to the inhibition of cyclooxygenase-2.NSAIDs not only inhibit the metabolism of this inflammatory mediator, but also actively affect the production of prostaglandins associated with calcium mobilization in smooth muscle.For back muscle pain, patients are given muscle relaxants.
If there is no effect from analgesics and non-steroidal anti-inflammatory drugs or 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 and prolonged release of the medication.
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 lower back pain, active physical exercise is ineffective during the first two weeks of the illness.
One of the most effective modern treatments for chronic back pain is “pain management.”The method has 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's back pain for a long time.
Hospital doctors combine drug therapy for back pain with the following types of treatment:
- Physiotherapy;
- Massage;
- Acupuncture;
- Kinesiotherapy.
When acute back pain occurs, the doctor may recommend that the patient wear muscle corsets.Its effectiveness in chronic pain syndrome has not been proven.Individually selected physiotherapy exercises begin the tissue restoration process and completely restore the motor functions of the spine.Therapeutic massage and myostimulation with state-of-the-art equipment that the rehabilitation clinic is equipped with can quickly alleviate the patient's 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.It involves blocking pain through electrical impulses at the location of its location.Another effective pain relief method used in the hospital is the biofeedback method.It was created at the intersection of psychology and physiology.A special device reads information coming from the patient's body.After that, a computer model is formed on the screen.Clearly shows all 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 the patient for chiropractic therapy.
Which doctor treats back pain?The hospital takes a multidisciplinary approach to treating patients with chronic back pain.It involves drug treatment programs, patient education, therapeutic exercises and psychotherapeutic interventions, which are carried out regularly with the participation of various 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 an important role.With the help of individually selected exercises, motor and neurological disorders are corrected, trophism and tissue restoration are improved.The hospital's rehabilitation specialists use ideomotor and passive exercises for back pain.
Passive exercises are performed 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 the large joints and then gradually moving to the small ones.Ideomotor exercises are used to restore damaged pathways for transmitting 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 effortlessly and without holding their breath, maintaining tension.These exercises improve blood circulation in spasmodic muscles, prevent muscle loss and restore the transmission of nerve impulses.When increasing muscle strength, active dynamic exercises from light starting positions are used.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 call 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 comprehensive treatment.After relieving acute back pain, patients undergo a course of rehabilitation therapy in a rehabilitation clinic with the latest equipment and innovative techniques.