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 (lumbar spine).Back pain can affect all age groups, but the most common condition occurs between the ages of 30 and 60.
Illness-related pain in the lumbar region
Lower back pain is a non-specific symptom that can have many causes.Doctors differentiate between primary and secondary lumbar pain syndromes.Most pain in the lumbar region is due to morphofunctional changes in the musculoskeletal system (primary lumbar pain syndrome).These are primarily degenerative-dystrophic lesions of the spine:
Possible causes of secondary low back pain syndrome:
- Primary and metastatic tumors of the vertebrae, spinal cord and retroperitoneal space.
- Vertebral fractures.
- Infectious lesions of the vertebrae and intervertebral discs (tuberculosis, brucellosis, epidural abscess).
- Non-infectious inflammatory diseases (bechterew's disease, Reiter's syndrome, rheumatoid arthritis).
- Metabolic bone lesions (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute circulatory disorders of the spine (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 lumbar area can also be acute or chronic and is caused by damage to the spine or nerve roots.Possibly wandering pain from deeper structures:
- kidneys;
- Pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumors.
Acute pain in the lumbar region
Acute sprain.During cramping, the pain is localized in the area of the long back muscles, which leads to restricted movement.There is no transfer of pain to the groin 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 to the bones or Paget's disease.
Displacement of the intervertebral discs in the lumbar region.Symptoms of this disease include pain in the lumbar region, forced posture and limited mobility.The involvement of nerve roots in the pathological process is indicated by: radicular pain, usually unilateral;Sensory disorders (paresthesia, hyperesthesia or hypalgesia);reduced or absent Achilles tendon 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 upper and lower facets of the intervertebral joint are enlarged, resulting in narrowing of the intervertebral canal or foramen.
Epidural abscess.It most commonly occurs in the thoracic spine and can be accompanied by acute back pain when palpating or tapping the affected area.Requires rapid diagnosis and initiation of treatment measures, including surgery, if signs of spinal cord compression are present.Pathological processes in the hip joint can be accompanied by pain that radiates to the buttocks and lower limbs up to the level of the knee joint.
Chronic lower back pain
Spondylosis deformans.Spondylosis deformans involves 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 while walking with neurological symptoms (loss of sensitivity, sensory disturbances or weakness in both lower extremities), intermittent claudication syndrome is suspected, which is associated with the spine and results from a narrowing of the spinal canal.The diagnosis is confirmed by an examination.
Ankylosing spondylitis.It should be suspected in young people who have pain in the lower back that extends to the hips.First, there is limited mobility and morning stiffness, a reduction 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.Similar symptoms with limited mobility of the lower spine can occur with:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.The following pathological conditions must be excluded using X-rays and myelography: 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 ESR determination, bone x-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- Lipoma
The tumors mentioned above can cause chronic pain even before other neurological symptoms appear.Alternating pain in the lumbar region due to diseases of the internal organs.If 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 stiffness in the back;Full back movements do not increase the pain.
Treatment
With osteochondrosis of the lumbar spine, the patient experiences pain in the lower back when walking, sitting, lifting heavy objects, coughing and sneezing.Lower back pain sometimes radiates down the leg.In this case, you need to urgently contact a neurologist.
Do not hesitate to see your doctor if:
- suffering from severe lower back pain for more than 3 days;
- Pain occurred after an injury;
- at the same time you feel pain in the lower back, lower leg and foot;
- Lower back pain is accompanied by numbness in the buttocks, thighs, legs, feet and groin areas.
Lower 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 to the causes of lower back pain.