Left back pain

Pain in the left side of the back can have different localization and accumulate in the area of ​​the shoulder blade, chest, under the ribs or in the lower back. The pain syndrome can be of a different nature (acute, dull, aching, shooting) and sometimes acquires chronic status. In case of acute back pain on the left, you should immediately consult a doctor, as they can signal the development of very serious pathologies.

Pain syndrome in the left side of the back can be primary (nonspecific), secondary (specific) and reflected (arising due to diseases of the internal organs).

Types of lumbar pain

For lower back pain in women, the causes begin to be identified by determining the type of pain. They can be either acute periodic or constant aching or “radiating” to other parts.

Drawing-aching pain

Nagging and aching pain in the lower back in women most often indicates the following diseases:

• osteochondrosis, intervertebral hernia or other processes in the spine, in which the elasticity and ability of bone tissue to withstand loads during movement are lost;
• inflammation of the lower back muscles or female genital organs, which occurs, for example, during hypothermia;
• kidney diseases, which include pyelonephritis, glomerulonephritis, urolithiasis, etc.;
• characteristic spinal injuries can lead to frequent lower back pain;
• Some women experience lower back pain at the beginning of menstruation or during pregnancy.

Sharp and sharp pain

Often sharp pain in the lower back in women “spreads” to the lower limbs and makes it difficult to move. Acute pain may result from:

• inflammation or pinching of the sacral plexus nerve for various reasons;
• infectious diseases, tumors;
• spasms of the piriformis muscle;
• spinal injuries or problems with bone strength, etc.

Shingles

Lumbar girdling pain, as a rule, indicates ailments of adjacent organs and systems. Exacerbation of pyelonephritis, cholelithiasis, pancreatitis, problems with the heart or esophagus - this is a common cause of back pain in the lumbar region in women at night. This type of pain is an alarming signal and a reason to immediately consult a doctor; self-medication can lead to serious negative consequences for the entire body.

Causes of left back pain

Pain in the left side of the back may indicate various pathological processes in the body:

• diseases of the cardiovascular system (angina pectoris, small focal myocardial infarction, aortic aneurysm, pericarditis);
• diseases of the respiratory system (pleurisy, spontaneous pneumothorax, pneumonia, tumor processes in the lungs or bronchi);
• diseases of the digestive system (acute pancreatitis);
• diseases of the urinary system (renal colic and renal artery thrombosis, retroperitoneal hematoma);
• damage to the spinal cord and peripheral nervous system;
• degenerative-dystrophic lesions of the spine (osteochondrosis, spondyloarthrosis)
• injuries and bruises;
• inflammatory processes;
• infectious lesions.

Sometimes the appearance of pain is triggered by psychogenic factors. In this case, the syndrome develops under the influence of depression and severe emotional stress.

Causes of lower back pain in women

Features of lower back pain in women are associated with the structure of the female body, in particular, the reproductive system and urinary tract, as well as hormonal “shifts” and other factors.

Diseases of the spinal column

Pathologies of the spinal column that cause back pain in the lumbar region in women include osteochondrosis and, as a result, hernias and pinched nerves. This disease is associated with wearing uncomfortable high-heeled shoes, a sedentary lifestyle, or, conversely, excessive stress. Pain due to spinal diseases can affect the lower limbs, coccyx, sacrum and interfere with normal motor activity.

Physical inactivity

Another reason why lower back pain in women is lack of movement or physical inactivity, leading to muscle atrophy. As a result, the physiological position of the spinal column is disrupted, protrusions and hernias form, causing pain in various parts of the back.

Hypothermia

The summer period is characterized by back pain associated with muscle inflammation after hypothermia. It is in hot weather, when sweating is increased, that even the slightest draft is dangerous for the lower back. Pain may also be accompanied by weakness, swelling, and insomnia. The best solution to this problem is bed rest, ointments that have a warming effect, and warming up.

Pregnancy

Lower back pain in women during pregnancy can be divided into two categories:

• pain in the first trimester of pregnancy, which is an alarming symptom of the onset of a miscarriage. They may be accompanied by discharge, temperature, etc. In this case, immediate medical intervention is required;
• intensive growth of the fetus, preparation of the pelvis for labor, changes in the center of gravity and redistribution of the load - this is what causes lower back pain in women in late pregnancy.

Pathology of the reproductive system organs

The female pelvic organs are located in such a way that pathologies in their structure (ovarian cysts, adnexitis, ectopic pregnancies, endometriosis and others) can manifest as girdle pain in the lower lumbar region.

