What to do with back pain and exacerbation of lumbar osteochondrosis?

Every year, a number of patients who turn to medical institutions for help complain of back pain. Even if you don’t do enormous physical activity on your skeleton, your activity consists of a sedentary lifestyle - your back still hurts in the evening.

Why does this happen and how to eliminate constant discomfort?

The causes of back pain can be hidden in a number of pathologies. If you have an unpleasant feeling in the lumbar area, immediately contact a neurologist. Persistent pain and discomfort in the back can lead to limited mobility and decreased activity.

In most situations, the reason that causes back pain may lie in ailments of the spinal column, ailments of vital organs, or be a consequence of professional activity, or birth trauma. Only an experienced specialist can make an accurate diagnosis after an examination. In some situations, a number of additional diagnostic measures are prescribed.

According to statistics, back pain affects 50% of the population worldwide.

At the same time, in infancy, such a phenomenon is a sign of pathologies of internal organs, which occurs infrequently. In most cases, back pain plagues elderly patients.

What can low back pain look like?

Most often, lower back pain occurs suddenly, sharply and is acute. In this case they talk about lumbago

(outdated popular name -
lumbago
). The pain is described as sharp, “shooting.” Movements are constrained, sometimes it is even impossible to straighten your back. With any movement the pain intensifies.

An attack of pain can last a couple of minutes, or it can last for a longer period of time (up to several days). It may be that the attack will pass and the pain will no longer remind itself, but often the pain returns and the person gets used to the fact that his lower back can hurt.

Lower back pain can not only be acute (sharp), it can be nagging and chronic. Mild but constant pain in the lower back, sometimes worsening, for example, during physical activity, an infectious disease, hypothermia, etc., is called lumbodynia

. Sometimes there is no direct pain, but stiffness remains in the lower back, and the patient experiences discomfort.

Ointments

To quickly relieve back and lower back pain at home, you can use:

Dolobene is an effective remedy that simultaneously relieves pain and inflammation;
Warming ointments such as finalgon or capsicam improve blood circulation and stimulate tissue metabolism. The painful lumbar region fills with blood and the pain subsides;
Chondroprotectors for external use, such as arthrocin, accelerate cartilage regeneration;
Traditional warming rubs can also be used to treat back pain, but they should be used with caution. If discomfort occurs, it is better to immediately abandon the method used.

Causes of lower back pain

Lower back pain can be caused by various reasons, but the statistics are as follows:

in 90% of cases the pain is caused by problems with the spine and back muscles;
in 6% the cause of pain is kidney disease;
4% - diseases of other internal organs (genitourinary system, intestines).

The spine accounts for the majority of all cases of low back pain, and this is no coincidence. In humans, the center of gravity of the body is located exactly at the level of the lower back, and when walking, the entire load falls almost entirely on the lumbar spine (animals that move on four legs do not have this problem). And when a person sits down, the vertebrae of the lower back and sacrum experience the same force of pressure with which a 170-meter layer of water presses on a diver. Naturally, this area is particularly vulnerable.

Questioning and examination at a doctor's appointment

Pain, a feeling of stiffness, or increased painful muscle tension in the area between the lower ribs and buttocks is usually referred to as “lumbodynia.” If these symptoms are accompanied by pain in the leg, this condition is usually called lumboischialgia.

First of all, the severity of the pain is important, that is, how long ago it occurred. Pain lasting up to 12 weeks (3 months) is called acute; pain lasting more than 12 weeks is called chronic. Chronic pain syndrome can occur with exacerbations and periods of improvement.

How the pain feels is of fundamental importance. This is either a sensation at a certain point, or the spread (“projection”, “irradiation”) of pain along the nerve to the thigh, buttock, knee joint, foot, or a vague, “dull” pain. It is necessary to understand whether movements in the spine are limited when pain occurs, or whether movements are unimpeded (this may indicate the mechanical nature of the damage, for example, a vertebral fracture). At what moments does pain appear? Does it occur during exercise, or at rest, during night sleep? An affirmative answer to the last question is generally a “red flag” for a rheumatologist and makes one think about the diagnosis of inflammatory disease of the spine in the patient (we’ll look at them a little later). If the pain intensifies when moving the head, walking, jumping, we are most likely talking about so-called projection pain, the cause of which is damage to the nerve structures (most often radiculitis).

Osteochondrosis of the spine, or spondylosis, is a condition in which there is compaction and deformation of the vertebrae, with the appearance of small bone outgrowths, similar to spikes, along the edges of the vertebrae. For a long time, it was generally accepted to consider spondylosis to be the result of the natural course of degenerative processes and aging of the body. However, it has been convincingly proven that not only age can be the cause of osteochondrosis. A sedentary lifestyle, increased load on the lumbar spine during prolonged work at a computer or during long periods of driving (for example, the profession of a truck driver) contribute to the occurrence of osteochondrosis even in young people. Under the influence of all these factors, the intervertebral disc buffers are flattened, and the nerve roots branching from the spinal cord are compressed and then injured by the growing marginal bone spines. Constant irritation and compression of these roots causes pain. In Latin, the root is called radix, so this inflammation is usually called radiculitis.

So-called inflammatory diseases of the spine are an area of interest for rheumatologists. These mysterious diseases can “smolder” for several years, starting mainly at a young age and affecting mainly men, and ultimately resulting in immobility and disability of the patient. Patients in this group usually “endure to the last” night pain, morning stiffness in the back, weakness, and increasing decline in performance. Unfortunately, on average, about seven years pass from the appearance of the first symptoms of the disease to the correct diagnosis. During this time, changes in the spine may become irreversible, and functional (motor) activity may become low. The spine becomes motionless, changes shape, and a hump appears. This pathology does not occur as often as osteochondrosis, for example, but the costs of treatment and the total time of disability of such patients are disproportionately higher.

If, in addition to back pain, the patient, when questioned, talks about inflammation of the joints (more often we are talking about the knee joints, joints of the hands or feet), pain in the buttocks, unstable stool with unusual impurities, blurred vision or pain in the eyes, this is also a reason to urgently refer him to rheumatologist to conduct a specific additional examination and exclude the disease from the group of spondyloarthritis (for example, seronegative spondyloarthritis or Crohn's disease).

There are diseases that manifest as pain in the lower back and completely unaffected vertebral or nervous structures. One of these diseases is myofascial pain syndrome. Patients (usually young women) indicate prolonged exposure to an uncomfortable position or physical overload that preceded the development of pain. During a medical examination, attention is drawn to sharp pain when pressing on certain points located near the spine. This condition significantly reduces the patient’s quality of life, but minor changes in muscle tissue (local overstrain) do not pose a danger to either the nerve roots or internal organs. Usually, the therapeutic effect can be achieved by prescribing muscle relaxants (mydocalm), low doses of non-steroidal anti-inflammatory drugs (meloxicam, diclofenac), local injection (injection) of a steroidal anti-inflammatory drug (diprospan) into the “pain point”.

