Pain in the lumbar region 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 (lower back).All age groups can suffer from back pain, but the peak incidence occurs between the ages of 30 and 60.
Pain in the lumbar region due to illness
Back pain is a non-specific symptom that can be caused by many reasons.Doctors distinguish between primary and secondary low back pain syndromes.Most pain in the lumbar region is based on morphofunctional musculoskeletal changes (primary lumbar 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 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 disorders of spinal circulation (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Referred pain in diseases of the pelvic organs (including renal abdominal pain, gynecological infectious diseases, such as chlamydia, gonorrhea, trichomoniasis, ureaplasmosis, adnexitis).
Pain in the lumbar region can also be acute or chronic and the causes are damage to the spine or nerve roots.Perhaps the movement of pain 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 movement restrictions.There is no displacement of pain to the groin or lower extremities.
Vertebral fractures.Usually this is the result of injury during bending or falling on the leg, but the same result can be 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 bones, Paget's disease.
Displacement of the intervertebral discs in the lumbar region.Symptoms of this disease include pain in the lumbar region, 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 hypoalgesia);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, which is most often associated with the L5 root, occurs when the superior and inferior faces 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 can be accompanied by acute pain in the back when touching or touching 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 can be accompanied by pain that radiates to the gluteal region and lower limbs up to the level of the knee joint.
Chronic lower 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 occurs with neurological symptoms while walking (loss of sensation, sensory disturbances or weakness in both lower extremities), there is a suspicion of intermittent claudication syndrome associated with the spine and resulting from a narrowing of the spinal canal.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with low back pain radiating to the hips.First, there is limited mobility and stiffness in the morning, a decrease in respiratory movements of the chest, and 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.Symptoms similar to 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 should be confirmed or excluded by determining ESR, bone X-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before other neurological symptoms appear.Displacement of 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 the pain.
Treatment
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Back pain sometimes radiates to the legs.In this case, you should urgently contact a neurologist.
Do not delay the visit to the doctor if:
- experience severe lower back pain for more than 3 days;
- the pain occurred after the injury;
- at the same time you feel pain in the lower back, leg and foot;
- Pain in the lower back is combined with numbness in the area of the buttocks, thigh, leg, foot and hip.
Back pain is a fairly common symptom, especially among 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 to the causes of back pain.