A characteristic feature of such pain is the absence of its manifestation during movement, intensification or weakening in accordance with the female cycle. Chronic diseases often cause shooting pains that radiate to the rectum.

Menopause

During menopause, a woman experiences changes in hormonal levels; they cannot pass without leaving a mark on the bone tissue, which becomes fragile and susceptible to osteochondrosis - this is why women have lower back pain during this period. It is important to monitor your diet and perform light exercise to strengthen your muscles.

Menstruation

A woman's hormonal background influences the occurrence of pain during menstruation. The hormone progesterone lowers the pain threshold, which makes even minor contractions of the uterus painful. Also, pain during this period may be associated with irritation of the intestinal walls due to the action of hormones, fluid retention, which expands both organs and tissues, which begin to put pressure on the lumbar spine.

Excessive physical activity

Along with physical inactivity, physical overload of a woman’s body also leads to lower back pain. Excessive stress on untrained muscles causes spasms and affects the nerve endings located along the spinal column. Typically, such pain goes away quickly and does not require treatment or observation by a specialist. But if discomfort persists for a long time, you should consult a doctor.

Kidney and urinary tract diseases

Lower back pain is often due to kidney or urinary tract diseases. Pyelonephritis, cystitis, urolithiasis, along with pain, provoke an increase in temperature, the appearance of blood or pus in the urine, sweating and other symptoms.

Bust size

The size of the mammary glands can also affect discomfort. Pulls the lower back in women, especially those with a thin build, due to the additional load on the spinal column that large breasts create. Properly selected underwear or a corset can help reduce pain.

Climax

Female menopause is associated, first of all, with the cessation of the functioning of the ovaries and changes in the structure of this organ due to hormonal changes, which can cause pain in the lumbar region. Additionally, a woman is worried about such manifestations of menopause as increased sweating, flushing of the face, etc. Once menopause ends, the pain goes away on its own.

Excess weight

The human muscular corset performs the task of distributing the load during the operation of the musculoskeletal system. Increasing weight with weak muscles leads to additional tension, tears and other negative consequences that can cause pain in the lumbar back. In order to avoid this, a woman needs to monitor her weight and strengthen her muscles.

Oncology diseases

Lower back pain in women can sometimes indicate cancer. Bone cancer affects spongy bone tissue, which includes the vertebrae. Pain in the early stages is periodic, then the pain intensifies, and motor function is impaired. In this case, the woman needs multifunctional treatment, taking special medications prescribed by the doctor.

High heels

Women who abuse stiletto or high-heeled shoes are at high risk of developing spinal diseases due to improperly distributed load on the foot. This is especially true for people who have a genetic predisposition to flat feet, scoliosis, etc. Shoes should be as comfortable as possible; it is better to opt for orthopedic models.

Diagnosis and treatment of back pain in postmenopausal women

In recent years, there has been a steady increase in the number of patients with pathology of the musculoskeletal system (Waddell G., 1994). Chronic back pain affects up to 30% of the population in developed countries (Aronoff G. M., 1992, Bonica JJ, 1990).

In our country, the prevalence of vertebrogenic pain syndromes among the adult population reaches 62% in some regions.

Among the most common diseases, in the clinical picture of which pain syndrome predominates, are dorsopathies.

Dorsopathies are a group of diseases of the musculoskeletal system and connective tissue, the leading symptom complex of which is pain in the trunk and limbs of non-visceral etiology.

Degenerative changes in dorsopathy

Various structures of spinal motion segments may be involved in the degenerative process: intervertebral disc; facet joints; ligaments; muscles.

Dystrophic changes in the spine can vary in location.

Dystrophic changes in the disc: spondylosis (formation of spondylous marginal bone growths); Osteochondrosis is a pathology of the disc core.

A disc herniation should be considered as a manifestation of spinal osteochondrosis. The formation of pain syndrome during disc herniation is influenced by:

• violation of the biomechanics of the motor act;
• violation of posture and balance of the muscular-ligamentous-fascial apparatus;
• imbalance between the anterior and posterior muscle girdle;
• imbalance in the sacroiliac joints and other pelvic structures.

