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Back pain symptoms checker. Comprehensive Guide to Back Pain Symptoms: Causes, Diagnosis, and Treatment Options

by alexxlab

What are the common causes of back pain. How can you differentiate between acute and chronic back pain. When should you seek medical attention for back pain. What are effective home remedies for relieving back pain. How is back pain diagnosed and treated by medical professionals. Can lifestyle changes help prevent or manage back pain. What are the potential complications of untreated back pain.

Understanding the Anatomy of Back Pain

Back pain is a complex issue that affects millions of people worldwide. To truly comprehend the nature of back pain, it’s essential to understand the intricate anatomy of the back. The spine, consisting of vertebrae, discs, nerves, and muscles, plays a crucial role in supporting our body and facilitating movement.

The spine is divided into several regions:

  • Cervical (neck)
  • Thoracic (upper back)
  • Lumbar (lower back)
  • Sacral (bottom of the spine)
  • Coccygeal (tailbone)

Each region has its unique characteristics and potential sources of pain. For instance, lower back pain often stems from issues in the lumbar region, while neck pain typically originates in the cervical area.

Common Structures Involved in Back Pain

Several structures within the back can contribute to pain when injured or irritated:

  • Vertebrae: The bony structures that make up the spine
  • Intervertebral discs: Act as cushions between vertebrae
  • Spinal cord and nerves: Transmit signals between the brain and body
  • Muscles and ligaments: Provide support and enable movement
  • Facet joints: Allow for flexibility and movement between vertebrae

Understanding these structures helps in identifying the potential causes of back pain and determining appropriate treatment options.

Identifying Different Types of Back Pain

Back pain can manifest in various forms, each with its own set of characteristics and potential causes. Recognizing these different types can help in determining the appropriate course of action and treatment.

Acute vs. Chronic Back Pain

How long does back pain typically last? Back pain is often categorized based on its duration:

  • Acute back pain: Lasts less than 6 weeks
  • Subacute back pain: Persists for 6 to 12 weeks
  • Chronic back pain: Continues for 12 weeks or longer

Acute back pain is often the result of a sudden injury or strain, while chronic back pain may be caused by underlying conditions or long-term issues.

Localized vs. Radiating Pain

Back pain can also be described based on its location and whether it spreads to other areas:

  • Localized pain: Confined to a specific area of the back
  • Radiating pain: Spreads from the back to other parts of the body, such as the legs or arms

Radiating pain, particularly when it extends down the legs, may indicate conditions like sciatica or a herniated disc.

Common Causes of Back Pain

Back pain can arise from a multitude of factors, ranging from simple muscle strains to more serious underlying conditions. Understanding these causes is crucial for proper diagnosis and treatment.

Mechanical Causes

Many cases of back pain are due to mechanical issues, which involve problems with the way the spine moves or is supported:

  • Muscle or ligament strains
  • Herniated or bulging discs
  • Osteoarthritis
  • Spinal stenosis
  • Spondylolisthesis

These mechanical issues often result from poor posture, improper lifting techniques, or repetitive motions that stress the back over time.

Inflammatory Conditions

Inflammation in the back can lead to significant pain and discomfort. Some inflammatory conditions that can cause back pain include:

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Psoriatic arthritis

These conditions often require specialized treatment from a rheumatologist or other medical specialist.

Other Medical Conditions

Back pain can also be a symptom of various other medical conditions, including:

  • Fibromyalgia
  • Osteoporosis
  • Kidney stones or infections
  • Endometriosis
  • Tumors (rarely)

In these cases, treating the underlying condition is often necessary to alleviate back pain.

Diagnosing Back Pain: When to Seek Medical Attention

While many instances of back pain can be managed at home, certain symptoms warrant immediate medical attention. It’s crucial to recognize these red flags to prevent potential complications.

Red Flags for Serious Back Pain

When should you be concerned about back pain? Seek immediate medical care if you experience any of the following:

  • Severe, persistent pain that doesn’t improve with rest
  • Pain accompanied by fever
  • Unexplained weight loss
  • Pain following a traumatic injury
  • Loss of bowel or bladder control
  • Numbness or weakness in the legs
  • Pain that worsens at night or when lying down

These symptoms may indicate serious conditions such as infections, fractures, or nerve compression that require prompt medical intervention.

