Most often, aching lower back pain is associated with overwork. Less commonly, pain indicates an intervertebral hernia, ankylosing spondylitis, or diseases of the internal organs (pancreas, kidneys, uterus, prostate). Diagnostics consists of a clinical, laboratory, and instrumental approach. Therapeutic measures depend on the root cause of the pain.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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What is special about it?
According to statistics, about 40% of the world’s population from 17 to 70 years old are concerned about lower back pain. Most often, such sensations are associated with overwork or stressful situations. However, in some cases, the pain syndrome occurs against the background of severe pathologies.
In 2/3 of the patients, the cause of lumbar pain is a lesion of the spine, less often – of internal organs. And only in 5% of cases, pain provokes diseases of the muscular and nervous systems.
Today, chronic pain of any localization is a serious medical and social problem. So, patients tend to get used to soreness, avoiding a full examination and treatment. Such a solution contributes to the exacerbation of the disease, the development of complications and subsequent disability of patients.
Why does it appear?
As mentioned above, aching lower back pain can provoke spinal pathologies or somatic diseases.
- Congenital malformations associated with the fusion or separation of additional vertebrae (sacralization, lumbarization);
- Traumatic lesions of the spine (compression fractures, etc.);
- Osteochondrosis – the destruction of the intervertebral disc and its protrusion between the vertebrae in the form of a hernia;
- Spondylosis – senile wear of bone and connective tissue structures of the spinal column;
- Spondylarthrosis – the destruction of the cartilage surfaces of the intervertebral joints;
- Spondylolisthesis – instability of the spine, manifested by slipping of the vertebrae relative to each other;
- Ankylosing spondylitis – inflammation of the intervertebral joints, leading to their immobilization (ankylosis).
The lumbar spine is considered the most vulnerable to these pathologies. The reason for this is increased mobility of the vertebrae in this area. A significant role is played by pressure on the spine, the maximum of which falls precisely on the lower back.
- diseases of the abdominal cavity and small pelvis – pancreas, kidneys, uterus and appendages, prostate (pancreatitis, urolithiasis, pyelonephritis, glomerulonephritis, prostatitis, uterine fibroids, adnexitis);
- tumor neoplasms of the spinal column, nervous tissue and internal organs (neurinoma, osteosarcoma, etc.);
- infectious processes – abscess, osteomyelitis, discitis with tuberculosis, syphilis, brucellosis and other infections;
- fibromyalgia – musculoskeletal pain of unknown origin;
- dermatomyositis is a disease of the connective and muscle tissue with the development of severe muscle weakness.
Predisposing factors of pain are metabolic disorders (obesity), hormonal disorders (diabetes), poor muscle corset development (sedentary lifestyle) or excessive stress on the spinal column (weight lifting).
In women, soreness in the lower back can occur against the background of pregnancy, when the uterus enlarged by the fetus puts pressure on the surrounding tissue.
The most common causes of lower back pain are intervertebral hernia, ankylosing spondylitis, fibromyalgia and pathologies of internal organs.
Lumbar hernia is considered a complication of osteochondrosis, during which the intervertebral disc is destroyed and protrudes toward the spinal canal. The disease provokes senile changes in the body, as well as excessive physical exertion.
For a long period, the disease is asymptomatic: the first signs appear only when the hernia begins to put pressure on the nerve fibers. In this case, patients develop acute paroxysmal or chronic pain, which can have a burning, stitching or aching character. Exacerbations of the pain syndrome are often accompanied by muscle spasm, which is why movements in the spinal column are limited.
Over time, the hernial sac increases and compresses the spinal roots. Then patients have disorders:
- Sensitivity (numbness, “goosebumps”, burning, cold, heat on the skin of the lower back, legs);
- Movement activity (weakness of the muscles of the lower extremities, which can progress to their partial or complete immobilization).
The disease is characterized by chronic inflammation of the small intervertebral joints with their subsequent immobilization – ankylosis. The exact causes of the disease are still unknown, however, young men are mainly affected by the disease.
The first symptom of the pathology is aching pain in the lower back and sacrum, which occurs at rest or at night. Over time, pain spreads to the entire spinal column and hip joints. The spine itself is bent, a “hump” occurs. The range of movements in the back is first reduced, and then disappears altogether, due to which the patient cannot straighten (“freezes” in a hunched form).
