Up to 76% of the population experiences back pain during the year;in 7% of cases, patients complain of acute back pain.Hospital rheumatologists use the latest instrumental and laboratory research methods to determine the cause of back pain.For pain relief and further treatment of patients, doctors prescribe modern drugs that are very 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 caused by muscle spasm.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 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:
- Spondylosis and intervertebral osteochondrosis;
- Dysfunction of the muscular-ligamentous apparatus of the back;
- Intervertebral disc herniation.
Psychogenic back pain in its pure form is rare.It is difficult to make a diagnosis because a patient suffering from a psychological disorder often has comorbid musculoskeletal and other neurological disorders that can cause pain.In patients younger than twenty and over fifty, secondary pain syndrome prevails.
Doctors consider pain that lasts less than six weeks to be acute, pain that lasts six to twelve weeks is subacute, and pain that lasts longer than twelve weeks is chronic.Pain in the back muscles 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 in diagnosing the causes of various pains and treating them.
Causes of back pain
One of the most common causes of back pain is traumatic lesions of the spine that 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 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 tumors of the spine;
- Fascia damage;
- Muscle spasm.
Causes of chronic back pain can be diseases of internal organs (heart, lungs, kidneys), burns, cancer pathology, sedentary lifestyle and emotional overload.Severe back pain can be caused by uncontrolled use of certain medications.If the 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 in men and diseases of the reproductive system in women.Pain in the spine in the middle of the back can be a manifestation of myocardial infarction.Pain under the ribs from the back occurs with intercostal neuralgia.
Recently, in clinical guidelines dealing with the problem of back pain, the expression "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 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 the data of 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.
X-ray examination has an important diagnostic value for back pain.Standard diagnostic methods include radiography in anteroposterior and lateral projection, functional spondylograms in the position of maximum flexion and extension.Computed tomography and magnetic resonance enable the localization of the pathological process to be clarified.
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 (determining the density of bone tissue);
- Electroneuromyography;
- Spiroarteriocardiorhythmography.
Patients undergo a complete blood count, urinalysis, tests for C-reactive protein and rheumatoid factor.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 horse's tail, traumatic, tumor, inflammatory and infectious lesions of the spine, osteoporosis and diseases of internal organs);
- Compression radiculopathy;
- Benign musculoskeletal back pain.
Only after determining the exact cause of back pain, doctors draw up a treatment plan for the patient.
Treatment of back pain
The pain syndrome is based on 2 main mechanisms that determine the treatment of a patient with back pain: damage to the spine and spasm or stretching of muscles and ligaments.From the first day of treatment, patients are prescribed non-steroidal anti-inflammatory drugs (NSAIDs).Their anti-inflammatory action is a consequence of cyclooxygenase-2 inhibition.NSAIDs not only inhibit the metabolism of this inflammatory mediator, but also actively affect the production of prostaglandins associated with calcium mobilization 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 for 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 sustained 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 concurrent depression.Pepper plasters can be used for short-term pain relief.
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 activity 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 action on the affected areas: painkillers are injected into precisely defined areas with the help of radiography.Blocking pain impulses in combination with a set of individual treatments 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 physiotherapy exercises start the tissue regeneration process and completely restore the motor functions of the spine.Therapeutic massage and myostimulation with the latest equipment that the rehabilitation clinic is equipped with can quickly relieve the patient of back pain.These methods are necessary for the complete recovery of the patient.
One of the popular drug-free methods for localized back pain relief is transcutaneous electrical nerve stimulation.This is the blockade of pain using electrical impulses at the place of its localization.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 the information coming from the patient's body.After that, a computer model of it is formed on the screen.It clearly shows all the processes taking place 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, he should be referred for chiropractic therapy.
Which doctor treats back pain?The hospital has a multidisciplinary approach to the treatment of patients with chronic back pain.It includes drug treatment programs, patient education, therapeutic exercises 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 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, tissue trophism and restoration are improved.Rehabilitators in the hospital use ideomotor and passive exercises for back pain.
Passive exercises are performed with the greatest 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 moves to the small joints.Ideomotor exercises are used to restore the damaged pathways of transmission of nerve impulses from the center to the periphery.They are widely used for persistent pain syndrome.
Rehabilitation therapists prescribe active isometric muscle exercises to patients with muscle weakness.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 easy starting positions.When performed, the attachment points of the antagonist muscle 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 alleviating acute spinal pain, patients undergo rehabilitation therapy in a rehabilitation clinic using the latest equipment and innovative techniques.