The following main diagnostic criteria for lumbar intervertebral disc herniation are distinguished:

• the presence of vertebrogenic syndrome, manifested by pain, limited mobility and deformities (antalgic scoliosis) in the affected part of the spine; tonic tension of paravertebral, as well as other muscles, the degree of involvement of which is determined by the intensity of nociceptive impulses from the affected SMS and compressed root;
• sensory disorders in the area of ​​the neurometamere of the affected root;
• motor disturbances in the muscles innervated by the affected root;
• decreased or lost reflexes;
• CT, MRI or X-ray data verifying the pathology of the intervertebral disc, spinal canal and intervertebral foramina;
• data from electroneurophysiological studies (F-wave, H-reflex, somatosensory evoked potentials, transcranial magnetic stimulation), recording conduction disturbances along the root, as well as the results of needle electromyography with analysis of action potentials of motor units, allowing to establish the presence of denervation changes in the muscles of the affected myotome;
• the presence of relatively deep biomechanical disturbances in motor compensation.

Dystrophic changes in the joint - spondyloarthrosis.

Dystrophic changes in the vertebral bodies - aseptic necrosis (Kümel's disease); vertebral dystrophy - the strength of the vertebrae decreases, the disc straightens and gradually penetrates into the bodies of neighboring vertebrae - the shape of the disc is formed in the form of a biconcave lens.

In recent years, due to an increase in the proportion of elderly people in the population, among whom postmenopausal women predominate, the problem of dorsopathies is also considered from the point of view of the role that osteoporetic disorders play in the development of this process.

Osteoporosis is defined as “a systemic skeletal disease characterized by decreased bone mass and deterioration of bone microarchitecture, leading to increased bone fragility and risk of fracture.” According to some estimates, osteoporosis is found in more than 30% of women over 50 years of age.

The development of postmenopausal osteoporosis is primarily associated with insufficient estrogen production, which leads to disruption of the synthesis of local mediators of bone tissue remodeling.

With age, other important mechanisms play an increasingly important role in the progression of osteoporosis, the main of which is vitamin D deficiency and the development of resistance of a number of tissues, including skeletal bones, to the effects of this vitamin.

The following risk factors for the development of osteoporosis can be identified:

• genetic and anthropometric: old age, low bone mass, ethnic predisposition (Caucasian and Mongoloid races);
• hormonal: female gender, early menopause, late onset of menstruation, amenorrhea, infertility;
• lifestyle: dietary habits, smoking, low physical activity, caffeine abuse;
• the presence of concomitant diseases: endocrine, rheumatic, hematological, tumor, etc.;
• long-term use of medications, surgical operations: glucocorticosteroids, chemotherapy, oophorectomy, removal of the thyroid gland.

The most common causes of secondary low back pain in postmenopausal women are:

• congenital anomalies: Spina bifida, spondylolisthesis;
• trauma: vertebral fractures, protrusion of intervertebral discs;
• arthritis, including reactive arthritis, ankylosing spondylitis, etc.;
• other diseases: metabolic (osteoporosis), tumors, infections (tuberculosis, osteomyelitis), mental illness;
• projection pain in diseases of the internal organs: ulcer or tumor of the posterior wall of the stomach, inflammation, cyst or tumor of the pancreas, dissecting aneurysm of the abdominal aorta, colon tumors;
• diseases of the genitourinary organs: urolithiasis, endometritis, uterine prolapse, uterine cancer.

The diagnostic algorithm for a doctor’s actions when a postmenopausal patient comes to complain of lower back pain is presented in Fig. 1.

First of all, the doctor takes a medical history and performs a physical examination of the patient.

Then, in the absence of neurological deficit, it is necessary to conduct an x-ray examination of the lumbar and sacral spine. In this case, the following pathological changes can be diagnosed: metabolic bone diseases (osteoporosis, osteomalacia, hyperparathyroidism), osteoarthritis, compression fracture, ankylosing spondylitis (Bechterew's disease), spondylolisthesis, tumors (hemangioma, osteosarcoma, metastases, osteoma, myeloma), spinal osteochondrosis, urolithiasis disease.

If no pathological changes are detected during X-ray examination, it is necessary to conduct a manual examination of the pelvic organs (rectal, vaginal). Endometriosis, tumors in the pelvic area, infections of the pelvic organs (abscess, cervicitis) can be diagnosed.

If there are no pathological changes in the pelvic organs, it is necessary to conduct a computer or magnetic resonance examination. In this case, the following pathological changes can be detected: infectious process (osteomyelitis, tuberculosis, syphilis), retroperitoneal tumors, intervertebral disc herniation, spinal canal stenosis.

