Up to 76% of the population suffers from back pain during the year;In 7% of cases, patients complain of acute back pain.The hospital's rheumatologists determine the cause of back pain using the latest laboratory research methods and instruments.To relieve pain and further treat patients, doctors prescribe modern drugs that are highly effective and have few side effects.Rehabilitation specialists use innovative rehabilitation therapy methods 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 (localized) pain, radicular pain, radicular pain and pain that occurs due to muscle spasms.The most common forms of back pain are combined.Low back pain is characterized by 3 types of pain: muscle hypertonia in the form of piriformis syndrome, gastrocnemius and gluteus medius, vascular neuropathy and neurodystrophy.
There is primary and secondary back pain.Primary pain syndrome most often develops between the ages of 20 and 50 years.It is based on the following mechanical elements:
- Spondylosis and osteoarthritis;
- Dysfunction of the musculo-ligamentary apparatus of the back;
- Disc herniation.
Psychogenic back pain in its pure form is very rare.Diagnosis is difficult because patients with psychiatric disorders often have musculoskeletal and other neurological disorders that can cause pain.In patients under twenty years old and over fifty years old, secondary pain syndrome prevails.
Doctors consider pain that lasts less than six weeks as acute, pain that lasts six to twelve weeks as subacute, and pain that lasts more than twelve weeks as chronic.Muscle pain in the back occurs with myositis, osteoarthritis and after injury.Patients with acute, subacute, and chronic back pain have different prognosis regarding recovery and return to work.Rheumatologists use different methods to diagnose the cause of different pain and treat it.
Causes of back pain
One of the most common causes of back pain is spinal injury, which occurs due to excessive stress during physical activity and sports.Such injuries have the following consequences:
- Spine fractures;
- Deformed or ruptured disc;
- Inflammation and relaxation of the joint capsule;
- Rupture of the ligaments of the spine.
Microtrauma can occur due to sudden unsuccessful movements during continuous physical activity.
The following causes of back pain are also identified:
- Curvature of the spine;
- nerve pain;
- osteoarthritis;
- Compression of nerve endings;
- Arthritis and inflammatory diseases;
- Cancerous spinal tumors;
- Damage to the fascia;
- Muscle spasms.
Causes of chronic back pain can be diseases of internal organs (heart, lungs, kidneys), burns, cancer, sedentary lifestyle and emotional overload.Severe back pain can occur due to uncontrolled use of certain medications.If back pain spreads down your legs, you should think about sacral radiculitis.Lumbar back pain is characteristic of diseases of the intestines, kidneys, prostate in men and diseases of the reproductive system in women.Pain in the middle of the back can be a sign of a heart attack.Pain under the ribs from behind occurs with intercostal neuralgia.
Recently, in clinical guidelines addressing back pain, the term “non-specific back pain” is often used.It represents pain associated with a musculoskeletal disorder without signs of damage to the cervical, thoracic, lumbar and sacral roots, or specific injury to the spine.
Determine the cause of back pain
The hospital has unique diagnostic capabilities that allow you to quickly determine the cause of your back pain.Doctors establish a connection between the clinical manifestations of the disease and data from additional research methods.The examination program for back pain patients includes the following diagnostic measures:
- X-ray examination of the spine;
- Computed tomography;
- Magnetic resonance imaging.
X-ray examination has important diagnostic value for back pain.Standard diagnostic methods include radiographs in anteroposterior and lateral projections, and functional spine imaging in maximal flexion and extension positions.Computed tomography and magnetic resonance imaging help clarify the location of the pathological process.
Patients with back pain are prescribed the following types of instrumental studies:
- Electrocardiogram (for heart dysfunction);
- Magnetic resonance or computed tomography with contrast;
- Optical topography of the skeleton and diagnostic stability;
- Ultrasound examination of joints and spine;
- Densitometry (determination of bone tissue density);
- EEG;
- Spiroarteriocardio heart rate measurement.
Patients underwent complete blood count, urinalysis, C-reactive protein and rheumatoid factor testing.Differential diagnosis of acute back pain is carried out between the following diseases:
- Potentially dangerous diseases of vertebral and non-vertebral origin (cauda equina insertion, trauma, tumors, inflammatory and infectious lesions of the spine, osteoporosis and diseases of internal organs);
- compressive radiculopathy;
- Benign musculoskeletal back pain.
