Up to 76% of the population suffers from back pain during the year;In 7% of cases, patients complain of acute back pain.Rheumatologists at the hospital determine the cause of back pain using the latest laboratory and instrumental research methods.To relieve pain and better treat patients, doctors prescribe modern medications 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 exist?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: muscle tonic in the form of syndromes of the piriformis, gastrocnemius and gluteus muscles, neurovascular and neurodystrophic.
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 musculoligamentous apparatus of the back;
- Intervertebral disc herniation.
Psychogenic back pain in its pure form is rare.It is difficult to diagnose because the patient suffering 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 that lasts less than six weeks to be acute, pain that lasts between six and twelve weeks is subacute, and pain that lasts more than twelve weeks is 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 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 physical activity and stereotypical sports.These 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 spine.
Microtrauma can occur as a result of a failed 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, oncological pathology, sedentary lifestyle and emotional overload.Severe back pain can be caused by uncontrolled use of certain medications.If your back pain radiates to your 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 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.It denotes pain associated with musculoskeletal disorders without signs of damage to the cervical, thoracic, lumbar and sacral roots, or specific spinal injuries.
Determine the cause of back pain.
The hospital has unique diagnostic capabilities that allow it 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 of a patient with back pain includes the following diagnostic measures:
- X-ray examination of the spine;
- CT scan;
- Magnetic resonance imaging.
X-ray examination has 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);
- MRI or CT scan 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.The differential diagnosis of acute back pain is made 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 make a treatment plan for the patient.
Treatment for back pain
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).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 muscles.For muscle pain in the back, patients are prescribed muscle relaxants.
If analgesics and non-steroidal anti-inflammatory drugs do not produce any effect or if there are contraindications to their use, weak opioids (codeine, tramadol) are used to reduce severe back pain.Potent opioids are used in the form of transdermal therapeutic systems with gradual and 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 or resume normal daily activities 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 consists of a targeted effect on the affected areas: analgesics are injected using x-rays into exactly defined areas.Blocking pain impulses in combination with a set of individual treatment procedures can relieve the patient from back pain for a long time.
Doctors at the hospital 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 demonstrated.Individually selected physiotherapy exercises start the process of tissue restoration 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 patient's complete recovery.
One of the most popular non-pharmacological methods for relieving localized back pain is transcutaneous electrical nerve stimulation.It is a blockage of pain through electrical impulses at the site 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 the information coming from the patient's body.After this, a computer model 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, referral for chiropractic therapy is necessary.
Which doctor treats back pain?The hospital takes a multidisciplinary approach to treating patients with chronic back pain.These are programs of pharmacological treatment, patient education, therapeutic exercises and psychotherapeutic interventions, which are carried out periodically with the participation of various specialists (neurologist, vertebrologist, rheumatologist, psychotherapist, rehabilitator, 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.Hospital 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 large joints, and then gradually moving 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 or holding their breath, maintaining tension.These exercises improve blood circulation in spasmodic muscles, prevent muscle atrophy and restore the transmission of nerve impulses.When increasing muscle strength, active dynamic exercises are used from light starting positions.When performed, the attachment points of the antagonist muscles are brought closer together and the attachment points of the trained muscle are moved as far apart 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 comprehensive treatment.After relieving acute pain in the spine, patients undergo rehabilitation treatment in a rehabilitation clinic using the latest innovative equipment and techniques.