Pain in the lower back is the most common pain syndrome in outpatient practice.30-60% of the population in developed countries suffer from recurrent back pain and up to 80% of all back pain occurs in the lumbar (lumbar) region.All age groups can suffer from low back pain, but the peak incidence occurs between the ages of 30 and 60.
Lower back pain due to illness
Low back pain is a non-specific symptom that can be caused by several reasons.Doctors distinguish between primary and secondary low back pain syndromes.Most pain in the lower back is based on musculoskeletal morphofunctional changes (primary low back pain syndrome).These are mainly degenerative-dystrophic lesions of the spine:
Possible causes of secondary low back pain syndrome:
- Primary and metastatic tumors of the vertebrae, spinal cord, retroperitoneal space.
- Vertebral fractures.
- Infectious lesions of the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess).
- Non-infectious inflammatory diseases (ankylosing spondylitis, Reiter's syndrome, rheumatoid arthritis).
- Metabolic bone lesions (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute spinal circulatory disorders (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Referred pain in diseases of the pelvic organs (including renal colic, infectious gynecological diseases such as chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis).
Pain in the lower back can also be acute or chronic, and the causes are injuries to the spine or nerve roots.Possibly moving pain from deeper structures:
- kidneys;
- pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumors.
Sharp pain in the lower back
Acute sprain.The pain is localized in the region of the long back muscles during spasm, which causes restrictions in movement.There is no displacement of pain to the groin area or lower extremities.
Vertebral fractures.Usually this is a consequence of an injury when bending or falling on the legs, but the same result can occur without injury or with minimal trauma if the patient has an affected skeletal system, osteoporosis, Cushing's syndrome, hyperparathyroidism, myeloma, metastases of malignant tumors in the bones, Paget's disease.
Displacement of intervertebral discs in the lumbar region.Symptoms of this disease include pain in the lower back, forced body position, and limited mobility.The participation of nerve roots in the pathological process is indicated by: radicular pain, usually unilateral;sensitivity disorders (paresthesia, hyperesthesia or hypalgesia);decreased or absent Achilles or knee reflex.
Facet syndrome.Compression of the root as it exits the spinal canal causes root pain that is not caused by disc damage.Unilateral facet syndrome, most often associated with the L5 root, occurs when the upper and lower facets of the intervertebral joint are enlarged, which leads to a narrowing of the intervertebral canal or foramen.
Epidural abscess.Most often found in the thoracic spine, it may be accompanied by sharp back pain when palpating or tapping the affected area.It requires rapid diagnosis and initiation of treatment measures, including surgery, if there are signs of spinal cord compression.Pathological processes in the hip joint can be accompanied by pain that radiates to the gluteal region and lower limbs up to the level of the knee joint.
Chronic low back pain
Deforming spondylosis.Spondylosis deformans are degenerative changes in the lumbar vertebrae with the formation of bone spurs that narrow the spinal canal and put pressure on the roots.If lumbosacral pain appears with neurological symptoms when walking (loss of sensitivity, sensory disturbances or weakness in both lower extremities), intermittent claudication syndrome associated with the spine and resulting from narrowing of the spinal canal is suspected.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with pain in the lower back that extends to the hips.First, there is limited mobility and morning stiffness, decreased respiratory movements of the chest, and progressive curvature and flexion of the thoracic spine.Radiographic signs: destruction and restructuring of the sacroiliac joints, formation of the so-called “bamboo” spine.Similar symptoms with limited movement in the lower spine can occur with:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.Using radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (breast, lung, prostate, thyroid, kidney, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.Caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;the possibility of these infections must be confirmed or excluded by determining ESR, bone radiography and tuberculin skin testing.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before other neurological symptoms appear.Displaced pain in the lower back due to diseases of internal organs.When the pelvic organs are affected, the pain shifts to the sacral region, the organs of the lower abdominal cavity - to the lumbar segments, the upper abdominal cavity - to the lower thoracic and upper lumbar segments.There are no local symptoms or back stiffness;full back movements do not increase pain.
Treatment
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Lower back pain sometimes radiates down the leg.In this case, you need to urgently contact a neurologist.
Don't delay visiting your doctor if:
- experience severe lower back pain for more than 3 days;
- pain occurred after injury;
- at the same time you feel pain in the lower back, leg and feet;
- pain in the lower back is combined with numbness in the buttocks, thighs, legs, feet and groin.
Low back pain is a very common symptom, especially in elderly people.Rheumatism, lumbar osteochondrosis and radiculitis - all these diseases cause sharp pain in the lower back.Only a proper examination of the body can show the results and give a clear answer about the causes of lower back pain.