Lumbar pain is one of the most common reasons forcing a patient to seek help from a neurologist or therapist. Pain in the lumbosacral spine can be permanently disabling, making movement and self-care impossible. Acute lower back pain affects both men and women equally often. With a greater frequency in middle and old age, lower back pain can often be observed 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 may be associated with processes occurring both in the spine itself and outside of it. . . Consider the main pathological conditions in which acute lower back pain can be observed.
- The most common problem and cause of pain is lumbosacral osteochondrosis. . . It is caused by age-related involutive changes in the spine, dystrophy (malnutrition) of the corresponding segments of the spine and cartilage, and a decrease in the height of the vertebrae. These pathological processes lead to bone growths and infringement 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 experienced prolonged physical exertion, contributing to the wear of all structures of the vertebra. Frequent injuries, falling on the back, carrying weights, and concomitant osteoporosis aggravate 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.
- Herniated disc is an equally rare cause, the clinical manifestation of which is pain in the lumbosacral back. The intervertebral disc (internal nucleus pulposus) with prolonged traumatic exposure, as well as with age, loses its elastic properties and elastic capacity. With continued exposure (overweight, trauma, progressive osteoporosis), the annulus fibrosus of the disc becomes thinner, and defects form in it. Through these weak points in the annulus fibrosus, the nucleus pulposus of the disc can shift and even protrude.
A herniated disc is formed when the annulus fibrosus 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 disc herniation may be accompanied by sensory disturbances and various types of numbness in the corresponding segments of decompression (compression). Lower back pain radiates (gives) to the lower limb, causing muscle tension due to spasm. With a prolonged course, a herniated disc causes chronic pain in the lumbosacral region. Muscle tension in the back, being constant, further increases the pain syndrome, causing it to become chronic.
- Stenosis (narrowing) of the spinal canal- Pain in the lumbosacral back is noted in connection with prolonged walking or physical activity. Acute lower back pain may be accompanied by weakness in the legs, convulsive symptoms in the lumbar, gluteal muscles. With significant damage, there may be disorders of sensory functions.
- Tumor lesion of the segments of the lumbosacral vertebraeoften manifests itself in varying degrees of severity of pain in the lumbar region. Typically, lower back pain tends to get worse as the process progresses. The nature of the tumor lesion can be both benign (vertebral cysts) and malignant (a tumor of the spine, or metastatic lesions by a tumor located distantly). By its morphological nature, the tumor can be osteosarcoma, hemangioma, or develop as a result of myeloma. Pain in the lumbosacral region with this pathology often bothers the patient both day and night (constantly, without light gaps), increasing at rest, with shaking, tapping. Lower back pain is accompanied by muscle tension, cramps, sensory disturbances, weight loss, changes in the blood (anemia).
- Osteoporosis (bone loss)- quite often it is the cause of pain in the bones of various localizations. Osteoporosis develops as a result of the accelerated excretion of calcium from the bones, as a result of which all bones become fragile, prone to fractures with little mechanical stress (often of a domestic nature). Pain in the lumbosacral back in osteoporosis is combined with other pain in the bones, has an average degree of pain syndrome. Pain in the lumbar region can give muscle tension, cramps, often combined with a decrease in the patient's height. The most common type of osteoporosis is postmenopausal, which develops in women after the extinction of ovarian function.
- Ankylosing spondylitisoften, along with pain throughout the spine, is characterized by pain in the lumbar region and the ileosacral joint. The disease leads over time to stiffness in the spinal column, and the involvement of other peripheral joints in the chronic process.
In addition to these conditions, pain in the lumbar region may be due to the following reasons not associated with vertebrogenic defects:
- diseases of the kidneys, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis of the kidneys, neoplastic diseases of the kidneys and metastases of tumors to the kidney. At the same time, pain in the lumbar region is localized somewhat higher (in the place of projection of the kidneys), pain in the lumbosacral region is not very typical. Pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urinalysis, temperature reaction);
- diseases of the upper floor of the digestive tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) at a certain localization sometimes manifest themselves as pain in the lumbosacral region. But back pain is not associated with movements, it can be combined with other complaints (vomiting, stool disturbance, nausea, burning along the esophagus);
- acute back pain, in some cases, may occurfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. Lower back pain in women sometimes occurs during menstruation, or just before them. During pregnancy, there may also be heaviness and pain in the lumbar region and sacrum;
- deforming osteoarthritis of the hip joint(coxarthrosis), especially with an exacerbation of the process, in addition to gait disturbance, difficulty walking, it can give pain in the lumbosacral region, in the area of the muscles of the gluteal region on the corresponding side of the lesion, tension in the muscles of the lower back and buttocks.
Acute lower back pain: what to do?
If a 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 that has appeared. More often, the patient goes to a neurologist, where, after appropriate diagnostics (X-ray examination, computed tomography, MRI) and a neurological examination, he is diagnosed with a spinal disease.
In the absence of convincing data for the pathology of the spine (osteochondrosis, herniated disc), additional methods (ultrasound imaging of internal organs, densitometry, pelvic ultrasound) and consultations of related specialists (oncologist, gynecologist, endocrinologist) may be required.
Treatment of back pain in the lumbar region
Acute lower back pain, as prescribed by a doctor, is stopped by non-steroidal anti-inflammatory drugs (in the form of tablets or injections), the appointment of muscle relaxants, rest, bed rest, applications of anti-inflammatory ointments, the imposition of compresses. Treatment in the acute phase can be carried out in a stationary setting, or in a polyclinic.
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 - calcium and vitamin D3 preparations. Physiotherapeutic effects (provided there are no contraindications), physiotherapy exercises, and at the stage of rehabilitation - follow-up treatment in sanatoriums can be used.