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 back).All ages can suffer from lower back pain, but the peak incidence occurs between the ages of 30 and 60.
Pain in the lumbar region due to illness
Lower back pain is a non-specific symptom that can have many causes.Doctors distinguish between primary and secondary lumbar pain syndromes.Most pain in the lumbar region is based on morphofunctional changes in the locomotor system (primary lumbar pain syndrome).These are mainly degenerative-dystrophic changes 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 changes (osteoporosis, osteomalacia).
- Growing pains (scoliosis).
- Acute spinal cord circulatory disorders (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 region can be acute or chronic, and the causes are damage to the spine or nerve roots.Possibly moving pain from deeper structures:
- kidney;
- pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumors.
Acute pain in the lumbar region
Acute sprain.The pain is localized in the area of the long back muscles under the spasm, which causes restriction of movement.The pain does not shift to the lumbar region or lower limbs.
Vertebral fractures.This is usually the result of an injury from bending or falling, 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, malignant tumor metastases 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 posture and limited movement.The involvement of the nerve roots in the pathological process is indicated by the following: 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 a disc injury.Unilateral facet syndrome, most commonly associated with the L5 root, occurs when the superior and inferior sides of the intervertebral joint become enlarged, resulting in narrowing of the intervertebral canal or foramen.
Epidural abscess.It is most often located in the thoracic spine and may be accompanied by acute back pain when palpating 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 of the hip joint can be accompanied by pain radiating to the gluteal region and the 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 the lumbosacral pain is accompanied by neurological symptoms during walking (sensory disturbances, sensory disturbances, or weakness in both lower limbs), a spinal-related intermittent claudication syndrome resulting from a narrowing of the spinal canal is suspected.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 movement and morning stiffness, a decrease in the respiratory movement of the chest, and progressive curvature and bending of the thoracic spine.X-ray signs: destruction and structural transformation of the sacroiliac joints, the formation of the so-called "bamboo" spine.Similar symptoms can occur in the case of limited movement of the lower part of the spine:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.With the help of radiography and myelography, the following pathological conditions must be excluded: metastatic carcinoma (breast, lung, prostate, thyroid gland, kidney, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.Caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;the possibility of these infections should be confirmed or ruled out by ESR determination, bone X-ray and tuberculin skin test.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before the appearance of other neurological symptoms.Variable pain in the lumbar region due to diseases of the internal organs.When the pelvic organs are affected, the pain is shifted 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, sneezing.Back pain sometimes radiates to the legs.In this case, you should urgently contact a neurologist.
Do not delay your visit to the doctor if:
- experience severe lower back pain for more than 3 days;
- pain occurred after the injury;
- at the same time, he feels pain in the lower back, lower leg and foot;
- lower back pain accompanied by numbness in the buttocks, thighs, legs, feet, and groin.
Lower back pain is a fairly common symptom, especially among the elderly.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.