Diseases of the musculoskeletal system that cause lower back pain:

pinched sciatic nerve. The nerve roots extending from the spinal cord are compressed by neighboring vertebrae. In this case, a sharp, shooting pain occurs. As a rule, pinched roots become possible due to degenerative changes in the spine (osteochondrosis): the intervertebral discs separating the vertebrae from each other are destroyed, the gap between the vertebrae narrows and sudden movement (tilting, turning) can lead to pinching of the nerve branch;
sciatica (lumbosacral radiculitis). Pinched nerve roots can become inflamed. Inflammation of the nerve roots is called radiculitis (from the Latin radicula - “root”); To indicate inflammation of the sciatic nerve, a special name is sometimes used - sciatica. If the sciatic nerve is damaged, lumbar ischialgia may be observed - pain in the lower back, also spreading to the buttock and leg along the sciatic nerve;
intervertebral disc herniation – protrusion of a fragment of the intervertebral disc into the spinal canal. Occurs as a result of injury or degenerative changes in the spine (osteochondrosis);
myositis of the lumbar muscles. Myositis is an inflammation of skeletal muscles. The cause of myositis of the lumbar muscles can be hypothermia or sudden tension.

Also, lower back pain can be caused by diseases such as multiple sclerosis, degenerative sacroiliitis, osteoporosis.

Drug treatment

To eliminate chronic and acute back pain, drugs from the group of non-steroidal anti-inflammatory drugs are almost always used. Although they cannot cure the underlying disease, they do an excellent job of treating pain and inflammation. These drugs exist in all dosage forms (injections, tablets, capsules, ointment, patch, etc.). This allows you to simultaneously influence the pathological focus from several sides.

Main representatives:

diclofenac,
ibuprofen,
piroxicam,
indomethacin,
nimesulide,
meloxicam,
ketoprofen,
ketorolac,
aceclofenac,
celecoxib.

You can use drugs from the NSAID group only on the recommendations of a doctor, as they have serious side effects and contraindications. Their use is prohibited for gastric and duodenal ulcers, gastritis and other gastrointestinal diseases (they can cause acute bleeding). NSAIDs should also be used with caution in people with liver and kidney pathologies.

Rules that will reduce the risk of side effects when treating NSAIDs:

It is necessary to take medications strictly according to the doctor’s recommendation, having carefully read the instructions for the specific drug.
You should not take these medications (tablets, capsules) on an empty stomach; they must be washed down with a whole glass of water to reduce the negative effect on the gastric mucosa.
After taking the medicine orally, it is forbidden to take a horizontal position for 30 minutes (this is necessary so that the tablet does not linger in the esophagus, the walls of which are not protected from its negative effects).
Do not use with alcoholic beverages (increases the risk of gastric bleeding).
Along with NSAID treatment, it is necessary to take medications to protect the gastric mucosa. As a rule, doctors prescribe proton pump inhibitors (omeprazole, pantoprazole, lansoprazole).
It is forbidden to take medications for longer than the time specified in the instructions; do not exceed the recommended doses.

As a rule, to eliminate acute pain or in case of exacerbation of chronic pain, 5-7 injections of NSAIDs are sufficient, followed by switching to internal administration of tablets of the same drug for another 5-7 days. If such therapy does not help, then medications of other groups are prescribed.

Ketorol is an effective medicine for back pain

In the complex treatment of back pain, drugs must be prescribed to eliminate pathological muscle spasms. As a result, the pain goes away much faster and the person gets back on his feet. Drugs such as mydocalm, baclofen, and sirdalud are used.

Most often, mydocalm is used according to the scheme below. For acute pain, the drug is administered in injections of 1 ml (100 mg) 2 times a day. When the pain subsides, mydocalm tablets are prescribed 1 (150 mg) 3 times a day. Treatment is continued until chronic pain is completely eliminated (1-2 months).

Chondroprotectors are prescribed in complex treatment to many patients whose back pain is diagnosed as osteochondrosis. The therapeutic course consists of 20-30 injections followed by a transition to tablet forms. The most commonly used are Chondroxide, Mucosat, Dona, Structum, Teraflex, Alflutop, Artra.

Patients are also prescribed decongestant therapy, which eliminates swelling of the spinal cord roots, which reduces the intensity of pain. For this purpose, medications such as furosemide, torsemide, and L-lysine aescinate are used.

To strengthen the nerve roots, B vitamins are used in long courses, as well as drugs to normalize microcirculation (trental, nicotinic acid, latren, etc.).

In severe cases, novocaine paravertebral blockades are prescribed. Local anesthetics are injected into the soft tissue on both sides of the spinal column in the affected area. This treatment can effectively eliminate pain. If necessary, blockades can be repeated several times.

Prevention of low back pain

The occurrence of lower back pain is often provoked by a careless attitude towards one’s own health. Pain may be caused by:

staying in the same position for a long time (for example, during sedentary work);
incorrect posture;
low mobility;
excessive physical activity.

All these factors contribute to the development of diseases manifested by lower back pain. The risk of pain can be reduced by following the following advice from doctors:

watch your posture;
Avoid uncomfortable postures when working while sitting. It is advisable that the knees are slightly higher than the hip joints. To do this, use a low chair or footrest. Place a small pillow between your lower back and the back of the seat;
When working sedentarily, you need to get up from time to time to move around. Take five-minute breaks every hour; how to lift weights correctly
It is advisable to sleep on an orthopedic mattress (elastic and quite hard);
You need to lift weights by bending your knee joints, not your back. That is, you need to squat down, bending your knees, and then straighten them, while maintaining a straight line of your back;
When carrying a load, it must be evenly distributed between both hands; you cannot carry the entire load in one hand (one heavy bag);
Every day you should do a set of exercises aimed at strengthening the abdominal and back muscles.

Diagnosis and treatment for back pain

Back pain is one of the most common complaints of patients in general medical practice. They rank second in frequency (after respiratory diseases) among calls for medical help. In many countries, the assessment and treatment of patients with back pain is carried out primarily by general practitioners. In our country, these patients traditionally fall under the purview of neurologists and manual therapy specialists, but with the development of family medicine, the proportion of patients who are examined and treated by general practitioners for back pain is increasing.

Causes of back pain

Back pain is most often caused by degenerative processes in the spine:

osteochondrosis and spondyloarthrosis [1–4]. Spinal osteochondrosis includes degenerative lesions of the intervertebral disc cartilage and reactive changes in the adjacent vertebral bodies. Damage to the intervertebral disc occurs as a result of repeated injuries (heavy lifting, excessive static and dynamic load, falls, etc.) and age-related degenerative changes. The nucleus pulposus, the central part of the disc, dries out and partially loses its shock-absorbing function. The fibrous ring, located along the periphery of the disc, becomes thinner, cracks form in it, towards which the nucleus pulposus moves, forming a protrusion (prolapse), and if the fibrous ring ruptures, a hernia. In the affected spinal segment, relative instability of the spine occurs, osteophytes of the vertebral bodies develop (spondylosis), and ligaments and intervertebral joints are damaged (spondyloarthrosis). Osteochondrosis of the lumbar region is often combined with pathology of the sacroiliac joints.

