Back pain above the lumbar region - nature of pain, causes, prevention of back pain above the lumbar region

Character of pain above the lower back

The pain can be chronic, acute, nagging, accompanied by numbness or tingling. It also differs in intensity - from barely noticeable to unbearable, when even a small movement leads to severe discomfort:

Sharp, “shooting” pain in the lower back and above indicates pathologies of the spinal column.
Lower back pain, radiating to the sides just above the lower back, accompanies diseases of the musculoskeletal system. This also includes injuries, serious degenerative processes in the spine, and rheumatological ankylosing spondylitis.
Discomfort when inhaling indicates the presence of intercostal neuralgia.
When moving, pain occurs in cases of osteochondrosis, damage to the intervertebral discs. Sometimes they can spread to the groin area and lower extremities. An increase in unpleasant sensations is observed with increased physical activity.
Local pain areas accompanied by numbness of the limbs indicate a compression injury to the spine.
Chronic pain, independent of body position and stress, accompanied by weight loss should alert you - this is a common symptom of tumors in the spine. It is typical that when taking painkillers in this case, the pain still remains.
Constant “shooting” pain in the lower back and above, increased temperature is a sign of infectious inflammation in the spinal column. A blood test will help determine this.
Girdle pain above the lower back, radiating to the collarbones and under the shoulder blades, is a signal of an attack of acute pancreatitis. An additional symptom may be vomiting.
Intense pain in the thoracic region, radiating to the area above the lower back, tachycardia, are a sign of an aortic aneurysm.
In the area of the shoulder blades there is a sharp, nagging, throbbing pain in various locations (under the shoulder blade, on the left, between the ribs) that varies in duration (periodic, with a sharp onset, intensifying). The main causes are: intercostal neuralgia, angina pectoris, osteochondrosis, scapular-costal syndrome or gastric ulcer.

Often pregnant women complain of back pain above the lower back. This is due to the increasing load on the spine and a possible shift in the woman’s center of gravity. Women who, before pregnancy, had osteochondrosis, curvatures of various types, and poorly developed muscle corset are especially susceptible to back problems.

Back pain in the spinal area: epidemiological significance of the symptom

People often complain of back pain in the spinal region. Statistics say that about 70-80% of people experience at least one episode of such pain during their lives. Therefore, this is an unusually pressing medical problem.

Therefore, medical statistics have collected a large amount of epidemiological data about this symptom. It is known that 40-80% of people experience back pain in the lower part of the spine. The percentage of patients seeking help for pain in the thoracic and cervical regions is somewhat lower.

In 10-20% of patients of working age, acute pain in the spine transforms into chronic pain. It is this category of patients that often has an unfavorable prognosis for complete recovery, so that healthcare costs for treating people of working age with chronic back pain in the spinal region account for about 80% of all funds aimed at treating this symptom.

Causes

The most commonly observed are so-called nonspecific back pain associated with muscle strain caused by uncomfortable posture or stereotypic movements. Often the trigger for the occurrence of such pain is hypothermia. As a rule, nonspecific back pain disappears within 1-3 months after its occurrence. However, in 10-30% of cases, the pain syndrome recurs throughout the year, and in 10% of patients, nonspecific back pain becomes chronic.

The second most common cause of back pain in the spinal region is radiculopathy - damage to the nerve root at the point where it exits the spinal canal. Radiculopathy syndrome accompanies many spinal lesions, the most common of which is osteochondrosis.

Less commonly, back pain in the spinal area is caused by direct damage to the spinal column.

The most common spinal pathologies that cause back pain are:

osteochondrosis;
injuries (bruises, fractures, dislocations or subluxations of the vertebrae, torn ligaments, etc.);
hormonal spondylopathy (menopausal, postmenopausal and senile);
tuberculous spondylitis;
ankylosing spondylitis (Bechterew-Strumpel-Pierre Marie disease)

And finally, back pain in the spinal area may indicate damage to many internal organs. In such cases, the pain syndrome radiates along the nerve fibers, and the radiating pain can be stronger than the primary one, and even mask it.

Irradiation of back pain to the spinal region most often occurs in the following pathologies:

damage to the heart and great vessels (angina pectoris, myocardial infarction, dissecting aortic aneurysm);
lung diseases (pleurisy, malignant neoplasms);
liver diseases (acute and chronic cholecystitis);
lesions of the esophagus;
diseases of the pancreas (acute and chronic pancreatitis, pancreatic cancer);
kidney and upper urinary tract diseases.

Thus, back pain in the spinal area may indicate diseases of various organs and systems, so even experienced doctors who have all the achievements of modern medicine in their arsenal sometimes find it difficult to make a diagnosis.

In order to resolve the issue of the cause of back pain in the spinal region, you should first of all know the main syndromes accompanying lesions of the spinal column.

Causes of pain in the back and spine - video

Back pain due to damage to the spine. Main syndromes of vascular and neurological disorders

Spinal column and its parts: structure and functions

To understand the mechanism of development of vascular and neurological disorders in spinal lesions, it is necessary to know its basic anatomical and physiological features.

The spinal column is an elastic connection of the vertebrae, providing several vital functions at once:

the main axis that gives the body stability and mobility;
a spring that guarantees shock absorption to all tissues and organs during movement;
the receptacle of the spinal cord and the conductor of nerve fibers from the center to the periphery;
protection for part of the vessels supplying the brain.