Only after determining the exact cause of back pain do doctors outline a treatment plan for the patient.
Back pain treatment
Pain syndromes are based on two main mechanisms that determine how to treat patients with back pain: damage to the spine and spasms or sprains of muscles and ligaments.From the first day of treatment, patients are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs).Their anti-inflammatory effects are due to inhibition of cyclooxygenase-2.NSAIDs not only inhibit the metabolism of this inflammatory mediator but also positively influence prostaglandin production associated with calcium mobilization in smooth muscle.For muscle pain in the back, patients are prescribed muscle relaxants.
If pain relievers and nonsteroidal anti-inflammatory drugs are ineffective or if there are contraindications to their use, weak opioids (codeine, tramadol) are used to relieve severe back pain.Potent opioids are administered as transdermal therapeutic systems with gradual sustained drug release.
Antidepressants are prescribed to treat chronic back pain.They reduce pain intensity in patients with chronic back pain.The analgesic effect of antidepressants does not depend on whether or not depression is present.For short-term pain relief, pepper patches can be used.
Patients with back pain should avoid bed rest and resume normal daily activities or resume them as soon as possible.For acute pain in the lumbar region, active exercise will not be effective during the first two weeks of the illness.
One of the most effective modern treatments for chronic back pain is “pain management.”This method has a targeted effect on the affected areas: painkillers are injected into precisely defined areas using radiography.Pain prevention combined with a series of individual treatment procedures can provide patients with long-term relief from back pain.
Doctors at the hospital combine back pain treatment with medication with the following treatments:
- Physical therapy;
- Massage;
- acupuncture;
- Exercise therapy.
When acute back pain occurs, the doctor may advise the patient to wear a compression garment.Their effectiveness in chronic pain syndrome has not been proven.Individually selected physiotherapy exercises will begin the process of tissue recovery and fully restore the motor functions of the spine.Massage therapy and muscle stimulation using the latest equipment that the rehabilitation clinic is equipped with can quickly relieve a patient's back pain.These methods are necessary for the patient to fully recover.
One of the popular non-pharmacological methods for local back pain relief is transcutaneous electrical nerve stimulation.This is pain blockade using electrical impulses at its localized site.Another effective pain relief method used in hospitals is biofeedback.It was created at the intersection of psychology and physiology.A special device reads information from the patient's body.Then a computer model of it will be formed on the screen.It clearly shows all the processes occurring in the body, including pain.If the patient has not returned to his normal level of daily activity four weeks after the onset of acute back pain, it is necessary to refer him for chiropractic therapy.
Which doctor treats back pain?The hospital applies a multidisciplinary approach to treating patients with chronic back pain.It includes drug treatment programs, patient education, therapeutic exercises and psychotherapeutic interventions, which are carried out regularly with the participation of several specialists (neurologists, vertebrologists, rheumatologists, psychotherapists, rehabilitation specialists, therapists).
Cognitive behavioral psychotherapy reduces back pain intensity and improves functional status.Programs that combine behavioral psychotherapy with gradually increasing physical activity allow patients to quickly return to normal work.
Physical rehabilitation for back pain
During the physical rehabilitation of back pain patients, therapeutic exercises play an important role.With the help of individually selected exercises, motor and nervous disorders are corrected, tissue and functional recovery are improved.Hospital-based rehabilitation specialists use cognitive and passive range-of-motion exercises to treat back pain.
Passive exercises are performed with the maximum possible range of motion in the joint, in one direction, completely in the same plane, at the same speed.The rehabilitator performs them, starting with large joints, then gradually moving to small joints.Neuromotor exercises are used to restore damaged nerve impulse pathways from the center to the periphery.They are widely used for persistent pain syndromes.
For patients with muscle weakness, rehabilitation therapists prescribe active isometric exercises.The patient performs them without tension and breath holding, while maintaining tension.These exercises improve blood circulation in spasmed muscles, prevent muscle atrophy and restore the transmission of nerve impulses.When increasing muscle strength, active dynamic exercises are used from a light starting position.When they are performed, the attachment points of the antagonist muscle 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 call center and make an appointment with a neurologist or rheumatologist.After a general examination and determining the cause of back pain, the doctor will prescribe comprehensive treatment.After relief of acute pain in the spine, the patient will undergo a rehabilitation course at the rehabilitation clinic using the latest equipment and advanced techniques.