Herniated intervertebral discs most often occur in the lower lumbar discs, less often in the lower cervical and upper lumbar discs, and extremely rarely in the thoracic discs. Disc herniations into the vertebral body (Schmorl's hernias) are not clinically significant; disc herniations in the posterior and posterolateral direction can cause compression of the spinal root (radiculopathy), the spinal cord (myelopathy at the cervical level) or their vessels.

In addition to compression syndromes, reflex (muscular-tonic) syndromes are possible, which are caused by irritation of receptors in response to changes in the discs, ligaments and joints of the spine. Impulses from the receptors reach the motor neurons of the spinal cord, which is accompanied by an increase in the tone of the corresponding muscles and, over time (if there is no decrease in muscle tone), trophic changes in the muscles.

Reflex syndromes of spinal osteochondrosis occur during the life of almost every person; compression syndromes develop much less frequently. Reflex muscle tension initially has a protective nature, since it leads to immobilization of the affected segment, but later becomes a factor maintaining pain.

In addition to degenerative-dystrophic changes in the spine, the cause of back pain can be its congenital or acquired deformities

(kyphosis, scoliosis), displacement of the vertebral bodies (spondylolisthesis), spinal stenosis, spinal instability and osteoporosis, observed more often in women during menopause, complicated by a compression fracture of the spine.

Another common cause of back and limb pain is myofascial pain.

caused by the formation of so-called trigger points in the muscles and/or associated fascia. Trigger points arise under the influence of muscle tension and often against the background of degenerative changes in the spine. These points can be in an active or passive state. An active trigger point represents an area of increased excitability of a muscle or its fascia; it causes pain at rest and during movement accompanied by muscle tension. A passive trigger point is detected only by palpation of the muscle, which allows it to be identified.

The cause of back pain is fibromyalgia, which is characterized by diffuse and usually symmetrical pain in the trunk and extremities. The combination of pain with mental disorders (sleep disorders, asthenia, depression) makes the most likely assumption about the somatoform origin of this disorder.

The causes listed above, which in the literature are usually regarded as mechanical, account for approximately 90–95% of all cases of back pain.

In more rare cases, back pain is caused by a neoplasm affecting the spine (primary and metastatic spinal tumors, multiple myeloma). They may also be the only symptom of a spinal cord tumor, syringomyelia and other spinal cord diseases. Back pain occurs with destruction of the vertebrae and damage to the nerve roots due to infectious processes (osteomyelitis, epiduritis), dysmetabolic disorders (hyperparathyroidism, Paget's disease). They develop with spinal fractures, ankylosing spondylitis (ankylosing spondylitis) and systemic autoimmune diseases in which the spine is involved in the process.

Back pain is possible with various somatic diseases (heart, stomach, pancreas, kidneys, pelvic organs, etc.), through the mechanism of referred pain.

Examination and diagnosis for back pain

To establish the cause of back pain, a thorough examination of the patient is necessary, including clarification of complaints, medical history, somatic, neurological and neuro-orthopedic examinations, and in some cases additional studies.

When collecting complaints and medical history, it is necessary to find out:

– localization and irradiation of pain;

– dependence of pain on body position and movement in the spine;

– previous injuries and diseases (malignant neoplasms and others);

– emotional state, reasons for simulating or intensifying complaints of back pain.

Somatic examination

aimed at identifying malignant neoplasms, infectious processes and somatic diseases that may manifest as back pain.
During a neurological examination
, it is necessary to assess the emotional state of the patient, determine whether there are paresis, sensitivity disorders and loss of reflexes.
Of great importance is a neuroorthopedic examination
, which determines the mobility of various parts of the spine, the range of movements of the limbs, the presence of local pain in the back and limbs, muscle tension and pain on palpation.

Often the diagnosis is established on the basis of somatic, neurological and neuro-orthopedic examinations if they reveal a typical clinical picture of reflex muscle tonic syndrome or damage to the spinal root or myofascial syndrome, fibromyalgia and there are no signs of oncological or inflammatory disease, as well as spinal injury.

For lumbago

(lumbar lumbago) is characterized by a sharp, shooting pain in the lower back, which usually develops during physical activity (lifting heavy objects, etc.) or awkward movement.
The patient often freezes in an uncomfortable position, and an attempt to move leads to increased pain. The examination reveals muscular-tonic syndrome: tension of the back muscles, usually scoliosis, flattening of the lumbar lordosis, severe limitation of mobility in the lumbar spine. Lumbodynia
(back pain) and
lumboischialgia
(pain in the back and along the back of the leg) are characterized by pain that occurs after physical activity, awkward movement or hypothermia . The pain is aching in nature and intensifies with movements in the spine, certain postures, and walking. The examination reveals muscular-tonic syndrome without paresis, sensitivity disorders and loss of reflexes.

Radiculopathy

lumbar and first sacral roots are manifested by acute shooting pain in the lower back and leg. When examining a patient, in addition to muscular-tonic syndrome, sensitive, reflex and, less commonly, motor disorders in the area of the affected root are detected. The fifth lumbar (L5) and first sacral (S1) roots are most often affected, less often the fourth lumbar root and very rarely the upper lumbar roots.

For cervicalgia

(neck pain) and
cervicobrachialgia
(pain in the neck and arm) are characterized by pain that occurs after physical activity or awkward movement of the neck. There is an increase in pain with movements in the neck or, conversely, with prolonged monotonous positioning (at the movies, after sleeping on a thick, high pillow, etc.). The examination reveals muscular-tonic syndrome: tension of the neck muscles, limitation of movements in the cervical spine. Radiculopathies of the lower cervical roots are much less common than reflex syndromes, and are manifested, in addition to muscular-tonic syndrome, by sensory, reflex and (or) motor disorders in the area of innervation of the affected root.

In the thoracic region

reflex and compression syndromes of osteochondrosis are much less common than in the lumbar and cervical regions. They are manifested by back pain, muscle tension and loss of sensitivity in the area of the affected roots. The appearance of pain in the thoracic spine is often mistakenly regarded as intercostal neuralgia, which may hide various diseases of the spine and internal organs. Any back pain cannot be attributed to “osteochondrosis” - a condition that is detected by X-ray examination in most middle-aged and elderly people.

The diagnosis of myofascial pain is based on clinical findings and requires the exclusion of other possible causes of pain. Myofascial pain is manifested by muscle tension and the presence of trigger points in them, which are identified through manual examination of the muscles. An active trigger point is a constant source of pain that increases with palpation in the muscle; a latent trigger point causes pain only when palpated. When palpating a trigger point, the patient often winces or screams due to pain. For each muscle there is an independent myofascial syndrome, with a characteristic localization of pain when the trigger point is irritated, spreading beyond the projection of the muscle to the skin surface. There are no symptoms of damage to the peripheral nervous system, except in cases where tense muscles compress the nerve trunk.

Myofascial pain often includes scalene and quadratus lumborum syndromes. When the scalene muscle is affected, head rotation is almost twice as limited due to pain that can spread around the shoulder joint and along the arm. With myofascial syndrome of the quadratus muscle, in addition to pain in the lower back and pain on palpation of the muscle, pain often spreads to the buttock, iliac crest and greater trochanter of the femur.