Diagnostic Procedures for Back Pain

How do doctors diagnose the cause of back pain? Medical professionals use various diagnostic tools and procedures to identify the root cause of back pain:

  • Physical examination
  • Medical history review
  • Imaging tests (X-rays, MRI, CT scans)
  • Blood tests
  • Nerve conduction studies
  • Bone scans

The choice of diagnostic procedure depends on the suspected cause and severity of the pain. In many cases, a combination of these methods is used to reach an accurate diagnosis.

Treatment Options for Back Pain

The treatment of back pain varies depending on its cause, severity, and duration. A comprehensive approach often yields the best results, combining various therapies and lifestyle changes.

Conservative Treatment Approaches

For many cases of back pain, especially acute cases, conservative treatments are often the first line of defense:

  • Rest and activity modification
  • Over-the-counter pain relievers (NSAIDs, acetaminophen)
  • Hot and cold therapy
  • Gentle stretching and exercise
  • Physical therapy
  • Massage therapy

These approaches aim to reduce pain, improve flexibility, and strengthen the muscles supporting the spine.

Medical Interventions

When conservative treatments are insufficient, medical interventions may be necessary:

  • Prescription pain medications
  • Muscle relaxants
  • Epidural steroid injections
  • Nerve blocks
  • Spinal cord stimulation

These treatments are typically administered under the guidance of a pain specialist or orthopedic surgeon.

Surgical Options

In some cases, surgery may be recommended for back pain, particularly when conservative treatments and medical interventions have failed to provide relief. Surgical options may include:

  • Discectomy
  • Laminectomy
  • Spinal fusion
  • Artificial disc replacement

The decision to undergo surgery should be made carefully, considering the potential benefits and risks associated with each procedure.

Lifestyle Changes and Prevention Strategies for Back Pain

While not all back pain can be prevented, certain lifestyle changes and preventive measures can significantly reduce the risk of developing back problems or exacerbating existing conditions.

Ergonomic Considerations

How can you improve your workspace to prevent back pain? Proper ergonomics play a crucial role in maintaining a healthy back:

  • Use a chair with good lumbar support
  • Position your computer monitor at eye level
  • Keep your feet flat on the floor or use a footrest
  • Take regular breaks to stand and stretch
  • Use a standing desk or adjust your workstation for alternating between sitting and standing

These simple adjustments can significantly reduce the strain on your back during prolonged periods of sitting or working.

Exercise and Physical Activity

Regular exercise is essential for maintaining a healthy back and preventing pain:

  • Engage in low-impact aerobic activities like walking or swimming
  • Strengthen core muscles through targeted exercises
  • Practice yoga or Pilates to improve flexibility and posture
  • Incorporate strength training to build muscle support for the spine

Always consult with a healthcare professional or certified fitness instructor before starting a new exercise regimen, especially if you have existing back problems.

Proper Lifting Techniques

Many back injuries occur due to improper lifting. To protect your back when lifting heavy objects:

  • Bend at the knees, not the waist
  • Keep the object close to your body
  • Avoid twisting while lifting
  • Use your leg muscles to lift, not your back
  • Ask for help with very heavy or awkward items

By following these guidelines, you can significantly reduce the risk of back injuries caused by lifting.

Alternative and Complementary Therapies for Back Pain

In addition to conventional medical treatments, many people find relief from back pain through alternative and complementary therapies. While the effectiveness of these treatments can vary, they may provide additional options for managing back pain.

Acupuncture

Acupuncture, an ancient Chinese practice, involves inserting thin needles into specific points on the body. Some studies suggest that acupuncture may help relieve chronic low back pain by:

  • Stimulating the release of natural pain-relieving chemicals in the body
  • Improving blood flow to affected areas
  • Reducing muscle tension

While more research is needed, many people report significant pain relief from acupuncture treatments.

Chiropractic Care

Chiropractic treatment focuses on the relationship between the spine’s structure and function. Chiropractors use various techniques, including:

  • Spinal manipulation or adjustment
  • Mobilization
  • Soft tissue therapy
  • Exercise recommendations

Many people find chiropractic care helpful for managing back pain, particularly when combined with other treatments.

Mindfulness and Meditation

Chronic pain can take a toll on mental health, which in turn can exacerbate physical symptoms. Mindfulness and meditation techniques can help by:

  • Reducing stress and anxiety associated with chronic pain
  • Improving pain coping strategies
  • Enhancing overall well-being and quality of life

These practices can be particularly beneficial when used in conjunction with other pain management strategies.

