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 instrumental and laboratory research methods.To relieve pain and further treat patients, doctors prescribe modern drugs that are highly effective and have minimal side effects.Rehabilitation specialists use innovative methods of restorative therapy to speed up the recovery process of patients with back pain.
What types of back pain are there?There are 4 types of back pain: local (local), projection, radicular (radicular) and pain that occurs due to muscle spasm.The most common forms of back pain are combined.Lumboischialgia is characterized by 3 forms of pain: muscular-tonic in the form of syndromes of the piriformis, gastrocnemius and gluteal muscles, neurovascular and neurodystrophic.
There are primary and secondary back pain.Primary pain syndrome most often develops between the ages of 20 and 50.It is based on the following mechanical factors:
- Intervertebral spondylosis and osteochondrosis;
- Dysfunction of the musculo-ligament system 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 the age of twenty and over the age of fifty, secondary pain syndrome predominates.
Doctors consider pain that lasts less than six weeks to be acute, pain that lasts six to twelve weeks to be subacute, and pain that lasts more than twelve weeks to be 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 injuries of the spine, which occur due to excessive stress during stereotyped physical activity and sports.Such injuries have the following consequences:
- Vertebral fracture;
- Deformation or rupture of the intervertebral discs;
- Inflammation and stretching of the joint capsule;
- Rupture of the spinal ligaments.
Microtraumas can occur as a result of a sudden unsuccessful 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, tumor pathologies, sedentary lifestyle and emotional overstrain.Severe back pain can be caused by the 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 intestine, kidneys, prostate in men and diseases of the reproductive system in women.Pain in the spine in the middle of the back can be a manifestation of myocardial infarction.Pain under the ribs from the back occurs with intercostal neuralgia.
Recently, in clinical guidelines addressing the problem of back pain, the term “nonspecific back pain” is often found.Denotes pain associated with musculoskeletal disorders without signs of damage to the cervical, thoracic, lumbar, and sacral roots, or specific injury to the spine.
Determine the cause of back pain
The hospital has unique diagnostic capabilities that allow you to quickly determine the cause of your back pain.Doctors establish a connection between the clinical manifestations of the disease and data from further research methods.The examination program for a patient with back pain includes the following diagnostic measures:
- Radiographic examination of the spine;
- Computed tomography;
- Magnetic resonance imaging.
The radiographic examination has an 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 allow to clarify the localization of the pathological process.
Patients with back pain are prescribed the following types of instrumental studies:
- Electrocardiography (for cardiac dysfunction);
- Magnetic resonance imaging or computed tomography with contrast;
- Optical topography of the skeleton and stabilization diagnostics;
- Ultrasound examination of the joints and spine;
- Densitometry (determination of bone tissue density);
- Electroneuromyography;
- Spiroarteriocardiorhythmography.
Patients undergo a complete blood count, urinalysis, and tests for C-reactive protein and rheumatoid factor.Differential diagnosis for acute back pain is carried out 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 draw up a treatment plan for the patient.
Treatment for back pain
The 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).Their anti-inflammatory effect is due to the inhibition of cyclooxygenase-2.NSAIDs not only inhibit the metabolism of this inflammatory mediator, but also actively influence the production of prostaglandins associated with calcium mobilization in smooth muscle.For back muscle pain, patients are prescribed muscle relaxants.
If no effect is found from analgesics and non-steroidal anti-inflammatory drugs or if there are contraindications to their use, weak opioids (codeine, tramadol) are used to reduce severe back pain.Strong opioids are used in the form of transdermal therapeutic systems with gradual 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 to continue with normal daily activities or resume them as soon as possible.For acute pain in the lumbar region, active physical exercise is ineffective during the first two weeks of illness.
One of the most effective modern treatments for chronic back pain is “pain management.”The method has a targeted effect on the affected areas: painkillers are injected into precisely defined areas using x-ray.Blocking pain impulses in combination with a series 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:
- Physical therapy;
- Massage;
- Acupuncture;
- Kinesitherapy.
When acute back pain occurs, the doctor may recommend that the patient wear muscle corsets.Their effectiveness in chronic pain syndrome has not been proven.Individually selected physiotherapy exercises start the process of tissue restoration and completely restore the motor functions of the spine.Therapeutic massage and myostimulation using the most modern equipment that the rehabilitation clinic is equipped with can quickly relieve the patient from back pain.These methods are necessary for the complete recovery of the patient.
One of the most popular non-pharmacological methods for relieving localized back pain is transcutaneous electrical nerve stimulation.This is a blockade of pain by electrical impulses at the site of its localization.Another effective method of pain relief 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.Next, 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, he or she should be referred for chiropractic therapy.
Which doctor treats back pain?The hospital takes a multidisciplinary approach to treating patients with chronic back pain.These are programs of drug treatment, patient education, therapeutic exercises and psychotherapeutic interventions, which are carried out regularly with the participation of various specialists (neurologist, vertebrologist, rheumatologist, psychotherapist, rehabilitation specialist, 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
Therapeutic exercises play an important role in the physical rehabilitation of patients with back pain.With the help of individually selected exercises, motor and neurological disorders are corrected, trophism and tissue restoration are improved.The hospital's rehabilitation specialists use ideomotor and passive exercises for back pain.
Passive exercises are performed with the maximum possible range of motion of the joint, in one direction, strictly in the same plane, at the same speed.The rehabilitator performs them, starting with the large joints, and then gradually moving on to the 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 and 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 from light starting positions are used.When performed, the attachment points of the antagonist muscles are brought closer together, while the attachment points of the trained muscle are separated as much as possible.
In some cases, surgery is used to treat back pain.To avoid surgery, if you suffer from 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 your back pain, your doctor will prescribe a comprehensive treatment.After relieving acute pain in the spine, patients undergo a course of rehabilitation therapy in a rehabilitation clinic using the most modern equipment and innovative techniques.