In the absence of supporting factors, myofascial pain can go away spontaneously if the muscle is left to rest for several days. On the contrary, physical activity, stressful situations and other negative influences can contribute to the chronic course of myofascial syndrome, which is accompanied by the development of dystrophic processes in the affected muscles.

Fibromyalgia

occurs predominantly in women. Characterized by diffuse and symmetrical pain in the trunk and limbs. Painful areas are noted, light palpation of which causes increased pain. With fibromyalgia (unlike myofascial pain), pressure on painful points does not cause muscle tension and spread pain to other areas. Painful areas are usually located in the occipital region, neck, interscapular region, lower back, buttocks, and the inner surface of the knee joints. There are no signs of damage to the peripheral nervous system. Patients with fibromyalgia often experience asthenia, depression, sleep disturbances, tension headaches and pain syndromes of other localizations.

For back pain, in some cases, additional research is needed to identify other diseases hiding under the guise of benign, mainly pain syndromes

. Such cases include:

atypical picture of pain syndrome (lack of connection of pain with movements of the spine; unusual localization of pain - in the perineum, rectum, abdomen, vagina; increased pain in a horizontal position and weakened in a vertical position; connection of pain with eating, defecation, urination, sexual intercourse);
history of back injury;
fever, symptoms of intoxication;
cancer;
dysfunction of the pelvic organs;
presence of mental disorders;
signs of spinal cord damage.

In this regard, additional research is needed, which in some cases is advisable to carry out when the patient is hospitalized in a neurological or other department, depending on the expected disease:

– radiography of the spine in several projections;

- general blood analysis;

– biochemical blood test (calcium, creatinine, phosphates, glucose, etc.);

– computed x-ray tomography (CT) or magnetic resonance imaging (MRI) of the spine;

– bone scintigraphy and other studies.

X-rays of the spine are used mainly to exclude congenital anomalies and deformities, vertebral fractures, spondylolisthesis, inflammatory diseases (spondylitis), primary and metastatic tumors. Signs of osteochondrosis or spondyloarthrosis are found in almost half of middle-aged people and in most elderly patients. Detection of degenerative-dystrophic changes during radiography does not exclude the presence of other causes of back pain and cannot be the basis of a clinical diagnosis.

An X-ray CT or MRI can identify a disc herniation, determine its size and location, and detect spinal stenosis, spinal cord tumor or other neurological diseases. It is important to note that CT and MRI of the spine often reveal dystrophic changes, especially in older age groups. Such changes are found in almost 90% of elderly patients with back pain. The presence of herniated intervertebral discs according to CT or MRI, especially small ones, does not exclude another cause of back pain and cannot be the basis of a clinical diagnosis.

For spinal cord tumors, syringomyelia and other spinal cord diseases

back pain is often combined with other neurological disorders; muscle-tonic syndrome is usually absent. The diagnosis is made using CT or MRI of the spine.

With destructive lesions of the spine

(tuberculous spondylitis, primary tumor or metastasis to the spine, osteoporosis, hyperparathyroidism), spinal fracture, congenital or acquired deformities, spondyloarthritis deformans, local pain is often observed, the diagnosis is established based on the results of an x-ray and (or) CT or MRI of the spine.

For somatic diseases

referred back pain, as a rule, is combined with other manifestations of the disease; it is not accompanied by tension in the back muscles and usually does not intensify with movements in the spine.

Treatment of back pain

Treatment of back pain is based on treatment of the underlying disease. The following describes treatment for the most common causes of back pain - reflex and compression complications of osteochondrosis, myofascial pain and fibromyalgia.

Treatment of reflex syndromes and radiculopathies due to osteochondrosis is based in the acute period on rest, avoidance of sharp bends and painful positions

. In the acute period, it is better to carry out treatment at home, without forcing the patient to visit the clinic for injections or physical therapy, the benefits of which are much less than the harm associated with the high probability of increased pain in connection with a visit to the clinic. They recommend bed rest for several days until the sharp pain subsides, a hard bed (a shield under the mattress), taking analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants.

Currently, bed rest is recommended only in the first (1–4) days and mainly in cases of severe pain. After this, a gradual increase in physical activity is recommended; the patient should be protected from excessive muscle tension (prolonged sitting, carrying heavy objects, driving a car, etc.). Rapid activation of patients and their gradual return to work reduce the likelihood of developing chronic pain syndrome

[4].

For acute pain in the lower back, you can use a fixation belt; for pain in the neck, you can use a cervical collar. However, long-term fixation of the cervical or lumbar spine is not recommended, except in certain cases, such as traumatic vertebral fracture or the presence of lumbar spondylolisthesis. The lumbar fixation belt can also be used periodically - when it is necessary to move in case of acute pain, as well as lifting heavy objects after the pain has subsided.

NSAIDs are the most commonly used drugs for back pain.

, which have a good analgesic effect and a pronounced anti-inflammatory effect. The mechanism of action of NSAIDs is to suppress the enzyme cyclooxygenase, which plays a leading role in the synthesis of arachidonic acid metabolites (prostaglandins and others), which enhance the inflammatory process and are directly involved in the formation of pain. NSAIDs are contraindicated for gastric ulcers; they are recommended to be taken orally with meals, and if there is a risk of complications, antacids are used to protect the stomach.

Among NSAIDs, diclofenac
(Voltaren)
, which is highly effective and sufficiently safe. In general, in terms of the severity of analgesic and anti-inflammatory effects, as well as safety, diclofenac has an advantage over other NSAIDs (indomethacin, piroxicam, naproxen, ibuprofen, acetylsalicylic acid). Diclofenac group drugs do not have a negative effect on the metabolism of the intervertebral disc, damage to which is often the cause of back pain. Average therapeutic doses of diclofenac are 75–150 mg/day. in several doses or in the form of rectal suppositories; to achieve a quick effect, intramuscular administration of the drug is used.

Meloxicam can be used as an NSAID that selectively inhibits cyclooxygenase-2, usually 15 mg/day. in 1–2 doses or celecoxib, usually 200 mg/day. in one or two doses.

Muscle relaxants are used to treat painful muscle spasms

orally or parenterally. Muscle relaxants reduce pain, reduce reflex muscle tension, improve motor functions and facilitate physical therapy. Treatment with muscle relaxants begins with the usual therapeutic dose and continues as long as the pain syndrome persists; As a rule, the course of treatment lasts several weeks. It has been proven that in case of painful muscle spasm, the addition of muscle relaxants to standard therapy (NSAIDs, therapeutic exercises) leads to a more rapid regression of pain, muscle tension and improved spinal mobility.

Sirdalud and tolperisone are used as muscle relaxants for back pain, and less often - baclofen and diazepam in an individually selected dose. Muscle relaxants are usually not combined.