The Impact of Back Pain on Quality of Life

Back pain can significantly affect various aspects of a person’s life, extending far beyond physical discomfort. Understanding these impacts is crucial for developing comprehensive treatment plans and support systems.

Psychological Effects

Chronic back pain can have profound psychological effects, including:

  • Depression
  • Anxiety
  • Mood swings
  • Sleep disturbances
  • Reduced self-esteem

Addressing these psychological aspects is often as important as treating the physical pain itself.

Social and Occupational Impacts

Back pain can also affect a person’s social life and ability to work:

  • Difficulty participating in social activities
  • Reduced work productivity
  • Increased absenteeism
  • Strained relationships with family and friends
  • Financial stress due to medical expenses and lost wages

Comprehensive pain management strategies should address these broader life impacts to improve overall quality of life.

Coping Strategies

Developing effective coping strategies is essential for managing the impact of back pain on daily life. Some helpful approaches include:

  • Joining support groups
  • Practicing stress-reduction techniques
  • Setting realistic goals and pacing activities
  • Maintaining social connections
  • Seeking professional counseling when needed

By addressing both the physical and emotional aspects of back pain, individuals can better manage their condition and maintain a higher quality of life.

Symptom Checker – Mayo Clinic














About this Symptom Checker

Adult Symptoms


  1. Abdominal pain in adults



  2. Blood in stool in adults



  3. Chest pain in adults



  4. Constipation in adults



  5. Cough in adults



  6. Diarrhea in adults



  7. Difficulty swallowing in adults



  8. Dizziness in adults



  9. Eye discomfort and redness in adults



  10. Eye problems in adults



  11. Foot pain or ankle pain in adults



  12. Foot swelling or leg swelling in adults



  13. Headaches in adults



  14. Heart palpitations in adults



  15. Hip pain in adults



  16. Knee pain in adults



  17. Low back pain in adults



  18. Nasal congestion in adults



  19. Nausea or vomiting in adults



  20. Neck pain in adults



  21. Numbness or tingling in hands in adults



  22. Pelvic pain in adult females



  23. Pelvic pain in adult males



  24. Shortness of breath in adults



  25. Shoulder pain in adults



  26. Sore throat in adults



  27. Urinary problems in adults



  28. Wheezing in adults


Child Symptoms


  1. Abdominal pain in children



  2. Constipation in children



  3. Cough in children



  4. Diarrhea in children



  5. Ear problems in children



  6. Earache in children



  7. Eye discomfort and redness in children



  8. Eye problems in children



  9. Fever in children



  10. Headaches in children



  11. Joint pain or muscle pain in children



  12. Nasal congestion in children



  13. Nausea or vomiting in children



  14. Skin rashes in children



  15. Sore throat in children



  16. Urinary problems in children



  17. Wheezing in children


  1. Walls RM, et al. , eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
  2. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
  3. UpToDate. https://www.uptodate.com/contents/search. Accessed Oct. 30, 2017.
  4. Zeiter D. Abdominal pain in children. Pediatric Clinics of North America. 2017;64:525.
  5. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
  6. Feldman M, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
  7. Merck Manual Professional Version. https://www.merckmanuals.com/professional. Accessed Oct. 30, 2017.
  8. AskMayoExpert. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  9. Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 2, 2017.
  10. Zitelli BJ, et al., eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
  11. Ferri FF. Ferri’s Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
  12. Muncie HL, et al. Dizziness: Approach to evaluation and management. American Family Physician. 2017;95:154.
  13. American College of Emergency Physicians. https://www.acep.org. Accessed Nov. 11, 2017.
  14. U.S. Food and Drug Administration. http://www.fda.gov. Accessed Nov. 11, 2017.
  15. Schmitt BD. Fever. In: Pediatric Telephone Protocols: Office Version 15th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2015.
  16. Mannenbach MS (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
  17. Goyal DG (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
  18. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 28, 2017.
  19. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org. Accessed Nov. 20, 2017.
  20. Petty RE, et al., eds. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 20, 2017.
  21. Elsevier Point of Care. https://www.clinicalkey.com.  Accessed Nov. 20, 2017.
  22. Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Nov. 20, 2017.
  23. Wein AJ, et al., eds. Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com.. Accessed Dec. 2, 2017.
  24. National Eye Institute. https://nei.nih.gov. Accessed Dec. 5, 2017.
  25. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 8, 2017.


