Up to 76% of the population experiences back pain throughout the year;In 7% of cases, patients complain of acute back pain.Hospital rheumatologists determine the cause of back pain using the latest instrumental and laboratory research methods.To relieve pain and treat patients, doctors prescribe modern drugs that are very effective and have minimal side effects.Rehabilitation specialists use innovative rehabilitation 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 spasms.The most common forms of back pain are combined.Lumboischialgia is characterized by 3 forms of pain: muscle-tonic in the form of piriformis syndrome, gastrocnemius, and gluteal muscles, neurovascular, and neurododystrophic.
There is 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:
- Spondylosis and intervertebral osteochondrosis;
- Dysfunction of the back musculo-ligamentous apparatus;
- Intervertebral disc herniation.
Psychogenic pain in its pure form is rare.It is difficult to diagnose because patients suffering from mental disorders often have 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 that lasts less than six weeks to be acute, pain that lasts for 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 injury.Patients with acute, subacute and chronic back pain differ in their prognosis for recovery and return to work.Rheumatologists use different approaches to diagnose the causes of various pains and treat them.
Causes of back pain
One of the most common causes of pain is traumatic injuries of the spine, which occur as a result of excessive stress during physical activity and stereotyped sports.Such an injury has the following consequences:
- Spine fracture;
- Deformation or rupture of the intervertebral disc;
- Inflammation and stretching of the joint capsule;
- Spinal ligament rupture.
Microtrauma can occur as a result of unsuccessful sudden movements during continuous 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;
- Spinal tumor oncology;
- Damage to the fascia;
- Muscle spasms.
The cause of chronic back pain can be diseases of internal organs (heart, lungs, kidneys), burns, cancer pathology, inactive lifestyle and emotional burden.Severe back pain can be caused by uncontrolled use of certain medications.If the back pain radiates to the legs, 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 dealing with back pain, the term "non-specific back pain" is often found.It indicates pain associated with musculoskeletal disorders without signs of damage to the cervical, thoracic, lumbar and sacral roots, or specific injury 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 relationship between the clinical manifestations of the disease and data from additional research methods.The examination program for patients with back pain includes the following diagnostic measures:
- X-ray examination of the spine;
- Computed tomography;
- Magnetic resonance imaging.
X-ray examination has important diagnostic value for back pain.Standard diagnostic methods include radiographs in anteroposterior and lateral projections, functional spondylograms in maximum flexion and extension positions.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;
- Frame optical topography and stabilization diagnostics;
- Ultrasound examination of joints and spine;
- Densitometry (determination of bone tissue density);
- Electroneuromyography;
- Spiroartiocardiorhythmography.
The patient underwent a complete blood count, urinalysis, tests for C-reactive protein and rheumatoid factor.Differential diagnosis for acute back pain is made between the following diseases:
- Potentially dangerous diseases of vertebral and non-vertebral origin (cauda equina compression, traumatic, tumors, inflammatory and infectious wounds of the spine, osteoporosis and diseases of internal organs);
- Compressive radiculopathy;
- Musculoskeletal back pain.
Only after establishing the cause of back pain, the doctor makes a treatment plan for the patient.
Treatment for back pain
The pain syndrome is based on 2 main mechanisms that determine the management of patients with back pain: damage to the spine and spasms or injuries 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 the inhibition of cyclooxygenase-2.NSAIDs not only inhibit the metabolism of these inflammatory mediators, but also actively influence the production of prostaglandins associated with calcium mobilization in smooth muscle.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 for their use, weak opioids (codeine, tramadol) are used to reduce severe back pain.Strong opioids are used in the form of a transdermal therapeutic system with a prolonged gradual 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 application can be used.
Patients with back pain are advised to avoid bed rest and resume normal daily activities or resume them as soon as possible.For acute pain in the lumbar region, active physical training is ineffective during the first two weeks of the disease.
One of the most effective modern treatments for chronic back pain is "pain management."This method is a targeted effect on the affected area: painkillers are injected into the area precisely defined using radiography.Blocking pain impulses in combination with a set of individual treatment procedures can relieve back pain patients 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 a muscle corset.Its effectiveness in chronic pain syndrome has not been proven.Individually selected physical therapy exercises Begin the tissue recovery process and restore spinal motor function.Therapeutic massage and myostimulation using the latest equipment that the rehabilitation clinic is equipped with can quickly relieve back pain patients.This method is necessary for the complete recovery of the patient.
One of the popular non-drug methods for local back pain relief is transcutaneous electrical nerve stimulation.This is pain relief using electrical impulses at the site of its localization.Another pain relief method used in hospitals is the biofeedback method.It was created at the intersection of psychology and physiology.A special device reads the information coming from the patient's body.After this, the computer model is formed on the screen.It clearly shows all the processes that occur in the body, including pain.If the patient does not return to normal daily activity levels 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 a program of drug treatment, patient education, therapeutic training and psychotherapeutic interventions, which are carried out regularly with the participation of several specialists (neurologists, vertebrologists, rheumatologists, psychotherapists, rehabilitation specialists, therapists).
Cognitive behavioral psychotherapy reduces back pain intensity and improves functional status.A program that combines behavioral psychotherapy with a gradual increase in physical activity allows patients 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 recovery are improved.Rehabilitation specialists at the hospital use ideomotor and passive exercises for back pain.
Passive exercises are carried out with various possible movements in the joint, in one direction, strictly in the same plane, at the same speed.The rehabilitator performs this, starting with the large joints, then gradually moving to the small joints.Ideomotor training is used to restore the damaged path of transmission of nerve impulses from the center to the periphery.They are widely used for persistent pain syndromes.
For patients with muscle weakness, rehabilitation therapists prescribe active isometric muscle exercises.The patient performs it without relaxing and holding his breath, while maintaining tension.This exercise improves blood circulation in spasmodic muscles, prevents muscle wasting, and restores the transmission of nerve impulses.When increasing muscle strength, active dynamic exercises are used from a light starting position.When it is done, the attachment points of the antagonist muscles are brought closer together, and the attachment points of the trained muscles are separated as much as possible.
In some cases, surgery is used to treat back pain.To avoid surgery, if you have back pain, contact 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 rehabilitation therapy at the rehabilitation clinic using the latest equipment and innovative techniques.