In the absence of the above diseases, it is necessary to do a clinical blood test and determine the erythrocyte sedimentation rate (ESR). If ESR increases, it is necessary to exclude rheumatism and spinal tuberculosis. If the ESR is normal, it should be taken into account that back pain can be caused by sprained muscles and ligaments, varicose veins of the pelvis, and psychosomatic disorders.

If a physical examination reveals neurological deficits or other abnormalities, a computer or magnetic resonance imaging study should be performed. In this case, the following pathological changes can be detected: abdominal aortic aneurysm, intervertebral disc herniation, spinal compression fracture, spinal tumors, epidural abscess of the lumbar spine (Fig. 2).

The main factors in the etiopathogenesis of back pain in elderly women are:

• metastatic lesion of the skeleton;
• osteoporosis, manifested by bone deformities;
• spinal osteochondrosis, complicated by disc herniation, spinal canal stenosis.

Differential diagnosis of lumbar dorsopathy

Visceral pathology:

• pancreatitis, pancreatic tumor;
• peptic ulcer;
• nephrolithiasis, pyelonephritis;
• renal vein thrombosis;
• abdominal aortic aneurysm;
• ovarian tumors, cysts;
• inflammatory processes of the abdominal and pelvic organs.

Spinal lesions:

• primary bone lesions (osteoporosis, osteomalacia);
• vertebral lesions (metastases, myeloma, fractures, spondylitis, primary tumors);
• degenerative diseases of the spine leading to gross changes, including intervertebral hernias, spinal stenosis.

Treatment of back pain in postmenopausal women

To treat dorsopathies, a number of methods are used, which include medications, including enzyme therapy, orthopedic, physiotherapy, massage, electroacupuncture, manual therapy, etc. (Khabirov F.A.). However, none of the listed methods fully meets modern requirements in terms of effectiveness and tolerability. In particular, this applies to the use of non-steroidal anti-inflammatory drugs (NSAIDs), which have a pronounced analgesic effect. However, along with reducing inflammation and pain, drugs in this group often cause adverse side effects, such as damage to the mucous membrane of the stomach and intestines (“ulcerogenic effect”), impaired renal function, platelet function, etc.

In recent years, the group of NSAIDs has been supplemented with new drugs - so-called selective cyclooxygenase-2 inhibitors. A distinctive feature of these drugs is a more selective inhibition of the activity of one of the 2 isoforms of the key enzyme in the biosynthesis of prostaglandins - cyclooxygenase-2 (COX-2), which, according to modern concepts, is responsible for the biosynthesis of these anti-inflammatory and algogenic substances in the lesion. inflammation. At the same time, new NSAIDs have a slight effect on another isoform of this enzyme - cyclooxygenase-1 (COX-1), which carries out the biosynthesis of prostaglandins outside the focus of inflammation. The prostaglandins formed with its participation are important physiological regulators of microcirculation in the mucous membrane of the gastrointestinal tract and kidneys, gastric secretion, blood cell functions, etc. It is the non-selectivity of the action of “old” NSAIDs in relation to COX-1 and COX-2 that is considered as the cause of the development most of the side effects they cause. At the same time, selective COX-2 inhibitors have demonstrated a high level of safety in controlled clinical trials.

Celebrex and Movalis are new specially developed drugs in this group that have minor side effects on the gastrointestinal tract.

Celebrex (celecoxib) is a new specially developed drug in this group that has minor side effects on the gastrointestinal tract and is highly effective, comparable to the “gold standard” NSAID - diclofenac.

Celebrex is recommended for use in a dose of 200 mg 2 times a day in the complex treatment of patients with severe pain syndrome due to dorsopathy.

Celebrex does not cause platelet aggregation, does not have a negative effect on cartilage tissue and combines well with antihypertensive drugs (ACE inhibitors) and oral hypoglycemic drugs (glibenclamide and tolbutamide)

From the point of view of the speed of achieving the effect, parenteral and rectal routes of administration of non-steroidal anti-inflammatory drugs have an advantage.

Local use of analgesic ointments, gels, creams, characterized by a high content of non-steroidal anti-inflammatory drugs, is indicated.

Finalgel is a gel consisting of piroxicam. Penetrates well into subcutaneous fatty tissue, muscles and ligaments. Has an analgesic, anti-edematous, cooling effect. Directions for use: squeeze out the gel in a volume of 3 cm, rub well. Use 3-4 times a day.