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ITT-20009075






Low back pain in adults














About this Symptom Checker

Low back pain in adults

Find possible causes of low back pain based on specific factors. Check one or more factors on this page that apply to your symptom.

Pain


  • Began suddenly



  • Gradually worsens



  • Started gradually



Triggered by


  • Everyday activities



  • Injury



  • Overuse



Worsened by


  • Movement



  • Prolonged rest or inactivity



  • Prolonged sitting or standing



Accompanied by


  • Decreased range of motion or stiffness in neck



  • Knot or tight spot in back muscle



  • Loss of balance or coordination



  • Loss of bowel or bladder control



  • Muscle weakness



  • Numbness or tingling in limbs, most often on both sides of the body (bilateral)



  • Numbness or tingling in limbs, most often on one side of the body (unilateral)



  • Shoulder, arm or chest pain



  • Stiffness in lower back



  • Swelling



  • Weakness, numbness or tingling in leg or foot


  1. Walls RM, et al. , eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
  2. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
  3. UpToDate. https://www.uptodate.com/contents/search. Accessed Oct. 30, 2017.
  4. Zeiter D. Abdominal pain in children. Pediatric Clinics of North America. 2017;64:525.
  5. Palmer J, et al. Abdominal pain mimics. Emergency Medicine Clinics of North America. 2016;34:409.
  6. Feldman M, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 30, 2017.
  7. Merck Manual Professional Version. https://www.merckmanuals.com/professional. Accessed Oct. 30, 2017.
  8. AskMayoExpert. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  9. Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 2, 2017.
  10. Zitelli BJ, et al., eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
  11. Ferri FF. Ferri’s Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 11, 2017.
  12. Muncie HL, et al. Dizziness: Approach to evaluation and management. American Family Physician. 2017;95:154.
  13. American College of Emergency Physicians. https://www.acep.org. Accessed Nov. 11, 2017.
  14. U.S. Food and Drug Administration. http://www.fda.gov. Accessed Nov. 11, 2017.
  15. Schmitt BD. Fever. In: Pediatric Telephone Protocols: Office Version 15th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2015.
  16. Mannenbach MS (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
  17. Goyal DG (expert opinion). Mayo Clinic, Rochester, Minn. June 14, 2017.
  18. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 28, 2017.
  19. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org. Accessed Nov. 20, 2017.
  20. Petty RE, et al., eds. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 20, 2017.
  21. Elsevier Point of Care. https://www.clinicalkey.com.  Accessed Nov. 20, 2017.
  22. Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Nov. 20, 2017.
  23. Wein AJ, et al., eds. Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com.. Accessed Dec. 2, 2017.
  24. National Eye Institute. https://nei.nih.gov. Accessed Dec. 5, 2017.
  25. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 8, 2017.


Advertisement

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

Advertising & Sponsorship

  • Policy
  • Opportunities
  • Ad Choices

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

  • Mayo Clinic on Incontinence – Mayo Clinic PressMayo Clinic on Incontinence
  • NEW – Future Care – Mayo Clinic PressNEW – Future Care
  • Mayo Clinic on Hearing and Balance – Mayo Clinic PressMayo Clinic on Hearing and Balance
  • FREE Mayo Clinic Diet Assessment – Mayo Clinic PressFREE Mayo Clinic Diet Assessment
  • Mayo Clinic Health Letter – FREE book – Mayo Clinic PressMayo Clinic Health Letter – FREE book


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ITT-20009075






Back pain is the most common reason for visiting a neurologist

Article author:

Brand Pavel Yakovlevich

, neurologist

Back pain is the most common reason for visiting a neurologist and is only slightly less common than sore throat as a reason for visiting a general practitioner.

Then was the recent decision correct, according to which the patient can no longer make an appointment with a neurologist himself, but must first see a therapist? After all, now two doctors should deal with his problem, the burden on the healthcare system is increasing. Neurologist Pavel Yakovlevich BRAND, medical director of the Semeynaya clinic network, candidate of medical sciences, answered these and other questions of MV medical editor Alexander Rylov.

— Pavel Yakovlevich, what is the current treatment route for a Russian patient with back pain?

