Lumbar pain is one of the most common reasons forcing patients to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be permanently paralyzing, making movement and self -treatment impossible. Acute lower back pain often occurs in both men and women. With greater frequency in middle age and old age, lower back pain can often be seen in adolescents and young adults. This is due to rapid growth, weakness of the fragile muscles of the lower back, injuries. Therefore, pain in the lumbosacral spine is the most pressing problem that anyone can face.
Possible Causes of Back Pain in the Lumbar Region
Pain in the lumbosacral spine may be related to processes occurring in the spine itself and beyond. . . Consider a major pathological condition in which acute lower back pain can be observed.
- The most common problem and cause of pain is lumbosacral osteochondrosis. . . It is caused by age -related changes in the spine, dystrophy (lack of nutrients) of the appropriate spinal and cartilage segments, and a decrease in spinal height. This pathological process causes bone growth and violation of nerve roots at the site of narrowing. As a result, severe pain develops in the lumbosacral back (spine). Osteochondrosis of the lumbosacral region develops more frequently in obese people, as well as in patients who have undergone prolonged physical exercise, contributing to the wear of all vertebral structures. Frequent injuries, falls on the back, weight gain, and osteoporosis simultaneously exacerbate the picture and course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (causing muscle tension) and ligaments in the process.
- Herniated discs are the same cause, its clinical manifestation is pain in the lumbosacral spine. The intervertebral disc (nucleus pulposus) with prolonged exposure to trauma, as well as with age, loses its elastic properties and elastic capacity. With constant exposure (overweight, trauma, progressive osteoporosis), the fibrous annulus of the disc becomes thinner, and defects form in it. Through a weak point in the annulus fibrosus, the nucleus pulposus of the disc can shift and even protrude.
A herniated disc is formed when the fibrous annulus ruptures and the nucleus pulposus compresses the nerve root elements leaving the spinal cord. Compression leads to the fact that the pain in the lumbar region becomes very intense, sometimes unbearable. Pain in the lumbosacral spine with disc herniation may be accompanied by sensory disturbances and various types of numbness at the appropriate decompression (compression) segment. Lower back pain radiates (gives) to the lower limbs, causing muscle tension due to spasms. Over a long period of time, a herniated disc causes chronic pain in the lumbosacral area. Muscle tension in the back, becoming persistent, further increases the pain syndrome, causing it to become chronic.
- Stenosis (narrowing) of the spinal canal- Pain in the lumbosacral back was noted in connection with prolonged walking or physical activity. Acute lower back pain may be accompanied by weakness in the legs, symptoms of spasms in the lumbar, gluteal muscles. With significant damage, there may be impaired sensory function.
- Tumor lesions on the lumbosacral vertebral segmentoften manifests itself in varying degrees of pain severity in the lumbar region. Usually, lower back pain gets worse as the process goes on. The nature of tumor lesions can be benign (vertebral cysts) and malignant (spinal tumors, or metastatic lesions by distant tumors). By morphological properties, tumors can be osteosarcoma, hemangiomas, or develop as a result of myeloma. Pain in the lumbosacral region with this pathology often bothers the patient day and night (continuously, without light gaps), increases at rest, with trembling, knocking. Lower back pain is accompanied by muscle tension, cramps, sensory disturbances, weight loss, changes in the blood (anemia).
- Osteoporosis (bone loss)- quite often is the cause of pain in the bones from various places. Osteoporosis develops as a result of accelerated excretion of calcium from the bones, as a result of which all bones become brittle, prone to fractures with little mechanical stress (often of a domestic nature). Pain in the lumbosacral posterior osteoporosis combined with other pain in the bones, has a degree of pain syndrome. Pain in the lumbar region can cause muscle tension, cramps, often combined with a decrease in height of the patient. The most common type of osteoporosis is postmenopausal, which develops in women after the extinction of ovarian function.
- Ankylosing spondylitisoften, along with pain throughout the spine, is characterized by pain in the lumbar region and ileosacral joints. The disease causes stiffness in the spinal space, and involvement of other peripheral joints in chronic processes.
In addition to this condition, pain in the lumbar region may be due to the following reasons unrelated to vertebrogenic deformities:
- kidney disease, renal pelvis(exacerbation of chronic pyelonephritis), renal urolithiasis, renal neoplastic disease and tumor metastasis to the kidney. At the same time, pain in the lumbar region is localized relatively high (at the site of renal projection), pain in the lumbosacral region is not very common. Pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urinalysis, temperature reactions);
- diseases of the upper gastrointestinal tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) at certain localizations sometimes manifest themselves as pain in the lumbosacral region. But back pain is not associated with movement, it can be combined with other complaints (vomiting, stool disturbances, nausea, burning along the esophagus);
- Acute back pain, in some cases, may occurfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during menstruation, or just before them. During pregnancy, there is also heaviness and pain in the lumbar and sacral areas;
- deformity of osteoarthritis of the hip joint(coxarthrosis), especially with a deteriorating process, in addition to walking disorders, difficulty walking, it can cause pain in the lumbosacral region, in the area of the gluteal region muscles on the side of the appropriate lesion, tension in the muscles of the lower back and buttocks.
Acute lower back pain: what to do?
If a patient experiences acute back pain in the lumbar region, it is necessary to immediately seek the help of a qualified specialist to diagnose the cause of the emerging pain. More often, the patient goes to a neurologist, where, after making an accurate diagnosis (X-ray examination, computed tomography, MRI) and neurological examination, he is diagnosed with spinal disease.
In the absence of convincing data for spinal pathology (osteochondrosis, herniated disc), additional methods (ultrasound imaging of internal organs, densitometry, pelvic ultrasound) and consultation of relevant specialists (oncologists, gynecologists, endocrinologists) may be required.
Treatment of back pain in the lumbar region
Acute lower back pain, as prescribed by a doctor, is stopped by non-steroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxation, rest, bed rest, use of anti-inflammatory ointments, the imposition of compresses. Treatment in the acute phase can be done at rest, or in a polyclinic.
Prescribing drugs that increase microcirculation, with acute back pain, restrictions are used. Sometimes, with the ineffectiveness of other types of therapeutic effects, they resort to surgical treatment (with nerve root compression). When combined with osteoarthritis, chondroprotectors are used for a long time, in osteoporosis - calcium and vitamin D3 preparations. Physiotherapeutic effect (provided there are no contraindications), physiotherapy training, and at the stage of recovery - follow -up treatment in the sanatorium can be used.