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Lumbar pain

Lumbar pain 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 part of the back).All age groups can suffer from lower back pain, but the peak incidence occurs between the ages of 30 and 60.

back pain in the lumbar region

Lumbar pain 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.
  • 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).
  • Indicated 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 displacement of pain from deeper structures:

  • kidneys;
  • pancreas;
  • colon;
  • pelvic organs;
  • retroperitoneal tumors.

Sharp pain in the lumbar region

Acute sprain.The pain is localized in the area of the long back muscles during their spasm, which leads to limitations in movements.There is no displacement of pain in the groin or lower extremities.

Vertebral fractures.Usually this is a consequence of injury when bending or falling on the feet, 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.

Displacement of the intervertebral discs in the lumbar region.Symptoms of this disease include pain in the lumbar region, a forced position of the body and limited mobility.The involvement of nerve roots in the pathological process is indicated by: radicular pain, usually unilateral;sensitivity disorders (paresthesia, hyperesthesia or hypoalgesia);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, most commonly associated with the L5 root, occurs when the superior and inferior facets of the intervertebral joint are enlarged, resulting in narrowing of the intervertebral canal or foramen.

Epidural abscess.Most commonly found in the chest, it may be accompanied by sharp pain in the back 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 radiating to the gluteal region and lower limbs up to the level of the knee joint.

Chronic lower back pain

Spondylosis deformans.Spondylosis deformans represents 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 occurs with neurological symptoms when walking (loss of sensitivity, sensory disturbances or weakness in both lower limbs), a spinal-related intermittent claudication syndrome resulting from spinal canal narrowing is suspected.The diagnosis is confirmed by examination.

Ankylosing spondylitis.It should be suspected in young people with lower back pain that moves to the hips.First, there is limited mobility and morning stiffness, decreased respiratory movements of the chest, and progressive distortion and flexion of the chest.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 with:

  • psoriatic arthritis;
  • Reiter's syndrome;
  • chronic colitis.

Tumors and their metastases, metabolic diseases.With the help of radiography and myelography, it is necessary to exclude the following pathological conditions: metastatic carcinoma (of the 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 excluded by determining 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.Moving 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 part of the abdominal cavity - to the lower thoracic and upper lumbar segments.No local symptoms or back stiffness;full range of motion of the back does not increase the pain.

Treatment

With osteochondrosis of the lumbar spine, the patient experiences 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 should urgently contact a neurologist.

Do not delay the visit to your doctor if:

  • you have severe lower back pain for more than 3 days;
  • pain that occurred after an 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.

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.