Pain in the lower back is the most common pain syndrome in outpatient practice.30-60% of the population in developed countries suffer from recurrent back pain, and up to 80% of all back pain occurs in the lower back (lower back).All age groups can suffer from lower back pain, but the highest incidence occurs between the ages of 30 and 60.
Pain in the lower back due to illness
Pain in the lower back is a non-specific symptom that can be due to many causes.Doctors distinguish between primary and secondary lumbar pain syndromes.Most pain in the lower back is based on musculoskeletal morphofunctional changes (primarily lumbar pain syndrome).These are primarily degenerative-dystrophic lesions of the spine:
Possible causes of secondary low back pain:
- Primary and metastatic tumors of the vertebrae, spinal cord, retroperitoneal space.
- Vertebral fractures.
- Infectious lesions of the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess).
- Non-infectious inflammatory diseases (ankylosing spondylitis, Reiter's syndrome, rheumatoid arthritis).
- Metabolic bone lesions (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute spinal circulatory disorders (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Referred pain in diseases of the pelvic organs (including renal colic, infectious gynecological diseases, such as chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis).
Pain in the lower back can also be acute or chronic, and the causes are damage to the spine or nerve roots.Possibly moving pain from deeper structures:
- kidneys;
- pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumors.
Acute pain in the lower back
Acute sprain.The pain is localized in the area of the long back muscles during their spasm, which causes limitations in movement.There is no displacement of pain to the groin area or lower extremities.
Vertebral fractures.Usually this is a consequence of injury from bending or falling on the legs, but the same result can be without injury or with minimal trauma if the patient has an affected skeleton, osteoporosis, Cushing's syndrome, hyperparathyroidism, myeloma, metastases of malignant tumors in the bones, Paget's disease.
Displacement of intervertebral discs in the lower back.Symptoms of this disease include pain in the lower back, forced posture and limited mobility.The participation of nerve roots in the pathological process is indicated by: radicular pain, usually unilateral;sensitivity disorders (paresthesia, hyperesthesia or hypalgesia);decreased or absent Achilles or knee reflex.
Facet syndrome.Compression of the root at its exit from the spinal canal causes radicular pain that is not caused by disc damage.Unilateral facet syndrome, most commonly associated with the L5 root, occurs when the superior and inferior facets of the intervertebral joint are enlarged, causing a narrowing of the intervertebral canal or foramen.
Epidural abscess.Most commonly found in the thoracic spine, it may be accompanied by acute pain in the back when palpating or tapping the affected area.Requires rapid diagnosis and initiation of treatment measures, including surgery, if there are signs of spinal cord compression.Pathological processes in the hip joint may be accompanied by pain radiating to the gluteal region and the lower extremities to the level of the knee joint.
Chronic lower back pain
Spondylosis deformance.Spondylosis deformans are degenerative changes in the lumbar vertebrae with the formation of bone spurs that narrow the spinal canal and put pressure on the roots.If lumbosacral pain occurs with neurological symptoms during walking (loss of sensation, sensory disturbances or weakness in both lower extremities), intermittent claudication syndrome associated with the spine and resulting from a narrowing of the spinal canal is suspected.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with pain in the lower back that moves to the hips.First, there is limited mobility and morning stiffness, a decrease in respiratory movements in the chest, and progressive curvature and bending of the thoracic spine.X-ray signs: destruction and restructuring of the sacroiliac joints, the formation of the so-called "bamboo" spine.Similar symptoms of limited movement in the lower spine can occur with:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.With the help of radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (breast, lung, prostate, thyroid gland, kidney, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.Caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;the possibility of these infections must be confirmed or excluded by determining ESR, bone X-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before other neurological symptoms appear.Alternating pain in the lower back due to diseases of the internal organs.When the pelvic organs are affected, the pain shifts to the sacral region, the organs of the lower abdominal cavity - to the lumbar segments, the upper abdominal cavity - to the lower thoracic and upper lumbar segments.There are no local symptoms or stiffness in the back;full back movements do not increase pain.
Treatment
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Pain in the lower back sometimes radiates to the leg.In this case, you should contact a neurologist as soon as possible.
Do not delay visiting your doctor if:
- experiencing severe lower back pain for more than 3 days;
- pain occurred after injury;
- at the same time you feel pain in the lower back, lower leg and foot;
- pain in the lower back is combined with numbness in the buttocks, thighs, legs, feet and groin area.
Lower back pain is a fairly common symptom, especially in older people.Arthritis, lumbar osteochondrosis and radiculitis - all these diseases cause acute pain in the lower back.Only a proper examination of the body can show the results and give a clear answer about the causes of lower back pain.