A disease is a mental disorder associated with the occurrence of musculoskeletal pain for no apparent reason. Thus, people with a labile psyche are affected, mainly women.
A specific manifestation is widespread symmetrical pain in the muscles, tendons and joints. Patients often experience sleep disorders, dependence on weather conditions, and frequent changes in body temperature. Less common cramps and muscle cramps.
Pathology of internal organs
Pancreatitis (inflammation of the pancreas) is manifested by dull or burning pain in the upper abdomen. The characteristic symptoms are nausea, indomitable vomiting with impurities of bile, as well as changes in the stool (greasy light stool). The mucous membranes and the skin of the patient often acquire a yellowish tint.
Urolithiasis is considered an metabolic disorder associated with the deposition of salts in the kidney in the form of stones – “stones”. For a long time the disease is asymptomatic. Pain syndrome occurs only during exacerbation, when the stone enters from the kidneys into the ureters (ie, “leaves”). In this case, patients are concerned about cutting or cramping lower back pain. Gradually, the pain migrates to the lower abdomen and disappears after the passage of the “stone”.
Myoma is a tumor-like formation in the muscle layer of the uterus. The disease is characterized by aching pain in the lower back and abdomen that occurs during menstruation. The discharge these days is plentiful and prolonged, which often contributes to anemia. The uterus at the same time increases to 12 weeks of pregnancy or more.
Prostatitis (inflammation of the prostate) is accompanied by pain in the lumbar region and perineum. The main symptom is urination disorders – its intermittent or lethargy, frequent urges (especially at night), soreness. Over time, erection and ejaculation are disturbed. Patients have fever, fever, chills, and weakness.
Diagnostic measures for pain in the lower back include:
- Clinical examination, consisting of a survey of the patient, clarifying the cause and nature of the pain, as well as examining and feeling the lower back;
- Laboratory methods – general and biochemical blood tests with determination of the level of amylase, tumor markers and other indicators;
- Instrumental studies, including X-ray, ultrasound, CT and MRI – the need for each of them depends on the alleged disease.
The volume and tactics of treatment are selected after determining the root cause of the pain.
Conservative therapy is based on the use of anti-inflammatory drugs (Diclofenac, Meloxicam, Indomethacin). Corticosteroid injections (hydrocortisone) are less commonly prescribed. Surgical treatment consists of removing the intervertebral hernia using a microscopic or endoscopic method.
Medication includes anti-inflammatory drugs (Indomethacin, Prednisolone), as well as immunosuppressants (Rituximab, Methotrexate, Inflixumab). An important part of therapy is therapeutic exercises aimed at inhibiting the development of immobility of the spinal column and chest.
Given the psychogenic nature of the disease, patients are prescribed antidepressants (Prozac, Amitriptyline), tranquilizers (Clonazepam) and sleeping pills (Zolpidem).
Pathology of internal organs
With pancreatitis, peace, cold in the upper abdomen and a short starvation are indicated. Subsequently, a sparing diet with the exception of fatty, fried and alcohol is prescribed. In some cases, it is necessary to take enzymes (Pancreatin, Creon).
With urolithiasis at the time of exacerbation, the introduction of antispasmodics (Drotaverin) and painkillers (Spazmalgon, Analgin) is required. In the non-acute period, the use of surgical or alternative methods of treatment is recommended (removal of “stones”, their grinding or dissolution).
In the case of uterine fibroids, wait-and-see tactics can be performed, followed by hormone therapy and surgical removal of the node.
The basis for the treatment of prostatitis is antibacterial (Amoxicillin, Moxifloxacin) and antispasmodic (Tamsulosin, Prazosin) therapy.
Preventive measures for aching lower back pain are aimed at:
- Prevention, diagnosis and treatment of pathologies of the spinal column (congenital anomalies, traumatic lesions, osteochondrosis, spondylosis, spondylarthrosis, spondylolisthesis and ankylosing spondylitis);
- Correction of diseases of the abdominal cavity and pelvic organs – pancreas, kidneys, uterus and appendages, prostate;
- Early detection of tumor neoplasms of the spinal column, nervous tissue and internal organs (neuromas, osteosarcomas, etc.);
- Therapy of infectious processes (tuberculosis, syphilis, brucellosis);
- Treatment of psychogenic disorders (fibromyalgia, hysteria).
Remember, pain in the lumbar region can be both a result of overwork, and a symptom of much more formidable diseases of the musculoskeletal system, nervous system or internal organs!