Sirdalud

(tizanidine) is a centrally acting muscle relaxant, an agonist of a2-adrenergic receptors. The drug reduces muscle tone due to its stimulating effect on the monoaminergic nuclei of the brain stem. This leads to inhibition of spinal motor neurons and, accordingly, to muscle relaxation. Also, by selectively inhibiting a2-adrenergic receptors, the drug reduces the release of excitatory amino acids (in particular aspartate) from spinal interneurons, which underlies the analgesic effect of Sirdalud. There is an opinion that the additional antispastic effect of the drug is due to its influence on the receptors of noradrenergic neurons in the locus coeruleus region, which affect spinal structures.

When taken orally, the maximum concentration of Sirdalud in the blood is reached within an hour; food intake does not affect its pharmacokinetics. The drug is administered orally, 2–4 mg 3 times a day, in severe cases – an additional 2–4 mg at night.

To date, several dozen studies have been conducted to study the action of Sirdalud. According to their results, the drug reduces muscle tone, reducing only the tonic component, due to which muscle strength is maintained and, in some cases, even increased. Due to this feature and the analgesic effect, while taking Sirdalud, an increase in the daily activity of patients is noted. The authors also note that the drug is well tolerated, including by elderly patients. Studies have revealed the antiepileptic effect of high doses of Sirdalud, so the drug can also be used in patients with pain syndrome and epilepsy. Sirdalud is also characterized by a gastroprotective effect. Data from experimental and clinical trials indicate its ability to protect the gastric mucosa from the effects of NSAIDs.

Tolperisone has a predominantly central muscle relaxant effect. A decrease in muscle tone when taking the drug is associated with a depressive effect on the caudal part of the reticular formation, suppression of spinal reflex activity, and a central anticholinergic effect. The drug has a moderate central analgesic effect and a slight vasodilator effect. Tolperisone is prescribed orally at a dose of 150 mg two or three times a day. For a quick effect, the drug is administered 1 ml (100 mg) intramuscularly twice a day or intravenously with saline once a day.

Baclofen has a muscle relaxant effect mainly at the spinal level. The drug is an analogue of g-aminobutyric acid (GABA); it binds to presynaptic GABA receptors, leading to a decrease in the release of excitatory amino acids (glutamate, aspartate) and suppression of mono- and polysynaptic activity at the spinal level, which causes a decrease in muscle tone. The drug also has a moderate central analgesic effect. It is well absorbed from the gastrointestinal tract, the maximum concentration in the blood is reached 2-3 hours after administration. The initial dose is 15 mg per day (in three doses), then the dose is sometimes increased by 5 mg every day until the desired effect is obtained, the drug is taken with meals. Usual doses for treating painful muscle spasms are 15–30 mg. The maximum dose of baclofen for adults is 60–75 mg per day. Side effects often include drowsiness and dizziness at the beginning of treatment, although they may subside later. Sometimes nausea, constipation, diarrhea, and arterial hypotension occur; Caution is required when treating elderly patients.

Physiotherapeutic pain-relieving procedures can be used as treatment

, rubbing in ointments, compresses with a 30–50% solution of dimethyl sulfoxide and novocaine, novocaine and hydrocortisone blockades. When pain subsides, a gradual increase in physical activity and muscle strengthening exercises are recommended.

For radiculopathy, especially paralyzing sciatica, pentoxifylline 400 mg 2-3 times a day orally or 100-200 mg intravenously in saline is used. If reflex syndromes of osteochondrosis usually disappear within 1–4 weeks, then with radiculopathy the recovery period increases to 6–8 weeks.

In the chronic course of reflex syndromes and radiculopathies, physiotherapeutic treatment, NSAIDs, muscle relaxants, manual therapy, reflexology and spa treatment can be effective. In many patients with long-term pain syndrome, a significant effect can be obtained from the use of antidepressants in combination with other methods of therapy.

Traditionally, in our country, manual therapy, various types of physiotherapeutic treatment, and, in some centers, spinal traction are widely used for back pain. Many patients are observed and treated only by manual therapy specialists for a long time. However, according to WHO experts, these treatment methods have not yet received rigorous evidence of their effectiveness [5].

Surgical treatment (disc herniation removal)

necessary in those rare cases when compression of the spinal cord or cauda equina roots occurs. Surgical treatment is also indicated for discogenic radiculopathy, accompanied by severe paresis, and with long-term (more than 3-4 months) lack of effect from conservative treatment, as well as in the presence of a large disc herniation.

To prevent exacerbations of osteochondrosis, it is recommended to avoid provoking factors (lifting large loads, carrying a heavy bag in one hand, hypothermia, etc.), and regularly engage in therapeutic exercises.

For myofascial pain, it is necessary to rest the muscle for several days.

. As treatment, you can use muscle stretching exercises (post-isometric relaxation), taking muscle relaxants (Sirdaluda, tolperisone), physiotherapy (ultrasound), reflexology or local injection of anesthetics into trigger zones, compresses with dimexide and anesthetics.

Antidepressants are most effective for

. To reduce pain, NSAIDs, physiotherapy, therapeutic exercises and reflexology are used. Many patients experience only partial relief of pain after a course of treatment; exacerbations often occur, which requires repeated courses of treatment.

Thus, back pain is most often caused by reflex manifestations of spinal osteochondrosis, myofascial pain and fibromyalgia.
In such cases, the diagnosis is based on identifying typical manifestations of pain in the absence of signs of oncological, inflammatory and somatic diseases, as well as back injury. In the case of an atypical pain syndrome, additional examination is necessary, while the identification of degenerative changes in the spine according to X-ray data does not exclude other causes of back pain. In the treatment of reflex syndromes of osteochondrosis and myofascial pain in the acute period, rest, avoidance of painful positions and physical activity, the use of NSAIDs and muscle relaxants are effective, and in easing pain, therapeutic exercises are of great importance. In the treatment of chronic vertebrogenic pain syndromes and fibromyalgia, a significant effect can be obtained from the use of antidepressants. Literature:
1. Diseases of the nervous system. Guide for doctors. Edited by N.N. Yakhno, D.R. Shtulman. – M., 2001, volume 2.

2. Parfenov V.A., Yakhno N.N. Neurology in general medical practice. M., 2001.

3. Victor M., Ropper AH // Adams and Victor's principles of Neurology. New York. 2001

4. Waddel G. The back pain revolution. Churchill Livingstone. 1998.

5. WHO Department of noncomunicable disease management. Low back pain initiative. Geneve, 1999.

Lower back pain due to kidney disease

For lower back pain, it is important to determine what is causing it - pathologies of the musculoskeletal system or kidney disease (as well as other internal organs). Diagnosis must be carried out by a doctor. However, there are signs to suggest that the pain may be due to problems with the kidneys and/or other organs of the genitourinary system. If these symptoms occur, it is advisable to immediately contact a urologist. Kidney disease (or more broadly, the genitourinary system) can be suspected if lower back pain is accompanied by:

general deterioration in health (lethargy, drowsiness, weakness, increased fatigue);
swelling of the eyelids and face. Swelling is especially pronounced in the morning, after waking up, and subsides in the evening;
increased body temperature, chills, sweating;
loss of appetite, nausea, vomiting;
frequent or painful urination;
changes in the characteristics of urine (it may become more concentrated in color or, conversely, colorless, contain mucus or blood);
increased blood pressure.

