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 is 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 a number of 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 pain syndrome in the lower back:
- Primary and metastatic tumors of vertebrae, spinal cord, retroperitoneal space.
- Vertebral fractures.
- 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).
- Growing pains (scoliosis).
- Acute disorders of spinal circulation (stroke).
- Diseases of the gastrointestinal tract (atypical course of acute appendicitis, intestinal obstruction).
- Reference 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.Possible pain moving 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 limitations in movement.There is no movement of the pain to the groin or lower extremities.
Vertebral fractures.It is usually the result of an 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 bone system, osteoporosis, Cushing's syndrome, hyperparathyroidism, myeloma, metastases of malignant tumors in the bones, Paget's disease.
Movement of intervertebral discs 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 indicates: radicular pain, usually unilateral;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 implies a 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 tapping the affected area.It requires prompt 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 that spreads 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 on the lumbar vertebrae with the formation of bone spurs that narrow the spinal canal and put pressure on the roots.If lumbosacral pain occurs with neurological symptoms when walking (loss of sensation, sensory disturbances or weakness in both lower extremities), there is a suspicion of intermittent claudication syndrome related to the spine and caused by 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 hip.First, there is limited mobility and morning stiffness, decreased respiratory chest movements, 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 movement in the lower spine can occur in:
- psoriatic arthritis;
- Reiter's syndrome;
- chronic colitis.
Tumors and their metastases, metabolic diseases.Radiography and myelography should exclude the following pathological conditions: metastatic cancer (breast, lung, prostate, thyroid, kidneys, gastrointestinal tract), myeloma, lymphoma.
Osteomyelitis.It is caused by pyogenic bacteria (usually staphylococci) or Mycobacterium tuberculosis;the possibility of these infections must be confirmed or ruled out by determination of ESR, 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.Fluctuating pain 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.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.Pain in the lower back sometimes radiates to the leg.In this case, you must contact a neurologist immediately.
Do not delay your visit to the doctor if:
- experience severe lower back pain for more than 3 days;
- the pain appeared after the injury;
- you feel pain in the lower back, lower leg and foot at the same time;
- pain in the lower back is combined with numbness in the buttocks, thighs, legs, feet and groin.
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 results and give a clear answer about the causes of pain in the lower back.