Pain in the lumbar region is the most common pain syndrome in outpatient practice.30-60% of the population in developed countries suffers from recurrent back pain, and up to 80% of all back pain occurs in the lumbar region (lumbar back).All age groups can suffer from lower back pain, but the peak incidence is between 30 and 60 years old.
Pain in the lumbar region due to illness
Lower back pain is a non-specific symptom that can be caused by many reasons.Doctors distinguish between primary and secondary lower back pain syndromes.Most pain in the lumbar region is based on musculoskeletal morphofunctional 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 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 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 region can also be acute or chronic, and the causes are damage to the spine or nerve roots.Perhaps moving 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 long muscles of the back when they spasm, which causes restrictions in movement.There is no shift of pain to the groin or lower limbs.
Vertebral fractures.This is usually a consequence of injury when bending or dropping the legs, 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 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 body position and limited mobility.The participation of nerve roots in the pathological process is indicated by: radicular pain, usually one-sided;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 upper and lower facets of the intervertebral joint are enlarged, resulting in narrowing of the intervertebral canal or foramen.
Epidural abscess.It is most often found in the thoracic spine, it can be accompanied by sharp pain in the back when palpating or tapping the affected area.Requires prompt diagnosis and implementation of treatment measures, including surgical, if there are signs of spinal cord compression.Pathological processes in the hip joint can be accompanied by pain radiating to the gluteal region and lower extremities to the level of the knee joint.
Chronic lower back pain
Spondylosis deformans.Spondylosis deformans is a degenerative change in the lumbar vertebrae with the formation of bone spurs that narrow the spinal canal and exert pressure on the roots.If low back pain occurs with neurological symptoms when walking (loss of sensation, sensory disturbances or weakness in both lower extremities), intermittent claudication syndrome associated with the spine and resulting from narrowing of the spinal canal is suspected.The diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with lower back pain that moves towards the hips.First, there is limited mobility and morning stiffness, decreased respiratory movements of the chest, and progressive curvature and flexion of the thoracic spine.Radiographic signs: destruction and restructuring of the sacroiliac joints, formation of the so-called “bamboo” spine.Similar symptoms with limited movement in the lower spine may occur with:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.By radiography and myelography, it is necessary to exclude the following pathologies: 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 above tumors can cause chronic pain even before other neurological symptoms appear.Changing pains in the lumbar region due to diseases of the 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 pain.
Treatment
With osteochondrosis of the lumbar spine, the patient feels pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Lower back pain sometimes radiates down the leg.In this case, you should urgently contact a neurologist.
Do not delay seeing your doctor if:
- experience severe lower back pain for more than 3 days;
- the pain occurred after an injury;
- at the same time you feel pain in the lower back, lower leg and foot;
- Lower back pain is associated with numbness in the buttocks, thighs, legs, feet and groin.
Lower 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 about the causes of lower back pain.