– I believe that the new “road map” for a Russian patient with back pain, when he must first be examined by a therapist, is correct and consistent with the rules for providing medical care in developed countries. Depending on the causes of back pain, they are divided into specific and non-specific, respectively 15-20% and 80-85% of cases. Specific pains are caused not by damage to the spine, but to various internal organs. Among such pain syndromes, the leading ones are those caused by renal colic. In addition, specific back pain can be caused by rheumatic diseases, such as rheumatoid or psoriatic arthritis; such diseases of the abdominal organs as pancreatitis, cholecystitis, duodenal ulcer and others; cardiovascular pathologies, in particular aortic aneurysm and exacerbation of coronary artery disease; infectious diseases, tuberculosis, sarcoidosis, herpes zoster and others; urological and gynecological pathologies, where the pelvic organs are affected. And this list can go on and on. So, the task of the therapist is to “weed out” patients with specific back pain before seeing a neurologist and either treat them himself or refer them to specialists in suspected pathologies. I told you about an extremely important and crucial stage in the work of a therapist, since the main threat to the life of a patient, as a rule, is posed by diseases that are manifested not by vertebrogenic, but by specific back pain. Among the most dangerous of them, I will name breast, lung and prostate cancer, which metastasize to the spine.
— Are there any “threatening symptoms” that are common to specific back pain, indicating the presence of a serious disease not related to the spine?
— Yes, such “red flags” exist. This is the onset of persistent back pain before the age of 20 and after 50; the non-mechanical nature of the pain, that is, the pain does not decrease at rest, in the supine position, in certain postures; association of pain with trauma; gradual increase in pain;
history of oncology; the occurrence of pain against the background of fever, weight loss; complaints of prolonged stiffness in the morning; symptoms of spinal cord injury, including paralysis, pelvic disorders, sensory disorders; changes in urine and blood tests.
— What are the most common causes of non-specific back pain?
– In the first place are myositis, that is, muscle pain, in the second place – lesions of the joints and ligaments of the spine, and only in the third place – compression radiculopathy, or damage to the roots of the spinal cord itself, which is observed in no more than 3-5 % of patients with non-specific back pain.
– In connection with these disorders, should the patient, as you said, turn to a neurologist or, after all, to a vertebrologist?
— In world practice, as in Russian healthcare, such patients are treated mainly by a neurologist, and, in my opinion, this is correct. If we talk about Western countries, then there the division of neurologists into specialists in different areas, including neurosurgeons – into “children’s” and “adults”, operating on the spinal cord and brain, is becoming less common today. Experience has shown that in the role of a “general neurologist” a doctor who has extensive training in the fight against a wide variety of diseases of the nervous system manages to help patients more successfully and better realize himself as a specialist. But at the same time, neurologists who are not indifferent to their profession choose a direction for themselves, where they acquire in-depth knowledge and skills in clinical practice. For example, I position myself as a neurologist-algologist. That is, capable of recognizing and treating almost all neurological diseases, but having extensive experience in the fight against chronic pain syndromes. So, in Western countries today there are very few vertebrologists. But in Russia the situation is completely different. Let me explain that, as in the West, there are few vertebrologists in the classical sense of this term in our country. However, many chiropractors call themselves vertebrologists.
— Do you consider this activity to be quackery?
– Of course not. But if in the West manual therapy is a paramedical specialty, for which it is enough to be a paramedic, then in our country such practice is carried out by orthopedic doctors or neurologists. Becoming chiropractors, or, as they often call themselves, vertebrologists, they usually abandon traditional clinical practice, while undergoing significant professional deformation. The method of manual examination is recognized by evidence-based medicine only as a method for diagnosing nonspecific back pain, but not for treating these disorders. And yet, the professional community of neurologists for the most part recognizes manual therapy as a promising method of helping patients with dorsopathy. Indeed, in some patients, a chiropractor achieves, although short-term, but a quick and pronounced analgesic effect. Therefore, such techniques have gained wide popularity among patients.
— Please tell us about the algorithms for examining a patient with dorsopathy by a neurologist.