Also an important sign that lower back pain is caused by problems of the internal organs, and not the musculoskeletal system, is its independence from the position of the body: the pain does not increase or decrease from changes in the position of the body and limbs. However, with prolonged standing in a standing position due to check pathology, the pain may intensify. The location of the pain also matters. With kidney disease, pain is most often observed on one side (since usually only one kidney is affected). Kidney pain may not be limited to the lower back, but may spread along the ureter, to the groin, to the external genitalia, to the inner thighs.

Pain therapy

In order for the pain syndrome to leave you alone forever, you need to eliminate the cause of its occurrence. That is, he will be cured of the illness that provokes this pain. A neurologist or orthopedist selects individual therapy methods for each case.

But the treatment of all types of pathologies involves cupping, acupuncture, as well as manual therapy.

Pain relief

As a rule, pain in any disease subsides when the patient takes a supine position. But this is not recommended. When a person spends most of his time lying down, the disease begins to develop at a faster rate.

For certain types of pathologies, a specialist prescribes bed rest. Of course, you should follow the doctor’s recommendations, but try to reduce this period of time as much as possible. The sooner you get out of bed, the better it will be for your healing.

You shouldn't overload your spine either. While you are suffering from pain, try to avoid physical activity and wear a special medical corset for fixation.

Relief of pain syndrome includes conservative methods of influence. The specialist prescribes medications for oral administration, as well as for injection. Non-steroidal anti-inflammatory medications such as Diclofenac, Mexilocam, Xefocam are usually prescribed.

Muscle relaxants are also used: Tizanidine and Tolperisone. When dystrophic processes occur, chondroprotectors are used. The doctor may prescribe topical ointments and gels, which belong to the group of non-steroidal anti-inflammatory drugs.

After a full examination and an accurate diagnosis, the doctor may recommend physical therapy, which involves heating with dry heat. As well as a set of physical therapy exercises.

Manual therapy

If this method of treatment is performed by a qualified chiropractor in accordance with all the rules and regulations, the pain syndrome will subside in the shortest possible time. In addition, manual therapy helps eliminate spinal defects.

You cannot resort to such treatment on your own, without the permission of the treating specialist. Only after diagnostic measures have been carried out (X-rays and magnetic resonance imaging), a neurologist can recommend this method of exposure. This is due to the fact that therapy has its contraindications.

Manual therapy cannot be used if there is a hernia or defects in the spinal discs. Use is not recommended for cardiovascular pathologies, including after a heart attack or stroke.

Do not under any circumstances resort to this treatment method if cancerous tumors occur.

For thyroid pathologies and osteoporosis, the use of this method is also not recommended. If the disease is at an acute stage, refrain from manual therapy. And in conclusion, this method for eliminating pain in the spinal region cannot be used if blood clotting is poor.

Acupuncture

Acupuncture is also called acupuncture. This treatment method is usually used for pain that occurs due to heavy load on the spine or when the patient is in frequent stressful situations.

Experts suggest that acupuncture helps restore endorphins. The effect of these elements on the body is similar to the effect of morphine. As everyone knows, morphine is a narcotic substance that can completely suppress pain.

Chinese medicine practitioners believe that acupuncture can eliminate pain of any nature.

But still, guided by the research of Russian scientists, acupuncture cannot be used in the following cases:

for pathologies of the cardiac organ and its structures;
for tumors of a malignant and benign nature;
if you are undergoing surgery;
for diseases of the kidney organ and liver;
during pregnancy and breastfeeding;
with poor blood clotting;
in the presence of acute infectious diseases.

Lower back pain: what to do?

Low back pain is a symptom of a disease that requires treatment. Therefore, it is necessary to consult a doctor. But in the event of a sudden attack of acute pain (“lumbago”, typical of radiculitis), first of all, it is necessary to relieve the pain syndrome. Doctors advise:

use gentle heat. Tie a woolen scarf or woolen belt around your lower back;
take painkillers;
It is necessary to take a position that allows you to relax your back muscles. It is recommended to lie on your back, on a hard, flat surface (board); The legs should be raised and bent at the knees, for which a rolled blanket or pillow should be placed under them. (It is not advisable to lie on the floor; there may be a draft).

The proposed pose is not a dogma. The patient should feel relief, so other positions are possible; for example, lying on a board, place your legs bent at the knees on it, holding a pillow between them. You can try lying on your stomach and stretching your legs, placing a bolster under your ankle joints. If the severity of the pain has been relieved, this does not mean that a doctor is no longer needed. Without proper treatment, attacks will recur, and the situation as a whole will worsen.

Signs to watch out for

Secondary back pain, that is, not connected with osteochondrosis and an “overworked” back, is an alarming symptom that forces you to start searching for the underlying pathological process causing pain as soon as possible. Let us briefly look at the symptoms that may indicate a possible secondary (that is, not directly related to the spine) nature of the pain and require increased vigilance from both the doctor and the patient:

rapid, sudden loss of body weight (a tumor may be suspected);
kidney and bladder infections (in this case, pain may be a symptom of pyelonephritis);
increased pain at rest or after a night's sleep (this symptom is of particular interest to rheumatologists, as it may be a sign of developing ankylosing spondylitis);
increased body temperature;
changes in blood tests (increased blood clotting detected during a coagulogram, an increase in the level of leukocytes or a drop in hemoglobin, as well as an increase in ESR (erythrocyte sedimentation rate) in a general analysis, an increase in the level of C-reactive protein in an immunological analysis);
an established diagnosis of osteoporosis, or taking medications that reduce the amount of calcium in the bones;
age over 50 years (risk of developing osteoporosis in women in menopause) or less than 20 years, especially for young men;
reference to an injury, regardless of its duration (for example, a fall from a height of more than 2 meters, and for older people, a significant injury is a fall from the height of one’s own body);
signs of serious neurological abnormalities (impaired skin sensitivity, urination or defecation usually indicates deep damage to the spinal cord);
ineffectiveness of “routine” treatment within 4 weeks.

Which doctor should I contact with a complaint of lower back pain?

If you have lower back pain, it is best to consult a general practitioner, since first of all you need to determine which organ disease is causing the pain. Depending on the results of the examination, consultation with a particular medical specialist may be required. Can be assigned:

consultation with a neurologist to assess the condition of the spine, back muscles and nervous system;
consultation with a urologist – in case of suspected urinary system disease;
consultation with a gynecologist – if chronic diseases of the female reproductive system are suspected or present;
general blood test and general urinalysis - to confirm or exclude the inflammatory nature of the disease;
radiography of the spine;
Ultrasound of the hip joints;
as well as other studies.

Survey

It is generally accepted that if a patient complaining of pain in the lower back does not have “warning signs” (they are discussed below), then he does not need additional examination, and treatment can be carried out by a therapist without tests or even x-rays. But, as practice shows, such “signs” can be detected in almost any patient, which means there is a need to donate blood for at least a general (and better yet, immunological) analysis, and perform an x-ray of the lumbar spine in two projections ( ideally – with “capture” of the pelvic bones).