The spine consists of five sections, each of which has its own functional characteristics:

Cervical.
Chest.
Lumbar.
Sacral.
Coccygeal

The structure of the upper spine is more fragile and thin. The function of nerves and blood vessels here prevails over the function of support and shock absorption.

Downwards the vertebrae become more and more massive. So the five sacral vertebrae form a single bone - the sacrum.

The main functions of the sacral region are to provide support and participate in the creation of the pelvis - a protective container for internal organs. The coccyx, consisting of five fused vertebrae, is a rudiment of the tail, and its participation in the work of the spinal column is minimal.

Therefore, lesions of the sacral and coccygeal spine cause pain in the lower spine in the sacral region, but are not accompanied by severe vascular and neurological disorders characteristic of the pathology of the upper sections.

The cervical, thoracic and lumbar regions consist of separate vertebrae - seven, twelve and five, respectively. The structure of all vertebrae, except the first and second cervical ones, is the same - there is a body located in front and a vertebral arch that limits the spinal canal at the back.

The vertebral bodies are connected to each other by intervertebral discs, which give the spinal column strength and elasticity at the same time. The fact is that each intervertebral disc has a nucleus pulposus inside, capable of elastic compression. Therefore, the spine is often compared to a spring.

Additional mobility of the spinal column is given by joints formed by the paired articular surfaces of adjacent vertebrae.

The entire structure is reinforced with a powerful ligamentous apparatus. In addition, the back muscles, which are a kind of corset for the spine, play an important protective and supporting role. Therefore, people suffering from back pain due to spinal damage are advised to perform exercises that develop the back muscles.

The mechanism of development of vascular and neurological disorders in spinal lesions

Pain from spinal injury is often accompanied by neurological disorders associated either with damage to the nerve roots leaving the spinal canal at the level of injury, or with damage to the spinal cord, or with circulatory disorders in the spinal cord caused by pinched vessels in the affected area.

Nerve roots pass through the openings between the vertebral bodies and supply certain parts of the body - segments. Therefore, by the localization of neurological disorders, the level of damage to the spine can be determined.

Regardless of the level of damage to the spinal column (cervical, thoracic or lumbar), damage to the nerve roots is characterized by the following features of the pain syndrome:

shooting character;
distribution along the course of innervation along the segment;
increased by coughing, sneezing, sudden movements in the affected part of the spine;
night pain.

In addition to pain, radicular syndrome is characterized by symptoms of disruption of the basic functions of the radicular nerves in the corresponding areas:

Sensory disturbances (crawling sensation, decreased sensitivity up to complete anesthesia).
Movement disorders (muscle weakness, paralysis).
Trophic disorders (hypotrophy and atrophy of tissues, development of degenerative changes in joints, etc.).

Damage to the spinal cord is manifested by the development of paralysis and loss of sensitivity below the level of the lesion. Such disorders are most typical for lesions of the cervical and thoracic spine. At the level of the first lumbar vertebra, the spinal cord passes into the filum terminale, accompanied by a bundle of nerve fibers (the so-called cauda equina).

The spinal canal also contains blood vessels that supply the brain and accompany the spinal roots, therefore, in case of damage to the upper parts of the spine, disturbances in the blood supply to the tissues may be evident.

Damage to the spine in the cervical region

Increased lability and relative vulnerability of the cervical spine causes a high incidence of injury (whiplash fractures of motorists, diver injuries, etc.). Often, the consequences of a seemingly minor spinal injury will remind you throughout your life of headaches.

However, the most common cause of pain in the cervical spine is osteochondrosis and other degenerative changes in the spine. Tumors and congenital anomalies of the structure of the spinal column are less common.

Pain in the cervical spine caused by damage to the spinal column may be accompanied by:

Compression of the spinal cord with total paralysis of the limbs, and impaired sensitivity below the level of the lesion;
Circulatory disorders of the brain;
Radicular syndrome.

Severe damage to the spinal cord at the level of the cervical vertebrae, as a rule, occurs with spinal injuries, and leads to paralysis of the diaphragm and disruption of the functioning of vital internal organs, which often leads to death.

The development of vascular insufficiency of the brain is characteristic of chronic degenerative lesions of the spine. The causes of circulatory disorders in such cases are indicated by the connection between headaches and other symptoms with movements in the cervical spine, or prolonged static load (uncomfortable head posture, including during sleep).

The most typical symptoms are:

headache;
fainting;
visual disturbances (flickering flashes, etc.);
cochleovestibular pathology (tinnitus, slight persistent hearing loss, rotational vertigo);
laryngopharyngeal symptoms (impaired swallowing, choking, cough, sometimes perversion of taste);
changes in the mental sphere (sleep disturbances, tearfulness, irritability, sometimes hysteria).

Pain caused by radicular syndrome in the cervical spine, as a rule, radiates from the cervical spine through the shoulder girdle, and further along the outer surface of the shoulder.

The most common injuries are to the lower cervical spine. In this case, the irradiation of pain reaches the fingers. The pain is accompanied by sensory disturbances in the same segment, and paresthesia in the most distant places of pain irradiation. The weakness of the innervated muscles (biceps or triceps) is pronounced, and their hypotrophy develops over time.

