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 age groups can suffer from lower back pain, but the peak incidence occurs between the ages of 30 and 60 years.
Pain in the lumbar region due to illness
Lower back pain is a nonspecific symptom that can be caused by many reasons.Doctors distinguish between primary and secondary lumbar pain syndromes.Most pain in the lumbar region is based on musculoskeletal morphofunctional changes (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, 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 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 causes are damage to the spine or nerve roots.Possibly 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 area of the long back muscles during their spasm, which causes restrictions in movements.There is no displacement of pain to the groin area or lower extremities.
Vertebral fractures.Usually this is a consequence of injury when bending or falling on 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 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 at its exit from 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 upper and lower facets of the intervertebral joint are enlarged, which entails a narrowing of the intervertebral canal or foramen.
Epidural abscess.Most 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 region and lower limbs 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 appears with neurological symptoms when 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 a narrowing of the spinal canal.The 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 mobility and morning stiffness, 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, the 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.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 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 the internal organs.When 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 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 to the leg.In this case, you urgently need to contact a neurologist.
Do not delay visiting your doctor if:
- experience severe lower back pain for more than 3 days;
- pain occurred after injury;
- at the same time you feel pain in the lower back, lower leg and foot;
- pain in the lower back is combined with numbness in the buttock, thigh, leg, foot, 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 examination of the body can show the results and give a clear answer about the causes of lower back pain.