Pain in the lumbar region is the most common pain syndrome in outpatient practice.30-60% of the population in developed countries experience recurrent back pain, and up to 80% of all back pain occurs in the lumbar region (lumbar back).All age groups can experience lower back pain, but the peak incidence occurs between the ages of 30 and 60.
Pain in the lumbar region due to disease
Lower back pain is a non-specific symptom that can be caused by many reasons.Doctors distinguish between primary and secondary lumbar pain syndrome.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 vertebrae, spinal cord, retroperitoneal space.
- Broken spine.
- 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).
- Increasing pain (scoliosis).
- Acute spinal 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 also be acute or chronic, and the cause is damage to the spine or nerve roots.Pain that may travel from deeper structures:
- kidney;
- pancreas;
- colon;
- pelvic organs;
- retroperitoneal tumor.
Acute pain in the lumbar region
Acute sprain.The pain is localized in the area of the long back muscles during their spasm, which causes restriction in movement.There is no displacement of pain to the groin or lower leg.
Broken spine.Usually this is the result of an injury when 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, metastasis of malignant tumors in the bones, Paget's disease.
Intervertebral disc displacement in the lumbar region.Symptoms of this disease include pain in the lumbar region, forced body position, and limited mobility.The involvement 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 reflexes.
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 often associated with the L5 root, occurs when the top and bottom of the intervertebral joint are enlarged, which involves narrowing of the intervertebral canal or foramen.
Epidural abscess.Often found in the thoracic spine, it may be accompanied by acute pain in the back when palpating or tapping the affected area.Requires rapid 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 radiating to the gluteal area and lower limbs to the level of the knee joint.
Chronic back pain
Spondylosis deformans.Spondylosis deformans is a degenerative change in the lumbar vertebrae with the formation of bony spurs that narrow the spinal canal and put pressure on the roots.If lumbosacral pain appears 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 arising from narrowing of the spinal canal.Diagnosis is confirmed by examination.
Ankylosing spondylitis.It should be suspected in young people with pain in the lower back that moves to the hips.First, there is limited movement and morning stiffness, a decrease in chest breathing movements, and progressive curvature and flexion of the thoracic spine.X-ray signs: destruction and restructuring of the sacroiliac joint, the formation of a spine called "bamboo".Symptoms similar to limited movement in the lower spine may 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 this infection must be confirmed or excluded by determining ESR, bone x-ray, and skin test with tuberculin.
Intradural tumors:
- neurofibroma;
- meningioma;
- lipoma
The above tumors can cause chronic pain even before other neurological symptoms appear.Shifting 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 segment, the upper abdominal cavity - to the lower thoracic and upper lumbar.No local symptoms or stiffness in the back;full back movement does not increase pain.
Treatment
With osteochondrosis of the lumbar spine, patients feel pain in the lower back when walking, sitting, lifting heavy objects, coughing, sneezing.Lower back pain sometimes spreads to the legs.In this case, you should immediately contact a neurologist.
Do not delay visiting your doctor if:
- have severe back pain for more than 3 days;
- pain occurs after an injury;
- at the same time you feel pain in the lower back, lower legs and feet;
- pain in the lower back combined with numbness in the buttocks, thighs, legs, feet, and groin area.
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 physical examination can show results and give a clear answer about the cause of back pain.