Damage to the thoracic spine

Pain with damage to the thoracic spine is extremely rarely accompanied by radicular syndrome. The fact is that the displacement of the vertebrae is prevented by a physiological corset of ribs.

However, quite often with some diseases of the spine, for example, with ankylosing spondylitis, pain occurs in the chest area, which is very similar in nature to radicular pain.

In such cases, pain is associated with damage to the small joints of the spine connecting individual vertebrae with the ribs (costovertebral and costotransverse joints). In this case, there is a sharp pain in the region of the costovertebral joints (at a distance of half a finger from the spinous processes of the spine). An additional symptom is pain when pressing on the ribs in the affected segments.

Compression of the spinal cord as a result of pathology of the thoracic spine is also rare. Damage to the spinal cord in the area of the thoracic vertebrae is manifested by paralysis of the lower extremities, impaired sensitivity below the area of damage, delayed passage of feces and urine, as well as trophic disorders in the lower half of the body and lower extremities.

Most often, compression damage to the spinal cord in the thoracic region develops with severe spinal injuries (including gunshots) and oncological pathology. In case of traumatic injury, compression syndrome develops acutely, in case of spinal tumors it develops gradually.

Spinal circulation disorders caused by pathology of the thoracic spine can occur both acutely and chronically.

However, regardless of the cause, the development of symptoms of severe spinal cord damage in the thoracic spine is an alarming symptom that requires medical intervention.

Pain in the lumbar spine. Lumbar syndromes

Pain in the lower part of the spine with damage to the lumbar region with the development of radicular and compression syndromes, as well as vascular insufficiency syndrome of the spinal cord.

Due to the heavy load and lack of rib protection, the lumbar region is most often affected. This is a favorite place for spinal disc herniations and displacement of individual vertebrae.

Radicular syndrome is the main and most striking sign of damage to the lumbar spine. Lesions of the last lumbar vertebrae are typical.

As a rule, a clear picture of compression of the nerve roots in the lumbar region develops after periods of “lumbago”, and is characterized by severe pain in the area of the affected vertebra with irradiation into the buttock, down the outer edge of the thigh to the anterior outer surface of the leg, and then to the foot to the toes. In this case, the localization of radiating pain in the toes (mainly in the first or fifth toe) has diagnostic significance for determining the level of damage.

Compression of the cauda equina is manifested by severe pain spreading to both legs, disturbances in the acts of defecation and urination, loss of sensitivity in the anogenital zone and on the inner thighs like “rider’s pants.”

Circulatory disorders of the spinal cord with damage to the lumbar spine are quite common, and in typical cases they manifest themselves as pain in the leg and lower back, as well as weakness of the foot.

Sharp pain in the lower spine with characteristic irradiation in reflex lumbar syndromes.

With lesions of the lumbar spine, radicular syndrome is very common, but pain of a reflex nature is even more common. In this case, a sharp pain that occurs acutely is called lumbago, and a chronic pain is called lumbodynia.

In both cases, sharp pain in the lower spine with characteristic irradiation to the lower extremities occurs reflexively, due to irritation of the receptors of the fibrous ring of the affected disc, joints and ligaments of the spine.

A typical attack of lumbago occurs in an inclined position of the body, most often while lifting something heavy. Acute pain in the lower spine is usually shooting in nature (“lumbago”); it is very strong, bursting. Patients say: “It’s as if a knife was stuck in the lower back.” So the patient cannot straighten up, and any attempt to move, cough or sneeze greatly increases the pain, causing the patient to freeze in one place.

With lumbago, natural immobilization of the affected segment occurs, which is manifested by smoothing of lumbar lordosis (the natural anterior curve of the spine), and often scoliosis (curvature of the spine).

Lumbodynia occurs, as a rule, after awkward movement, physical overexertion or hypothermia. However, unlike lumbago, it develops over several hours or days. The pain is not so sharp and may intensify when standing or sitting, especially when changing body position.

The deformity of the lumbar region in this case is less pronounced. with intense palpation of the spinous vertebrae, one can identify particular pain in the area of the affected segment.

Pain in the spine due to osteochondrosis

Osteochondrosis is the most common cause of back pain caused by damage to the spinal column. About 95% of patients seeking treatment for neck or lower back pain suffer from osteochondrosis.

The causes and mechanism of development of this pathology are still not fully understood. Some researchers consider osteochondrosis to be a natural result of the aging of the body, which, in the presence of certain genetic defects (hereditary predisposition), occurs ahead of time. Physical inactivity or, conversely, heavy physical labor associated with frequent bending and heavy lifting contribute to the development of osteochondrosis.

To understand the essence of the pain syndrome in osteochondrosis, it is necessary to know the mechanism of development of the pathology. At the first preclinical stage of the disease, degenerative processes occur in the intervertebral disc, leading to displacement of the nucleus pulposus. As a result, the stability of the spinal segment is disrupted.

At the second stage, the instability of the spinal segment is compensated by reactive changes in the bodies of adjacent vertebrae, as well as in their joints and ligaments. At this stage, radicular symptoms appear, and sometimes signs of impaired blood supply, or compression of the spinal cord.

At the next, third stage, an intervertebral disc ruptures, often with the formation of a spinal hernia. And finally, the fourth stage is characterized by the pathological process extending beyond the intervertebral disc.