— Blood tests

may reveal an increase in erythrocyte sedimentation rate (ESR), which indicates inflammation, possibly of immune origin, or infection. An increase in the level of leukocytes also indicates infection or inflammation, and severe anemia indicates the possible presence of a tumor process.

— Analysis of urine

is given if kidney disease is suspected. The pain in the lumbar region is aching in nature, often “spreading” upward to the lower ribs. If there are changes in the urine test, a kidney ultrasound is performed, and further tactics are discussed in detail with a therapist or urologist.

— Radiography

– the cheapest of the instrumental examinations, this is the method of choice in the diagnostic search in this case. On an x-ray, you can see a violation of the structures of the spine, signs of inflammation of the vertebral joints, and by indirect signs determine the location of compression of the nerves. The “transparency” of the vertebrae on an x-ray will suggest osteoporosis (fragility) of the bone skeleton. As you know, against the background of osteoporosis, the most common complication is a vertebral fracture with subsequent compression of the adjacent nerves. If, unfortunately, a fracture has occurred, this will also be visible on the x-ray. The possibilities of this research method are enormous, but if a pathology is found, it is necessary to clarify how serious the damage is and whether the patient needs surgical intervention on the spine. This requires a more accurate study - layer-by-layer (tomography). There are two types of tomography – computed x-ray and magnetic resonance imaging.

— Computed tomography (CT)

. An examination method that allows you to literally look inside the spine. All bone structures that escaped the attention of the radiologist during conventional radiography will be clearly visible on the tomogram. If necessary, using the obtained data and a special computer program, you can reconstruct a 3D model of any structure of interest.

— Magnetic resonance imaging (MRI)

. Non-X-ray research method. It also differs from computed tomography in that it allows the doctor to more carefully assess the condition of the “soft” structures of the spine (only bone elements are clearly visible on CT): the spinal cord, roots. During this examination, vertebral hernias, changes in blood vessels and muscles can be seen in more detail. Usually, it is the MRI specialist who has the final say in the diagnostic search and determining further tactics.

Physiotherapeutic procedures

Most of these therapeutic measures are not prescribed to patients with pain caused by an acute inflammatory process. The procedures begin after it has been relieved with pharmacological drugs. Physiotherapy is used to normalize tissue metabolism, tissue regeneration, and prevent further degenerative changes in the lumbar spine. What physiotherapeutic procedure can be used to get rid of back pain:

electrophoresis. Therapeutic manipulation is designed to ensure rapid delivery of drugs (NSAIDs, analgesics, anesthetics, chondroprotectors) to damaged areas of the lower back. During electrophoresis, cotton swabs soaked in a medicinal solution are placed on the patient's back. Special plates are placed on top through which current is passed. Under the influence of electrical impulses, chemical molecules quickly penetrate the area of inflammation;
ultrasound therapy. Oscillations of ultrasonic waves stimulate blood circulation in the lower back. Nutrients and biologically active substances, as well as molecular oxygen, begin to penetrate into damaged tissues. After 5-10 procedures, the patient’s pain disappears as a result of muscle spasm relief and increased metabolism;
laser therapy. Laser polarized light is used in the treatment of destructive changes in the lumbar intervertebral discs. Under the influence of infrared radiation, the blood supply to joint and cartilage tissues is restored and metabolism is normalized. Physiotherapy helps remove waste, toxins, and end products of the inflammatory process from the spinal column;
magnetotherapy. During the procedure, the patient is exposed to a wave magnetic field to stimulate blood circulation in damaged tissues.

Therapeutic manipulation is prescribed to relieve further damage to the lumbar vertebrae and prevent the spread of inflammation to healthy tissue. The result is the disappearance of painful sensations and restoration of full range of motion.

To treat severe pain, which can radiate to the leg, arm, tailbone, physiotherapy is combined with taking pharmacological drugs. And during the rehabilitation period or during remission of chronic pathologies of the spine, patients are recommended mud therapy, mineral water baths, classical and precise massage, and acupuncture.

Electrophoresis is prescribed to patients for the treatment of lower back pain and relief of the inflammatory process

Recipes from traditional healers

To treat lower back pain, traditional healers recommend drinking plenty of fluids. Pure water, chamomile and rosehip tea, berry and fruit compotes will help quickly remove the end products of inflammation, waste and toxins from the spine. Infusions and decoctions of medicinal herbs are used as a drink in folk medicine. Useful plants contain biologically active substances with anti-inflammatory, analgesic and antiseptic properties.

How to cure back pain with healing infusions:

pour 3 tbsp into a thermos. spoons of lingonberry leaves, St. John's wort and marigold, pour a liter of boiling water and leave for about an hour. Strain, drink the aromatic infusion instead of coffee and tea;
Place a handful of dried rosehips, blueberries and junipers in an enamel or glass container, pour in 2 liters of hot water. Simmer in a water bath for 30-40 minutes, strain and drink 0.5 cups of infusion before each meal.

Back pain can be relieved with a compress or ointment made from natural products. How to prepare the potion:

Melt 3 tbsp in a water bath. spoons of natural honey, cool and mix with 2 tbsp. spoons of pharmaceutical alcohol.
Carefully add 100 ml of Vaseline into the mixture and rub into the damaged areas of the lower back.

This remedy is also used for therapeutic compresses for back pain. To do this, the mixture should not be rubbed, but distributed in a thin layer on the skin. You need to put plastic wrap on top and then wrap yourself in a warm scarf. The duration of the procedure is 3-4 hours.

Treatment for lower back pain usually occurs at home. Only when an acute inflammatory process is diagnosed is the patient hospitalized in a hospital. Depending on the cause of the pathology, therapy takes from two weeks to several months. But if you follow medical recommendations, recovery significantly accelerates, as evidenced by reviews from recovered patients.

Infusions of medicinal herbs relieve a person from lower back pain, cleanse the spine of waste and toxins

“One morning I simply couldn’t get out of bed, I even thought that I was paralyzed. But the pain refuted this assumption; it was so strong that it radiated to my legs. We were treated in the hospital with injections of Movalis and Mydocalm, and then took them at home for about a week. The pain went away on the second day, but the doctor ordered treatment until a victorious recovery.”

“My pain intensified gradually, as I suspect, after swimming in a cold river. My lower back simply couldn’t straighten and I had to go on sick leave. I followed all the doctor’s advice, drank Ibuprofen and Sirdalud, smeared myself with Voltaren, and put mustard plasters on my back. I was cured in five days.”

“The doctor warned that pain is not the worst thing. During the diagnosis, it turned out that my vertebrae were rapidly collapsing. I took Teraflex for about a year and rubbed Honda into my back. For pain, I took Nise with Omeprazole. After a new examination, the neurologist was pleased that no new damage was found.”

source

By localization

Let's consider the possible causes of pain in various parts of the back.

