Pain in the lumbar region is the most common pain syndrome in outpatient practice.Between 30 and 60% of the population in developed countries suffer from recurrent back pain and up to 80% of all back pain occurs in the lumbar region (lower back).All age groups can suffer from low back pain, but the peak incidence occurs between 30 and 60 years of age.
Pain in the lumbar region due to illness.
Low back pain is a nonspecific symptom that can be due to many reasons.Doctors distinguish between primary and secondary low back pain syndromes.Most pain in the lumbar region 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).
- Remitted 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 is caused by damage to the spine or nerve roots.Possible pain on movement from deeper structures:
- kidneys;
- pancreas;
- colon;
- pelvic organs;
- Retroperitoneal tumors.
Acute pain in the lumbar region.
Acute sprain.The pain is localized in the area of the long muscles of the back during their spasm, which causes restrictions in movements.There is no displacement of pain to the groin area or lower extremities.
Vertebral fractures.Usually this is a consequence of 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 position of the body and limited mobility.The involvement 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 radicular pain that is not caused by disc damage.Unilateral facet syndrome, most commonly associated with the L5 root, occurs when the superior and inferior facets of the intervertebral joint increase in size, leading to a narrowing of the intervertebral canal or foramen.
Epidural abscess.It is most commonly found in the thoracic spine and may be accompanied by sharp back pain when palpating or tapping the affected area.It requires prompt diagnosis and initiation of treatment measures, including surgery, if there are signs of spinal cord compression.Pathological processes in the hip joint may be accompanied by pain that radiates to the gluteal region and lower extremities up to the level of the knee joint.
Chronic low back pain
Spondylosis deformans.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 sensation, sensory disturbances, or weakness in both lower extremities), an intermittent claudication syndrome associated with the spine and arising from a narrowing of the spinal canal is suspected.The diagnosis is confirmed by examination.
Ankylosing spondyloarthritis.It should be suspected in young people with pain in the lower back that moves 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.Radiological signs: destruction and restructuring of the sacroiliac joints, formation of the so-called "bamboo" spine.Similar symptoms with limited movement in the lower spine may 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 staphylococcus) or Mycobacterium tuberculosis;The possibility of these infections should be confirmed or excluded by ESR determination, bone radiography, and tuberculin skin testing.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
Previous tumors can cause chronic pain even before other neurological symptoms appear.Changing pain in the lumbar region due to diseases of internal organs.When the pelvic organs are affected, the pain moves 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 stiffness in the back;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 and sneezing.Low back pain sometimes radiates to the leg.In this case, it is necessary to urgently contact a neurologist.
Don't delay visiting your doctor if:
- experience severe low back pain for more than 3 days;
- the pain occurred after the injury;
- at the same time you feel pain in your lower back, lower leg and foot;
- Pain in the lower back is combined with numbness in the buttocks, thighs, legs, feet and groin.
Low back pain is a fairly common symptom, especially in older people.Rheumatism, lumbar osteochondrosis and radiculitis - all these diseases cause acute pain in the lumbar region.Only a proper examination of the body can show the results and give a clear answer about the causes of lower back pain.