Up to 76% of the population experiences back pain during the year;in 7% of cases, patients complain of acute back pain.The rheumatologists of the hospital establish 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 very effective and have minimal side effects.Rehabilitation specialists use innovative methods of restorative therapy to speed up the recovery process for 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.Lumboschialgia is characterized by 3 forms of pain: muscle-tonic in the form of piriformis, gastrocnemius and gluteal muscle syndromes, neurovascular and neurodystrophic.
There is 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:
- Spondylosis and intervertebral osteochondrosis;
- Dysfunction of the musculo-ligamentous apparatus of the back;
- Herniated intervertebral disc.
Psychogenic back pain in its pure form is rare.It is difficult to diagnose because a patient who suffers from a mental disorder often has comorbid musculoskeletal and other neurological disorders that can cause pain.In patients under twenty and over fifty, secondary pain syndrome predominates.
Doctors consider pain lasting less than six weeks to be acute, pain lasting six to twelve weeks to be subacute, and pain lasting 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 their treatment.
Causes of back pain
One of the most common causes of back pain is traumatic lesions of the spine, which occur as a result of excessive stress during stereotyped physical activity and sports.Such injuries have the following consequences:
- Vertebral fracture;
- Deformation or rupture of intervertebral discs;
- Inflammation and stretching of the joint capsule;
- Rupture of spinal ligaments.
Microtrauma can occur as a result of an unsuccessful sudden movement during constant physical activity.
The following causes of back pain have also been identified:
- Curvature of the spine;
- neuralgia;
- Osteochondrosis;
- Compression of nerve endings;
- Arthritis and inflammatory diseases;
- Oncological tumors of the spine;
- Fascia damage;
- Muscle spasm.
The causes of chronic back pain can be diseases of internal organs (heart, lungs, kidneys), burns, oncological pathologies, sedentary lifestyle and emotional overload.Severe back pain can be caused by uncontrolled use of certain drugs.If the back pain radiates to the leg, you should consider sacral sciatica.Back pain in the lumbar region is characteristic of diseases of the intestines, kidneys, prostate gland 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 a myocardial infarction.Pain under the ribs from the back occurs with intercostal neuralgia.
Recently, in clinical guidelines that deal with the problem of back pain, the term "non-specific back pain" is often encountered.It means pain associated with musculoskeletal diseases without signs of damage to the cervical, thoracic, lumbar and sacral roots or specific spinal injuries.
Determining the cause of back pain
The hospital has unique diagnostic capabilities that allow you to quickly determine the cause of back pain.Doctors establish a connection between the clinical manifestations of the disease and data from additional research methods.The examination program for a patient with back pain includes the following diagnostic measures:
- x-ray examination of the spine;
- Computed tomography;
- Nuclear magnetic resonance.
X-ray examination has an important diagnostic value for back pain.Standard diagnostic methods include radiography in anteroposterior and lateral projection, functional spondylograms in the position of maximum flexion and extension.Computed tomography and nuclear magnetic resonance make it possible to clarify the localization of the pathological process.
Patients with back pain are prescribed the following types of instrumental examinations:
- Electrocardiography (for cardiac dysfunction);
- Magnetic resonance or computed tomography with contrast;
- Optical topography of the skeleton and stabilizing diagnostics;
- Ultrasound examination of joints and spine;
- Densitometry (determination of the density of bone tissue);
- electroneuromyography;
- Spiroarteriocardiorhythmography.
Patients undergo a complete blood count, urinalysis, C-reactive protein and rheumatoid factor.Differential diagnosis for acute back pain is carried out between the following diseases:
- Potentially dangerous diseases of spinal and non-vertebral origin (compression of 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 of back pain
The pain syndrome is based on 2 main mechanisms that determine the treatment 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 the mobilization of calcium in smooth muscles.For muscle pain in the back, patients are prescribed muscle relaxants.
If there is no effect of analgesics and nonsteroidal anti-inflammatory drugs or if there are contraindications for 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 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.Pepper applications can be used for short-term pain relief.
Patients with back pain are advised to avoid bed rest and to resume or resume normal daily activities as soon as possible.With acute pain in the lumbar region, active physical exercises are ineffective during the first two weeks of the disease.
One of the most effective modern treatments for chronic back pain is "pain management."The method represents a targeted impact on the affected areas: painkillers are injected into precisely defined areas by radiography.Blocking pain impulses in combination with a set of individual treatment procedures can free 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 therapeutic exercises start the tissue recovery process and completely restore the motor functions of the spine.Therapeutic massage and myostimulation using the latest equipment with which the rehabilitation clinic is equipped can quickly relieve the patient of back pain.These methods are necessary for the complete recovery of the patient.
One of the popular non-drug methods for localized back pain relief is transcutaneous electrical nerve stimulation.It is a blockade of pain with the help of electrical impulses at the place of its localization.Another effective method of pain relief that is used in the hospital is the biofeedback method.It was created at the intersection of psychology and physiology.A special device reads the information that comes from the patient's body.A computer model of it is then formed on the screen.It clearly shows all the processes taking place 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, a chiropractic referral is necessary.
Which doctor treats back pain?The hospital applies a multidisciplinary approach in the treatment of patients with chronic back pain.It includes drug treatment programs, patient education, therapeutic exercises and psychotherapeutic interventions, which are conducted regularly with the participation of several specialists (neurologist, vertebrologist, rheumatologist, psychotherapist, rehabilitator, 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 a major role in the physical rehabilitation of patients with back pain.With the help of individually selected exercises, movement and neurological disorders are corrected, trophic and tissue recovery is improved.Rehabilitation specialists at the hospital use ideomotor and passive exercises for back pain.
Passive exercises are performed with the maximum possible range of motion in the joint, in one direction, strictly in the same plane, at the same speed.The rehabilitator performs them, starting with large joints, then gradually moving to small joints.Ideomotor exercises are used to restore damaged pathways for transmission of nerve impulses from the center to the periphery.They are widely used in persistent pain syndrome.
For patients with muscle weakness, rehabilitation therapists prescribe active isometric muscle exercises.Patients perform them without straining and hold their breath, maintaining tension.These exercises improve blood circulation in spasmodic muscles, prevent the loss of muscle mass 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, and 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 have back pain, call the contact center and make an appointment with a neurologist or rheumatologist.After a complete examination and establishing the cause of the back pain, the 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 latest equipment and innovative techniques.