Pain on the right side

Back pain on the right can occur with kidney problems, sometimes it indicates inflammation of the appendix. In addition, there is a list of diseases that are characterized by pain in the right side from the back:

curvature of the spine is the most common reason why the sides hurt;
displacement of intervertebral discs;
gastrointestinal diseases;
kidney stones (pain radiates to the right side of the back, under the ribs, in the stomach);
obesity;
gynecological diseases, most often inflammatory;
diseases of the respiratory system (if it hurts in the upper right), with aching and dull pain, the pathology may transition to the chronic stage;
dysfunction of the peripheral nervous system;
injuries;
diseases of the muscles located near the spine;
too much physical activity;
ectopic pregnancy.

Pain on the left side

If the pain is localized in the back, on the left side, under the ribs or in the lumbar region , it may be:

pathologies of the spine (inflammation, pinching, etc.);
diseases of the kidneys and urinary system (accompanied by swelling of the legs);
gastrointestinal diseases;
spleen diseases.

In the left hypochondrium and above:

respiratory diseases;
cardiovascular diseases;
osteochondrosis;
intercostal neuralgia.

A nagging pain in the left side from the back in the lower part indicates pathologies of the reproductive system.

Pain in the lumbar region

If your back hurts in the lumbar region, such discomfort is typical for osteochondrosis, hernia, and radiculitis. Pain in the back muscles in the lumbar region occurs due to injuries and excessive stress.

Other causes of lumbar back pain:

rheumatoid arthritis;
Reiter's syndrome;
infections of the spine and intervertebral discs (brucellosis, tuberculosis, abscess);
tumor;
pinched nerve;
osteochondrosis;
sciatica;
osteoporosis.

In the area of the shoulder blades

Pain in the upper back (shoulder blade area) on the left :

diseases of the musculoskeletal system;
lung problems (pneumonia, abscess, pleurisy);
dysfunction of the stomach;
cardiac pathologies (angina pectoris, myocardial infarction);
diseases of the spine (osteochondrosis, hernia, scoliosis, spondylosis, spondyloarthrosis);
muscle inflammation;
spleen diseases.

Pain under the right shoulder blade from the back :

injury;
infections;
osteomyelitis;
cholecystitis;
hepatic colic;
pancreatitis;
cholelithiasis;
cirrhosis of the liver;
cervical osteochondrosis;
scoliosis;
intercostal neuralgia;
vegetative-vascular dystonia.

Pain along the spine and in the back

One of the main reasons why the spine hurts is compression of the nerve processes . May be accompanied by hernia, scoliosis, and vertebral displacement. Other reasons:

osteoarthritis;
myalgia;
osteochondrosis (pain in the spine can occur in the middle of the back, in the cervical or lumbar regions);
muscle fatigue;
curvature of the spine (scoliosis, kyphosis, lordosis);
spinal protrusion;
fracture, spinal injury;
inflammation of the sciatic nerve;
anomalies in the structure of the spinal column;
radiculitis;
Bekhterev's disease;
spondylosis.

Causes of pain below the lower back

A significant percentage of cases of lower back pain are:

scoliosis;
infections of the vertebrae and intervertebral discs;
non-infectious inflammations;
gastrointestinal diseases;
muscle strains;
displacement of intervertebral discs.

Causes of back pain

Back pain does not only mean serious pathologies. For example, pain when coughing or walking can be caused by simple overexertion. However, it is often a symptom of various diseases, the manifestations of which depend on many factors.

Why does my back hurt after sleep?

Possible reasons why you feel back pain in the morning after sleep:

hypothermia;
sudden lifting of weights during the day (or 3-4 days), causing night pain;
osteochondrosis;
intervertebral hernia;
incorrect body position when lying down;
incorrectly selected mattress;
in women, among the reasons is pregnancy;
curvature of the spine, leading to asymmetric muscle contraction;
excess weight and muscle weakness;
stress.

Diseases associated with joints and the spinal column

Back pain means in this case that the following may be present:

osteochondrosis;
spondylolisthesis;
ankylosing spondylitis;
Bekhterev's disease;
osteomyelitis;
rheumatoid arthritis;
displacement of intervertebral discs;
Reiter's syndrome;
intervertebral disc herniation.

Muscle-related diseases

Why do my back muscles hurt?

Very often, muscle pain is associated with heavy workload, fatigue, and hypothermia. Cramping and induration may occur, as well as decreased mobility and soreness (fibromyalgia). In addition, the back may hurt due to the following muscle pathologies:

Charcot's disease, or ALS;
dermatomyositis (additionally manifested by a rash);
rhabdomyolysis;
polymyositis;
infection of muscle tissue, abscess;
polymyalgia rheumatica.

Spinal cord pathologies

The spinal cord is an organ that provides communication between the body and the brain. Through the openings between the vertebrae, pairs of spinal nerves depart from the spinal cord - there are 31 of them. Each nerve innervates a specific area of the body. If you find numbness of the skin (locally), weakness of muscles, limbs, the spinal cord or some nerve may be damaged.

More diseases:

compression of the spinal cord (for example, with a fracture or cervical spondylosis, abscess, hematoma);
spinal injury;
cavities filled with liquid;
an inflammatory process caused, for example, by acute transverse myelitis;
impaired blood supply to the organ;
HIV;
abscess;
deficiency of copper, vitamin B;
syphilis;
benign or malignant neoplasms;
hemorrhages;
multiple sclerosis.

Back pain due to psychosomatics

Psychological reasons are officially recognized by medicine. Psychogenic factors can influence processes that cause dysfunction in a particular location. Thus, chronic stress and long-term depression, dissatisfaction with intimate life can lead to constant aching pain in the lumbar region.

Different diseases cause different types of back pain. Let's consider the main pathologies and the nature of pain associated with them.

Aching back pain (acute and chronic)

Lumbago (shooting in the lower back). The reason is hard physical labor. It usually goes away on its own within a few days.

Myositis, muscle strain, sudden heavy lifting, hypothermia, maintaining an uncomfortable position for a long time, for example during work.

Displacement of intervertebral discs. The most common cause is osteochondrosis, but displacement can also occur with sudden heavy lifting and constant high physical activity.

Sharp, radiating to the extremities

Osteochondrosis. Causes nagging pain in the back that radiates to the leg and becomes stronger when sneezing, coughing, or straining.

Radiculitis. Constant sharp (stabbing) or dull pain. It is usually localized on one side, can radiate to the thigh, buttock, leg, lower leg, and sometimes causes numbness and itching. The pain can also be burning and intensifies with movement.

Intervertebral hernia. With this pathology, pain occurs when bending over, lifting heavy objects, intensifies when sneezing, coughing, moving, and is accompanied by weakness in the leg.

Throbbing pain, severe, may not go away after taking an analgesic

Osteochondrosis, cracks in the vertebrae, lumbago, intervertebral hernia, spondylosis.

In the upper back and in the middle of the sternum - may indicate angina pectoris, myocardial infarction, pulmonary embolism. In the lower back - intestinal obstruction, spondyloarthrosis.

Angina pectoris, myocardial infarction, problems with the gallbladder (pain occurs after eating), atherosclerosis, hypertensive crisis.