The most characteristic of osteochondrosis is dyscalgia - acute pain in the spine caused by degenerative changes in the intervertebral disc. Dyscalgia is characterized by spread along the nerves of the affected segment and the addition of radicular symptoms (motor, sensory and trophic disorders).

It should be noted that the symptoms of osteochondrosis are polymorphic. Radicular pain is often accompanied by a pain syndrome caused by overstrain of the muscles that support the spinal column. Constant muscle hypertonicity, in turn, leads to compression of nerves and blood vessels by overstrained muscles, and the appearance of corresponding symptoms.

Thus, with osteochondrosis of the cervical spine, scalene muscle syndrome occurs, manifested by characteristic symptoms of compression of the subclavian artery and brachial plexus (swelling and pain in the arm, worsening in a horizontal position, decreased sensitivity and motor disturbances in the area of innervation of the ulnar nerve). By the same mechanism, piriformis syndrome occurs, manifested by symptoms of damage to the sciatic nerve compressed by the muscle (pain and trophic disorders in the lower leg and foot).

A very common symptom of spinal osteochondrosis is visceral pain. Particularly characteristic are dull aching pains in the heart that occur with osteochondrosis of the cervical spine. Another typical sign of damage to this part of the spine is headaches and other signs of impaired blood circulation in the brain.

A characteristic feature of visceral pain, regardless of its location, is the occurrence or intensification during movements, or prolonged static load on the affected part of the spine.

All of the pain syndromes described above will help to correctly diagnose and determine the location of the affected segment.

Spinal hernia

A herniated disc is usually a consequence of osteochondrosis. The impetus for the occurrence of pathology is any awkward movement or excessive physical effort. The most typical history: acute pain in the spine that occurred after lifting heavy objects. Statistics show that most often a herniated disc occurs during the holiday period, during travel that involves heavy lifting. This is why some researchers call spinal hernia a “suitcase disease.”

Pain from a herniated spine intensifies with movement, coughing, and sneezing. In cases of damage to the lumbar spine, pain often occurs when straining during bowel movements. The pain syndrome is often one-sided, so in the case of a typical lumbar hernia it is necessary to carry out a differential diagnosis with kidney damage.

Most often, spinal hernias occur in the lumbar region, less often in the cervical region, and extremely rarely in the thoracic region. Among the complications of spinal hernias is the development of spinal cord compression syndrome with the development of paralysis and sensory impairment below the site of the lesion. Spinal cord circulatory disorders caused by compression of blood vessels are often encountered.

Spinal fracture

The nature of pain from a spinal fracture depends on its type. Thus, with isolated fractures of the spinous processes of the spine, localized pain occurs in the fracture zone, and fractures of the transverse processes are characterized by pain radiating to the sides along the ribs.

In case of vertebral body fractures, the pain syndrome depends on the degree of stability of the fracture. For example, sometimes stable fractures of the vertebral bodies are practically asymptomatic and heal on their own. In severe cases, against the background of severe pain, signs of spinal cord compression develop, requiring immediate surgical intervention.

Aching and nagging pain in the spine due to spondyloarthrosis

Spondyloarthrosis is a disease of the small joints of the spine, belonging to the group of arthritic diathesis. It is often combined with other hereditary disorders - atherosclerosis, obesity, diabetes.

Pain in the spine with spondyloarthrosis is of an uncertain nature, intensifies after periods of prolonged immobility (in the morning, after severe illnesses with bed rest, etc.), with injury, hypothermia, after an infectious disease.

With a long course of the disease, reactive growth of bone tissue occurs, leading to a narrowing of the openings through which the spinal nerves pass. In such cases, radicular syndrome develops.

Severe pain in the spine after sleep with ankylosing spondylitis (Bechterew-Strumpel-Pierre Marie disease)

Pain in the spine with ankylosing spondylitis is in many ways similar to the pain syndrome with spondyloarthrosis, especially morning pain. However, the pain associated with ankylosing spondylitis is more intense; the disease disrupts the ability of patients to work from the very beginning of its development, and quickly leads to immobility of the affected areas of the spine. As a result, a characteristic curvature of the spine occurs (“supplicant pose”).

Ankylosing spondylitis is a systemic disease of connective tissue, predominantly affecting small joints of the spine, so other signs of this group of diseases (increased ESR, low-grade fever, increased fatigue, weight loss, general weakness) will help in diagnosis.

Hormonal spondylopathy (menopausal, postmenopausal and senile)

Pain in the spine with hormonal spondylopathies is caused by degenerative changes in the intervertebral discs and the leaching of calcium from the bones. Spontaneous spinal fractures often occur.

The pain syndrome resembles pain in the spine due to osteochondrosis. But hormonal spondylopathies are characterized by poor posture, increased thoracic kyphosis (in some cases, the costal arch can descend to the pelvic bones), and pain in the bones of the extremities.

Aching, pulling or boring pain in the spine with tuberculous spondylitis

Most often, the tuberculosis process affects the thoracic spine; lumbar localization of the process is less common; tuberculosis of the cervical spine is extremely rare. The disease can develop at any age, most often in the second or third decade of life.

The initial stages of tuberculous spondylitis are asymptomatic, so pain appears even when the process is far advanced.