— I would like to talk about the classic algorithm of clinical examination, which allows to localize the cause of pain with high accuracy in almost all patients where there is no need to conduct radiation examinations, including X-ray of the spine or CT and MRI, that is, who do not have radicular pain. The only drawback of this “ideal” survey would be its labor intensity. For example, the initial appointment of a patient with dorsopathy takes me up to an hour and a half. This is hardly possible in outpatient practice. When collecting patient complaints and interviewing for anamnesis, I always at least briefly double-check the work of the therapist, asking the patient questions in connection with the possible threat of a specific nature of back pain. Then I move on to examining the patient. None
Lack of time to see a patient cannot justify the fact that a neurologist “looks” only the back of a patient with dorsopathy! I am deeply convinced that such a patient needs, firstly, a complete standard neurological examination, including cranial nerves, reflexes,
preservation of skin sensitivity and muscle strength, and so on; as well as a complete neuro-orthopedic examination, which is necessary in such a situation to assess all the main biomechanical structures of a person.
– But an hour and a half for this whole complex of examinations – isn’t it too expensive?
– However, it is necessary except in cases where the neurologist can immediately suspect a lesion of some structure and focus on it. So that you understand what dangerous consequences a superficial examination of a patient with dorsopathy leads to, I will give two examples. Osteoarthritis of the hip joint causes specific back pain, which, among other non-vertebrogenic diseases, most accurately disguises itself as dorsopathy. A high-quality neuroorthopedic examination makes it possible to differentiate these pains with high accuracy.
— And if it was superficial or completely absent?
– Then, and I remember a whole string of such patients, on the one hand, an unsuccessful struggle, including neurosurgical operations, with supposedly present nonspecific dorsopathy lasts for months or even years. On the other hand, coxarthrosis progresses unceasingly up to necrosis of the femoral head. The second example relates to even more annoying situations, since it is much easier to detect a difference in the length of a person’s legs using a neuroorthopedic examination than a lesion of the hip joint. At the same time, the first of the violations I have indicated is one of the most common causes of discomfort and back pain. But to cope with it, the simplest of orthopedic remedies is enough – a heel pad. If for many years the difference in leg length is not corrected with it, then the biomechanics of not only the hip joints, but the entire spine up to its cervical region, changes, which causes severe back pain. Recently, I managed to cure a patient by prescribing such a heel pad, which passed at
of his life, through many examinations and courses of treatment by neurologists, underwent a useless neurosurgical operation, and all because not a single doctor who examined him noticed that the length of the legs of this patient differed by several centimeters.
— What are the indications for the use of various radiation methods in the diagnosis of dorsopathies?
– X-ray examination – the most common of the radiation examinations of such patients. It allows you to detect metastases in the spine, vertebral tuberculoma, osteoporosis, spinal scoliosis and a number of other pathologies. In recent years, radiography with functional tests has been increasingly used. The patient here is examined not lying, but standing, and with flexion and extension of the spine. This can reveal instability or spondylolisthesis, a common cause of nonspecific back pain. Spondylolisthesis is a displacement or
slippage of one of the vertebrae relative to the underlying one forward or backward. Spondylolisthesis is most common in the cervical and lumbar spine, which have greater mobility and experience the greatest vertical load than the thoracic spine. CT is the same x-ray that “sees” bone disorders, but much more sensitive. However, this method is more expensive and the patient receives a higher dose of radiation than with x-rays. MRI is used in the diagnosis of radicular pain and mainly in preparing the patient for surgery. This examination allows the neurosurgeon to determine what the root is “tightened” with – a herniated disc, an osteophyte, a tumor, a metastasis, a fragment of a broken vertebra, or other causes. Electromyographic examination is used in the diagnosis of damage to the roots of the spinal nerves in the diagnosis of radiculopathy.
— What medicines are used to treat non-specific back pain?
— International recommendations for the treatment of any type of these disorders include two groups of drugs: muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs). Now the latest generation of NSAIDs, coxibs, are superselective inhibitors of the inflammatory mediator COX-2. In terms of anti-inflammatory and analgesic activity, coxibs are comparable to “classic” NSAIDs, however, they do not cause complications typical for drugs in this group, such as NSAID-induced gastropathy. Major international
