Lumbar pain is one of the most common causes forcing a patient to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be permanently damaging, making movement and self-care impossible. Acute low back pain affects both men and women equally often. Low back pain is more common in adolescents and young adults. This is due to rapid growth, weakness in the fragile muscles of the lower back, injuries. Thus, pain in the lumbosacral spine is the most pressing problem that anyone can face.
Possible causes of back pain in the lumbar region
Pain in the lumbosacral spine can be associated with processes that take place both in the spine and outside it.. . . Consider the main pathological conditions in which acute low back pain can be observed.
- The most common problem and cause of pain is lumbosacral osteochondrosis. . . It is caused by age-related involutional changes in the spine, dystrophy (malnutrition) of the relevant segments of the spine and cartilage and a decrease in the height of the vertebrae. These pathological processes lead to bone growths and disruption of the nerve roots at the site of narrowing. As a result, severe pain develops in the lumbosacral back (spine). Osteochondrosis of the lumbosacral region develops much more often in obese people, as well as in patients who have undergone prolonged exercise, contributing to the wear of all vertebral structures. Frequent injuries, falling on the back, carrying weights and concomitant osteoporosis worsen the picture and course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (causing muscle tension) and ligaments in the process.
- Disc herniation is an equally rare cause, whose clinical manifestation is pain in the lumbosacral back. The intervertebral disc (inner nucleus pulposus) with prolonged traumatic exposure, as well as with age, loses its elastic properties and elastic capacity. With prolonged exposure (overweight, trauma, progressive osteoporosis), annular fibrosis of the disc thins and defects form in it. Through these weak spots in the fibrous ring, the nucleus of the pulp of the disc can shift and even protrude.
A disc herniation occurs when the annular fibrosis ruptures and the nucleus pulposus compresses the elements of the nerve roots leaving the spinal cord. Compression leads to the fact that the pain in the lumbar region becomes extremely intense, sometimes unbearable. Pain in the lumbosacral spine with a disc herniation may be accompanied by sensory disturbances and various types of tingling in the relevant segments of decompression (compression). The pain in the lower back radiates (gives) to the lower limb, causing muscle tension due to spasm. With a long course, the herniated disc causes chronic pain in the lumbosacral region. Muscle tension in the back, being constant, further increases the pain syndrome, causing its chronicity.
- Stenosis (narrowing) of the spinal canal- Pain in the lumbosacral back is noted in connection with prolonged walking or exercise. Acute pain in the lower back may be accompanied by weakness in the legs, convulsive symptoms in the lumbar, gluteal muscles. Sensory functions may be impaired with significant impairment.
- Tumor lesion of the segments of the lumbosacral vertebraeoften manifests itself in varying degrees of severity of lumbar pain. Usually, lower back pain tends to worsen as the process progresses. The nature of the tumor lesion can be either benign (vertebral cysts) or malignant (spinal tumor or metastatic lesions from a distant tumor). By its morphological nature, the tumor may be osteosarcoma, hemangioma, or develop as a result of myeloma. The pain in the lumbosacral area with this pathology often bothers the patient both during the day and at night (constantly, without light gaps), increasing at rest, with shaking, tapping. Lower back pain is accompanied by muscle tension, spasms, sensory disturbances, weight loss, changes in the blood (anemia).
- Osteoporosis (bone loss)- is quite often the cause of bone pain with different localization. Osteoporosis develops as a result of the accelerated release of calcium from the bones, as a result of which all the bones become brittle, prone to fractures with little mechanical stress (often of a domestic nature). Lumbosacral back pain in osteoporosis is combined with other bone pain, there is a moderate degree of pain syndrome. Pain in the lumbar region can lead to muscle tension, cramps, often combined with a reduction in the patient's height. The most common type of osteoporosis is postmenopause, which develops in women after the disappearance of ovarian function.
- Ankylosing spondylitisoften, along with pain throughout the spine, is characterized by pain in the lumbar region and ileosacral joint. The disease over time leads to stiffness in the spine and involvement of other peripheral joints in the chronic process.
In addition to these conditions, lumbar pain may be due to the following causes that are not related to vertebrogenic defects:
- diseases of the kidneys, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis of the kidneys, neoplastic kidney disease and metastases of tumors in the kidneys. At the same time, the pain in the lumbar region is localized a little more strongly (at the site of projection of the kidneys), the pain in the lumbosacral region is not very typical. The pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urine analysis, temperature reactions);
- diseases of the upper floor of the digestive tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) in a certain localization sometimes manifest as pain in the lumbosacral region. But back pain is not associated with movement, it can be combined with other complaints (vomiting, stool disorders, nausea, burning in the esophagus);
- in some cases, acute back pain may occurfor various inflammatory diseases of the female genitalia(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during or just before menstruation. During pregnancy, there may be heaviness and pain in the lumbar region and sacrum;
- deforming osteoarthritis of the hip joint(coxarthrosis), especially in exacerbation of the process, in addition to gait disturbance, difficulty walking, can give pain in the lumbosacral region, in the area of the gluteal area on the relevant side of the lesion, tension in the muscles of the lower back and buttocks.
Acute low back pain: what to do?
If the patient has acute back pain in the lumbar region, it is necessary to immediately seek the help of a qualified specialist to diagnose the cause of the pain. More often the patient goes to a neurologist, where after appropriate diagnosis (X-ray examination, computed tomography, MRI) and neurological examination he is diagnosed with spinal disease.
In the absence of convincing data on the pathology of the spine (osteochondrosis, disc herniation), additional methods may be needed (ultrasound of internal organs, densitometry, pelvic ultrasound) and consultations with related specialists (oncologist, gynecologist, endocrinologist).
Treatment of back pain in the lumbar region
Acute lower back pain, as prescribed by a doctor, is stopped by nonsteroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxants, rest, bed rest, application of anti-inflammatory ointments, application of compresses. Treatment in the acute phase can be performed in an inpatient setting or in a clinic.
Prescribe drugs that improve microcirculation, with acute back pain, blockade is used. Sometimes, with the ineffectiveness of other types of therapeutic effects, they resort to surgical treatment (with compression of the nerve roots). When combined with osteoarthritis, chondroprotectors are used for a long time, in osteoporosis - preparations of calcium and vitamin D3. Physiotherapeutic effects can be used (provided that there are no contraindications), physiotherapeutic exercises and at the stage of rehabilitation - subsequent treatment in sanatoriums.