Finalgon is an ointment containing two drugs: nonivamide, a synthetic derivative of xapsaicin, a locally irritating substance isolated from pepper, and nicoboxil, a derivative of nicotinic acid, which has a pronounced vasodilator effect. The main thing in the mechanism of action of finalgon is the stimulation of skin-visceral receptors. As a result of increased blood flow in the affected area, pronounced analgesic, antispasmodic and warming effects are observed, and local blood circulation improves. Method of use of the drug: approximately 0.5 cm of ointment is squeezed out of the tube; The drug is applied to a palm-sized area of ​​skin; to enhance the therapeutic effect, you can cover the sore spot with a woolen cloth.

To relieve tonic muscle tension during back pain in postmenopausal women, centrally acting muscle relaxants are used. Drugs in this group do not affect neuromuscular transmission and at the same time reduce the tone of skeletal muscles as a result of inhibition of mono- and polysynaptic reflexes by reducing the release of excitatory amino acids (glutumate and aspartate). It should also be noted that these drugs have a moderate analgesic effect.

The use of medications that have a positive effect on bone tissue also becomes of great importance in the treatment of dorsopathies (including those developing against the background of osteoporosis). Such drugs include preparations based on vitamin D, its active metabolites and derivatives.

Vitamin D plays an important role in the functioning of the body as a whole. It can be considered as a leading factor in maintaining calcium homeostasis; in addition, this vitamin is involved in key processes of skeletal formation and bone tissue remodeling. The main mechanisms of action of vitamin D are: increased absorption of calcium in the intestine, activation of bone remodeling processes, suppression of excessive secretion of parathyroid hormone, improvement of neuromuscular conduction and contractility of motor muscles.

Alfacalcidol, 1α-hydroxyvitamin D3, is a synthetic analogue of the active metabolite of vitamin D3, calcitriol. This drug is a prodrug, that is, a substance that turns into an active form after entering the body. As a rule, prodrugs are better tolerated, last longer, and are more effective. Alfacalcidol is characterized by a longer period of existence in the body than calcitriol, which allows it to be prescribed 1 or 2 times a day; in addition, unlike preparations of native vitamin D, alfacalcidol does not require re-hydroxylation in the kidneys, and in one stage it turns into active metabolite of vitamin D. Taking into account the reduced activity of the kidneys in elderly people, who have a reduced ability to form calcitriol, the use of alfacalcidol for a lack of vitamin D in the body can be considered justified.

When choosing therapy for postmenopausal women with back pain, an individual approach is required - the clinical manifestations of the disease, structural features of the spine, the stage of the pathological process, and the presence of concomitant pathologies should be taken into account.

Thus, osteoporetic and biomechanical disorders play an important role in the pathogenesis of dorsopathies in postmenopausal women.

The diagnostic algorithm for dorsopathy should include an assessment of the condition of bone tissue (densitometry, CT).

Complex treatment of dorsopathies in postmenopausal women involves the combined use of non-steroidal anti-inflammatory drugs and preparations of the active metabolite of vitamin D.

T. T. Batysheva, Candidate of Medical Sciences G. Ya. Shvarts Polyclinic for Rehabilitation No. 7, Moscow

Diagnostic methods

After an appointment with a specialist, the following diagnostic control methods are usually used:

• ultrasound examination of the kidneys, pelvic organs and abdominal area;
• X-ray of the spine to check for changes in the intervertebral discs;
• MRI image, reflecting a broad picture of the processes occurring in the spine;
• biochemical analysis of blood, urine, cerebrospinal fluid, etc.

When determining the source of a painful symptom, a highly specialized specialist may prescribe additional types of studies based on the patient’s medical history.

Treatment of lower back pain in women

After discovering unpleasant sensations in the back that are interfering with an active life, you need to consult a doctor without wasting time. Specialists at the Aspect Health clinic in Ufa provide consultation, diagnosis and treatment of lower back pain in women. Timely help from a professional for back pain in the lumbar region will help prevent serious consequences in time and stop the disease at its initial stage.

Diagnosis of back pain on the left

Diagnostic methods are aimed at identifying the underlying disease causing the development of pain. If pain is observed in the scapula area, you should consult a cardiologist. Cough and difficulty breathing accompanying pain syndrome require consultation with a pulmonologist. You may also need to be examined by a neurologist, gastroenterologist, gynecologist, urologist, surgeon and other specialists.

To establish a diagnosis, a number of laboratory tests are performed. The most informative diagnostic methods include x-ray, MRI and CT (if necessary).