Characteristic pain in the spine is aching or boring in nature, often radiating to the limbs, aggravated by coughing, sneezing, and flexion-extension movements of the torso. The pain syndrome is accompanied by sensations of tingling, crawling, heat, and pulsation. The pain is constant and can sometimes be relieved by walking.

Pain radiating to the spine

Just as damage to the spine often leads to visceral pain, damage to internal organs often causes pain radiating to the spine. Additional symptoms characteristic of damage to certain organs will help in diagnosis.

Pain in the chest and spine due to pathology of the heart and great vessels. Sharp pain

descending along the spine downward with dissecting aortic aneurysm

Wide irradiation of pain is characteristic of coronary heart disease. Pain in the chest and spine is especially severe during acute myocardial infarction. In this case, the pain is localized behind the sternum, and radiates under the left shoulder blade and into the spine, as well as up along the vessels, into the left supraclavicular region, into the jaw, and down into the left hand, to the little finger.

A dissecting aortic aneurysm is characterized by acute, sudden pain. As a rule, the pain syndrome is first localized behind the sternum, and then moves down along the aorta, and is described by patients as a sharp pain in the middle of the spine.

In typical clinical cases of diseases of the heart and great vessels, differential diagnosis with lesions of the spine will not cause difficulties, since it is possible to determine both the primary localization of pain and additional symptoms characteristic of acute damage to the cardiovascular system (impaired blood pressure and heart rate, cold sweat , fear of death, pallor).

Pain in the spine between the shoulder blades due to gallbladder diseases

Pain in the spine between the shoulder blades is a fairly common symptom of gallbladder damage. In the case of acute cholecystitis, the primary localization of pain can be determined in the right hypochondrium, with irradiation to the right subclavian region, under the right scapula and into the spine.

Difficulties in diagnosis may arise in the chronic course of the disease, since pain in the projection of the gallbladder may be weak or absent. In such cases, help will be provided by detailing the pain syndrome (the occurrence or intensification of pain after eating fatty fried foods, lack of connection with movements in the spine) and the presence of additional signs of damage to the gallbladder (bitterness in the mouth, pain on palpation in the projection area of the gallbladder).

Pain in the abdomen and spine due to lesions of the pancreas

Diseases of the pancreas are characterized by girdling pain in the abdomen and spine. In the case of acute and exacerbations of chronic pancreatitis, differential diagnosis with lesions of the spine is not difficult to carry out, since other signs of damage to the pancreas are clearly visible (the occurrence of pain after eating sweet, fatty foods and/or alcohol, nausea, vomiting that does not bring relief, etc.) .

Severe gnawing pain in the spine at night is specific to cancer of the body and tail of the pancreas. However, pain syndrome appears in the later stages of the disease, when the so-called minor signs of cancer are expressed (weight loss, general weakness of the body, etc.).

Severe pain in the spine and lower back due to pathology of the kidneys and upper urinary tract

With unilateral radicular syndrome in the lumbar region, it is necessary to carry out differential diagnosis with damage to the kidneys and upper urinary tract due to urolithiasis.

The fact is that the pain syndrome in typical renal colic is also characterized by the sudden appearance of severe pain in the spine and lower back.

However, there are times signs that allow you to distinguish these diseases.

Firstly, exacerbation of pain in the lower back and spine during urolithiasis cannot be associated with a sudden change in body position, lifting weights, and other typical factors that provoke an attack of radiculitis.

Secondly, pain from urolithiasis radiates along the ureters to the abdomen, groin area, genitals and inner thigh. Damage to the lumbar spine is characterized by irradiation down and back - to the buttocks, the outer surface of the thigh, up to the lower leg and foot.

Thirdly, with renal colic, patients rush around the room or in bed, while patients with damage to the lumbar spine, on the contrary, freeze in place, since any movement causes excruciating pain.

Treatment for pain in the spine. Answers to the most popular questions

What treatment may be needed for spinal pain? Which doctors should I contact?

In order to correctly prescribe treatment for pain in the spine, it is necessary to undergo a full examination and determine the cause of the pain syndrome.

Back pain in the spinal region may be a consequence of diseases of the internal organs; in such cases, contact the appropriate specialists.

If the pain is caused by damage to the spine, then treatment is prescribed in accordance with the disease and the stage of the pathological process.

The problem of spinal pathologies has recently become so popular that a special branch of medicine has emerged - vertebrology. So in difficult cases they turn to a specialist.

If this is not possible, then most likely you will need the help of two specialists - an orthopedist and a neurologist.

In cases where spinal damage is caused by tuberculosis (tuberculous spondylitis), there will be three attending physicians - a phthisiatrician, an orthopedist and a neurologist.

If pain in the spine is a consequence of menopausal spondylopathy, you may need to consult an endocrinologist.

In case of ankylosing spondylitis, recommendations from a rheumatologist are necessary.

If back pain in the spinal area occurs during pregnancy, consult a antenatal clinic doctor.

How to treat back pain resulting from spinal damage? In what cases is surgical treatment necessary?

There are the following indications for surgery:

severe constant pain in the spine, resistant to conservative therapy;
complicated herniation of the intervertebral disc (manifested by persistent radicular syndrome, as well as symptoms of compression of the spinal cord or cauda equina);
suspicion of unreducible spinal hernia or tumor;
instability of the spinal segment with a pronounced risk of complications;
some forms of scoliosis (progressive deformation of the spine in childhood and adolescence).

