Low back pain 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 region (lumbar region of the back). Pain in the lumbar region can affect all age categories, but the peak incidence is between 30 and 60 years.
Pain in the lumbar region with diseases
Pain in the lumbar region is a nonspecific symptom that can be caused by many reasons. Doctors distinguish between primary and secondary pain syndromes in the lumbar region. At the heart of most pain in the low back region are morphofunctional musculoskeletal 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 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 circulation disorders (cerebrovascular accident).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Reflected pain in diseases of the pelvic organs (including renal colic, infectious gynecological diseases such as chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis).
Pain in the lumbar region can also be acute and chronic, and the causes are damage to the spine or nerve roots. Maybe move the pain from deeper structures:
- pelvic organs;
- retroperitoneal tumors.
Sharp pain in the lumbar region
Acute sprain. The pain is localized in the region of the long muscles of the back during their spasm, which leads to restrictions in movement. There is no pain displacement in the groin or lower extremities.
Vertebral fractures. It is usually a consequence of an injury when bending or dropping the legs, but the same result can be without injury or with minimal trauma if the patient has a skeletal system, osteoporosis, syndromeCushing's disease, hyperparathyroidism, multiple myeloma, metastases of malignant tumors in the bones, Paget's disease.
Displacement of the intervertebral discs in the lumbar region. Symptoms of this disease include pain in the lumbar region, forced position of the body, limited mobility. Participation in the pathological process of the nerve roots is indicated by: root pain, usually one-sided; sensory disturbances (paraesthesia, hyperesthesia or hypoalgesia); decrease or absence of the Achilles reflex or patellar reflex.
Facet Syndrome. Compression of the root at the point of its exit from the spinal canal causes radicular pain, not caused by disc injury. Unilateral facet syndrome, which is most often associated with the L5 root, is manifested by an increase in the superior and inferior facets of the intervertebral joint, which leads to a narrowing of the canal or intervertebral foramen.
epidural abscess. Most commonly occurs in the thoracic spine, may be accompanied by sharp back pain when probing or tapping the affected area. Requires rapid diagnosis and the implementation of therapeutic measures that can go as far as surgery, if there are signs of spinal cord compression. Pathological processes in the region of the hip joint can be accompanied by pain radiating to the gluteal region and lower extremities to the level of the knee joint.
Chronic low back pain
Deforming spondylosis. Spondylosis deformans is a degenerative change in the lumbar vertebrae with the formation of bony growths that narrow the spinal canal and put pressure on the roots. When there is lumbosacral pain with neurological symptoms when walking (loss of sensation, sensory disturbances or weakness in both lower limbs), there is a suspicion of spine-associated intermittent claudication syndrome resulting from anarrowing of the spinal canal. The diagnosis is confirmed by examination.
Ankylosing spondyloarthrosis. It should be suspected in young adults with low back pain radiating to the hips. First, there is a limitation of mobility and morning stiffness, a decrease in the respiratory movements of the thorax, a progressive curvature and flexion of the thoracic spine. X-ray 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. With the help of radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (breast, lungs, prostate, thyroid, kidneys, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis. It is caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis; the possibility of these infections should be confirmed or excluded by determining ESR, bone x-ray, tuberculin skin test.
The above tumors can cause chronic pain even before other neurological symptoms appear. Motor pain in the lumbar region in 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. Characterized by the absence of local symptoms and stiffness in the back, movements of the back in fullness do not increase pain.
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting weights, coughing, sneezing. Low back pain sometimes radiates to the leg. In this case, an urgent need to contact a specialist neurologist.
Do not delay seeing a doctor if:
- experience severe lower back pain for more than 3 days;
- the pain arose after an injury;
- at the same time you feel pain in the lower back, lower leg and foot;
- pain in the lower back associated with numbness in the buttock, thigh, leg, foot, groin.
Low back pain is a fairly common symptom, especially in older people. Rheumatism, lumbar osteochondrosis and sciatica - all these diseases cause sharp pain in the lumbar region. Only a proper examination of the body will be able to show the results and give a clear answer about the causes of back pain.