It should be noted that in each specific case, the issue of surgical treatment is decided individually, taking into account all contraindications to surgery.

Pain appeared after spinal surgery. What to do?

Unfortunately, pain complicates the postoperative period in many patients. In such cases, you should seek advice from the surgeon who performed the operation.

Most often, pain after spinal surgery is caused by the formation of a postoperative scar, and disappears over time. However, in some cases, pain may indicate complications for which reoperation is recommended.

What are the basic principles of conservative treatment of back pain due to spinal lesions? Will exercise help with spinal pain?

The basic principle of any therapy is an individual approach. In the case of back pain caused by damage to the spinal column, not only the nature of the disease is taken into account, but also the stage of the pathological process, as well as the characteristics of the clinical course in this particular patient. In addition, attention is paid to concomitant diseases that may aggravate the pathology or become a contraindication to the use of a particular method of therapy.

Today, for back pain caused by damage to the spine, a gentle regimen is mandatory. In the acute period, maximum caution is prescribed when moving (especially when moving from a horizontal to a vertical position and back, when bending, etc.); during the period of remission, heavy physical labor and heavy lifting are contraindicated.

Drug therapy includes a wide range of drugs. For severe pain in the spine and severe radicular syndrome, novocaine blockade, non-steroidal anti-inflammatory drugs, muscle relaxants and glucocorticoids are used. Often they use products containing elements necessary to restore the spine (Swiss drug Rumalon, German drug Osteochondrin, etc.).

In addition to drug therapy, the following types of conservative treatment are most widely used:

orthopedic methods (corset, traction in water and other methods of spinal traction);
manual therapy;
physiotherapy;
massage;
balneophysiotherapy;
acupuncture (acupuncture).

Almost all methods have their contraindications. So, for example, a contraindication to manual therapy is compression of the spinal cord or cauda equina, and orthopedic traction is contraindicated in cases of intervertebral disc pathology associated with endocrine disorders.

As for physical exercises for pain in the spine, they are strictly contraindicated during the acute period. During remission, physical therapy complexes are prescribed by a specialist and carried out under medical supervision.

How to relieve pain from a spinal hernia?

In severe cases, to relieve severe pain from a spinal hernia, novocaine blockade is used. In the acute period of the disease, rest, drug therapy with drugs from the group of non-steroidal anti-inflammatory drugs and muscle relaxants are necessary, and further observation by a specialist.

How to treat pain in the spine during pregnancy?

The following factors contribute to the development of complications from the spine and the occurrence of pain during pregnancy:

Increased load on the spine associated with weight gain and uneven distribution.
Physiological loosening of connective tissue associated with prenatal preparation.
Forced vertical position of the body (“proud posture of pregnant women”).

Thus, pain in the spine during pregnancy can be caused either by static overstrain of the muscles that hold it, or by spinal pathology that develops during pregnancy. In addition, low back pain may be associated with kidney disease, which can lead to severe complications during pregnancy and childbirth.

So if you experience pain in the spine during pregnancy, you should seek advice from a doctor and, if necessary, undergo additional examination and treatment.

Before use, you should consult a specialist.

Author: Cherednik O.V.

Back pain above the lower back: causes

If your back hurts above the lower back, the cause may be various diseases or injuries:

Thoracic osteochondrosis.
Thoracic injury.
Muscular myositis.
Kyphosis, thoracic scoliosis.

Sometimes the cause of discomfort can be sciatica - pinching of the sciatic nerve due to muscle spasm (including piriformis), osteochondrosis, or the last trimester of pregnancy. Pain above the lower back can radiate to the back, neck, and below - to the buttock or leg. Each cause needs diagnosis to avoid complications. There are other factors that influence the occurrence of pain:

Genetic predisposition.
General and local hypothermia.
Sudden physical activity.
Features of the profession (presence of vibrations, loads, sitting posture).
Distortion of posture.
Excessive weight, metabolic disorders.
Infectious diseases of the gastrointestinal tract.
Osteoporosis.
Diseases of the pelvic organs.
Poor diet, bad habits.
Tumors.

The exact localization of pain is of great importance in making a diagnosis, which can only be determined by a qualified doctor.

Which doctor should you go to if your back hurts?

When asked which doctor to go to if you have back pain, the standard answer is this: if you have back pain, it is best to make an initial appointment with a general practitioner or therapist. Depending on the results of the examination, consultation with a particular medical specialist may be required. Can be assigned:

consultation with a neurologist to assess the condition of the spine, back muscles and nervous system;
consultation with a urologist – in case of suspected urinary system disease;
consultation with a gynecologist – if chronic diseases of the female reproductive system are suspected or present;
general blood test and general urinalysis - to confirm or exclude the inflammatory nature of the disease;
radiography of the spine;
computed tomography (for example, cervical or lumbar spine);
MRI of the spine;
Ultrasound of the hip joints;
as well as other studies.

Diseases of internal organs

Back pain on the right side is an “alarm bell” of lung damage and possible infection of the pleura. An additional symptom is shortness of breath. Sometimes unpleasant sensations can appear on the left side. Morning pain above the lower back may not always be a sign of spinal disease. Sometimes the cause may be kidney disease and even myocardial infarction.

Night pain in the back above the lower back is a sign of gastrointestinal diseases, stomach ulcers, colitis, pancreatitis or tumors. Often the unpleasant sensation is of a girdling nature.

Causes of discomfort

Before starting treatment, it is necessary to find out the cause of the pain, establish its exact location and time. Perhaps the cause was muscle strain as a result of intense physical activity or hypothermia. Here are the main pathologies that cause back pain on the left side.

Intercostal neuralgia

Pain syndrome that occurs when the nerves located between the ribs are compressed, irritated or inflamed. There are quite a few causes of the disease. The main ones include: an allergic reaction, diseases of the nervous system, a decrease in the body’s immune forces, neoplasms in the lungs or pleura, hypothermia, some infectious diseases (tuberculosis, shingles), injuries to the back and chest, diseases of the spine (scoliosis, intervertebral hernia, etc.) .d.). If the nerves on the left are damaged, the left side of the chest hurts, worsening with movement or inhalation, increased sweating, tearfulness, goosebumps, numbness of the affected areas, and sleep disturbances.

Pyelonephritis

Kidney disease, which is associated with damage to the parenchyma, calyces and pelvis of the kidney. In most cases, pyelonephritis develops due to the presence of infectious agents in the bladder that rise up the ureters. Other diseases also contribute to the development of pathology: urolithiasis, diabetes mellitus, diseases of the female reproductive system, etc.

Symptoms of kidney disease are pain in the lumbar region on the affected side, which radiates to the pubic area, general weakness and malaise, fever with increased sweating, urine becomes cloudy and acquires a reddish tint, urine analysis will show increased protein and the content of bacteria in the blood. increased ESR and leukocytosis.

Urolithiasis disease

A disease in which there are hard stone-like formations in the organs of the urinary system. These stones are nothing more than crystals of salts dissolved in urine. The occurrence of the disease is caused by several reasons: hereditary predisposition, consumption of water containing large amounts of mineral salts, insufficient fluid intake, physical inactivity. Depending on the location of the pain, the doctor can understand where exactly the stone is located.

If discomfort appears above the lower back, then the stones are located in the kidneys; a little lower pain indicates the ureters and bladder

This can be confirmed using an ultrasound examination. In addition to back pain, patients experience pain and burning in the lower abdomen above the pubis and in the urethra, increased body temperature, renal colic, and cloudy urine mixed with blood.

Myocardial infarction

A form of ischemic disease characterized by necrosis of the heart muscle due to insufficient blood supply. Most often, the disease occurs among men over 45 years of age. The causes of a heart attack can be diabetes, obesity, high blood pressure, alcohol abuse, smoking, and mental stress.

A sharp psycho-emotional overstrain can cause a heart attack against the background of coronary heart disease and angina pectoris. Clinical manifestations include burning and sharp pain in the heart area, which can radiate to the left arm, jaw, shoulder blade, and lower back. In addition, there is shortness of breath, cold sticky sweat, a feeling of lack of air and a feeling of fear of death, acrocyanosis.

Stomach ulcer

A chronic disease characterized by the appearance of ulcers on the gastric mucosa. The pathology is prone to frequent relapses, progression and the occurrence of various complications. Gastric ulcers develop for several reasons: untreated previous diseases of the digestive system, exposure to bile and hydrochloric acids, long-term use of non-steroidal anti-inflammatory drugs, ischemia of the gastric tissue.

It has been proven that heredity plays a significant role and cases of morbidity occur between blood relatives. Peptic ulcer disease is characterized by pain in the upper abdomen (under the xiphoid process), sometimes it can radiate to the back or hypochondrium. Usually, patients can pinpoint the location of the unpleasant symptom. In addition to pain, patients complain of a feeling of heaviness, fullness of the stomach on an empty stomach or after eating, upset stool, nausea, vomiting, which leads to the elimination of unpleasant symptoms and pain.

Pneumothorax

A pathological condition in which gases or air accumulate in the pleural cavity. It is caused by diseases of the respiratory system, trauma, malignant neoplasms, connective tissue diseases, tuberculosis, etc., and is most often found among people aged 20–40 years.

Pneumothorax always develops suddenly and the severity of symptoms depends on the degree of collapse of the lung. The main signs of the disease are: sharp pain on top of the chest on the affected side, which intensifies with inhalation and can radiate to the arm, dry cough, shortness of breath, bluish skin, cold sticky sweat, decreased blood pressure, and sometimes fainting. With an open form of pneumothorax, you can observe foaming blood from the wound.

Pulmonary tuberculosis

A serious infectious disease that affects lung tissue. Pulmonary tuberculosis is the most common form of the disease. The cause of the pathology is Koch's bacillus. Provoking factors for its reproduction are unfavorable conditions and some diseases that greatly weaken the immune system: smoking, HIV infection, taking glucocorticosteroid drugs, diabetes mellitus, cancer, chronic renal failure and others.

Also at risk are people in prison, migrants, drug addicts and alcoholics. At the beginning of its development, the disease has no symptoms or they are mild and occur in the form of a cold. There is no cough or appears rarely with the discharge of viscous sputum, which has an unpleasant odor, back pain on the left or right when the lung is damaged on one side. Patients also complain of increased fatigue, sweating, low-grade body temperature, swollen lymph nodes, rapid heartbeat, and sometimes hemoptysis.

In women, left ovarian cyst

A benign neoplasm that has liquid contents inside and a tendency to grow. The appearance of a cyst is associated with menstruation disorders, endocrine system disorders and poor lifestyle. Pathology does not depend on age. At first, the tumor does not manifest itself in any way. The only symptom may be a nagging pain in the lower abdomen.

If the cyst is of significant size, sharp, severe pain occurs above the pubis, sometimes in the back, in the lumbar region, disruption of the monthly cycle, nausea and vomiting after sex or physical activity.

Muscle diseases

Muscle diseases are also often accompanied by diseases of the lower back and overlying areas:

Myositis is inflammation of the lumbar muscles. Accompanied by aching pain. Usually occurs after hypothermia.
With injury or heavy physical activity, pain in the lower back often occurs, ranging from mild to cutting. Staying in one position for a long time is also often the cause of this unpleasant phenomenon.
Overexertion and muscle spasms are a consequence of sedentary work and a sedentary lifestyle.

To understand whether the pain is temporary or is it a serious inflammation, it is necessary to undergo a diagnosis.

Classification of pain syndrome

In general, it is customary to distinguish several types of back pain, which occur in different conditions. Namely:

nonspecific;
radicular;
specific.

Nonspecific ones are the most “harmless” ones, and they occur most often. Often such pain is a consequence of osteochondrosis, which was not treated in a timely manner, and is also associated with dysfunction of the skeleton and muscles. Radicular pain is a consequence of irritation or inflammation of the nerve roots. The cause may be a hernia, pinched or displaced vertebrae. The most dangerous are specific pains: the cause of such pain in the lower back on the left in men and women can be bone tuberculosis, fractures, oncology, etc.

Arthrosis and osteochondrosis

Arthrosis is a joint disease that manifests itself most intensely in the morning. In the early stages, after a short warm-up, the unpleasant sensation subsides. But in an advanced stage, pain can become a constant companion, intensifying every day. Arthrosis is usually attributed to age-related changes when metabolism in cartilage tissues is disrupted. Existing osteochondrosis aggravates the course of the disease. Thoracic osteochondrosis is a fairly rare occurrence. It can occur for various reasons:

As a result of injury or surgery.
With a sedentary lifestyle.
As a consequence of arthritis or spondylitis.
With existing osteochondrosis of other parts of the spine.

Arthrosis also gives a persistent feeling of discomfort and is characterized by periodic pain radiating to the thoracic region and lateral areas.

Complications and consequences

It is highly not recommended to neglect diseases associated with the spine and back. Even slight discomfort in this area can lead to serious complications:

If the spine is severely deformed, compression of the nerve roots may occur. The result is numbness of the limbs and complete paralysis. This happens in advanced cases of intervertebral hernia.
Back pain often serves as a signal for the onset of pyelonephritis. Untreated disease is fraught with tissue necrosis.
Loss of flexibility in the lumbar region occurs due to chronic injuries and myositis.

Chronic pain syndrome is practically not relieved by painkillers, so it is better to take preventive measures than to get constant excruciating pain. Unfortunately, discomfort in the lower back can “mask” serious diseases, such as kidney stones, acute inflammation of the intestines, rupture of a cyst in a woman, or inflammation of the ureter. In some cases (less than 4%), pain in the lower back may be associated with nerve damage (more precisely, the spinal nerve root). Previously, this disease was called radiculitis (today - radiculopathy). In rare cases, surgery may be required.

Prevention of pain above the lower back

To avoid pain, you should follow simple recommendations:

Comfortable sleep is the key to back health. The position should be comfortable, and the pillow and mattress should be of medium hardness. Ideally, they will be orthopedic.
Compliance with safety precautions during sports training, especially if they are carried out under load.
The ability to maintain posture has a positive effect on muscle tone and the health of the spine in general.
Regular walking will help keep your back muscles toned, which will eliminate many problems.
Maintaining a sleep and rest schedule.
Good nutrition in moderation.

If lower back pain lasts more than 3 days, you should not self-medicate - you should definitely consult a doctor.

When should you see a doctor if you have back pain?

If a symptom appears for the first time, it is usually not given any importance. Indeed, occasional pains are unlikely to indicate anything that seriously threatens our health. The pain may go away and never return. But much more often, back pain returns. And in this case, you should consult a doctor and not self-medicate.

Medical consultation required

if you encounter one of the following situations:

you often feel back pain when straining or doing physical activity;
back pain occurs sporadically (from time to time);
the feeling of pain does not go away within 3-4 days.

Back pain may indicate advanced pathological processes and dangerous diseases. Don't delay seeing a doctor

, If:

the pain is constant and localized in one place;
the pain does not decrease when lying down, or the pain occurs at night when you are sleeping;
back pain is accompanied by fever;
back pain is accompanied by numbness in the limbs (this may occur in the morning), muscle tension, or a feeling of lethargy in the legs and arms.

If, in the case of persistent or recurring back pain, the disease is not diagnosed in time and treatment is not started, its development can lead to irreversible consequences and disability. Thus, a chronic or acute inflammatory process in the kidneys can lead to renal failure, and osteochondrosis left untreated can lead to the formation of Schmorl’s hernias.