studies have confirmed that the incidence of erosive and ulcerative lesions of the upper gastrointestinal tract with the use of coxibs does not exceed the frequency of their occurrence with placebo and is much lower than with non-selective NSAIDs. Celecoxib was the first of the coxibs to be registered, followed by rofecoxib and other members of this group. Muscle relaxants, such as midocalm, sirdalud or baclofen, are prescribed along with NSAIDs in order to relieve muscle spasm that develops in tissues adjacent to the affected area of ​​​​the spine, and significantly increase pain. An obligatory component of the treatment of dorsopathies is also the maximum preservation of the usual motor activity. Bed rest is recognized as unnecessary and even harmful for such patients. The latest American guidelines for the treatment of dorsopathy also include the use of narcotic analgesics, but in doses of only 1-2 tablets. Then, as a result of a powerful antinociceptive effect, the patient begins to move more quickly. According to American neurologists, this noticeably speeds up recovery and leads to a pronounced economic effect. However, many European and Russian neurologists believe that such drugs are not needed in the vast majority of cases in the treatment of dorsopathies.
— And if a neurologist made a diagnosis of radicular syndrome, which was confirmed by MRI, then he does not prescribe conservative treatment, but immediately sends the patient to surgeons?
– No way! An outpatient neurologist is obliged, and urgently, to refer a patient with back pain to a neurosurgeon only when they are accompanied by signs of severe damage to the spinal cord. For example, urinary incontinence, feces or other disorders of the pelvic organs have appeared, or there is a clinic of lumbar stenosis, in other words, a narrowing of the spinal canal, leading to damage to the spinal cord or cauda equina roots and a specific pain syndrome. As a result, intermittent neurogenic or myelogenous claudication, loss of sensation in the legs, and muscle paresis may occur. In the vast majority of cases of radicular syndrome, treatment begins with drug therapy. However, it differs from situations where the vertebral joints, ligaments and
muscles. The reason is that the radicular syndrome is based on neuropathic pain caused by primary damage to the somatosensory system. Let me remind you that the mechanism of such pain is associated with pathological activation of pain pathways, which may be due to dysfunction of the nervous system at the level of the spinal cord and brain or peripheral nerves, plexuses and dorsal roots. So, for the treatment of neuropathic radicular pain, along with NSAIDs and muscle relaxants, anticonvulsants such as gabapentin and pregabalin, as well as tricyclic antidepressants, are used. But before using such therapy, an additional examination is carried out using pain questionnaires, as well as quantitative sensory testing. With this method, it is possible to check whether the pain is neuropathic.
— Does therapy begin with intramuscular drug injections?
– No, the drugs are immediately prescribed in tablets, since the bioavailability of drugs in this case practically does not decrease compared to the injection route. And if the treatment for musculoskeletal nociceptive, in other words “natural” pain is prescribed correctly, after 7-10 days its intensity decreases significantly, after 2-3 weeks recovery occurs. Conservative treatment of radicular pain can last 60, maximum – 90 days. After that, if the therapy is ineffective, the patient should be referred to a neurosurgeon. But here I must note that all over the world, as in Russia, there is excessive and often unreasonable surgical activity in the treatment of back pain, since in many cases “relative indications” for operations are used – this is pain syndrome, and not the presence of a neurological deficiency due to compression of the nerve root.
— And if musculoskeletal vertebral pains are not amenable to conservative treatment and if surgery for radicular syndrome did not help?
– In the first case, it most often turns out that the pain syndrome is of a mixed nature, and musculoskeletal pains are accompanied by nerve compression, as well as psychogenic origin. Often, rheumatic diseases, in particular Bechterew’s disease, become the pathogenetic basis of pain. The neurologist has two opportunities and at the same time duties to solve these problems: to think and to doubt. Including in the diagnosis he made, and in the ability to cure the patient on his own. My experience shows that a multidisciplinary team of doctors should operate here, which, in addition to a neurologist, includes a psychotherapist, rheumatologist, neurosurgeon and other specialists. As for patients with radicular syndrome who were not helped by surgery, here we touched on one of the most acute problems in the treatment of dorsopathies. More than half a million radiculopathies are performed annually in the United States, but about one in five operated patients have back pain that persists or worsens despite the anatomical defect being repaired. In economically less developed countries, there are fewer such operations, but the frequency of ineffective spinal surgeries is even higher. The recurrence of pain shortly after an anatomically successful discectomy is referred to as “bad spine syndrome”. It is amenable to treatment with great difficulty, dooming most patients to a lifelong intake of analgesics, anticonvulsants and antidepressants in ever-increasing doses.
— And the last question in our interview: do the international recommendations for the treatment of back pain include other methods of treatment than surgery and medication?
– Not included, as they do not have an evidence base. However, among these methods there are many understandable and effective ones that I and my colleagues successfully use. It seems that physiotherapy used for pain syndromes, blockades with local anesthetics and corticosteroids, as well as manual therapy, could prove their effectiveness, albeit less strong and prolonged compared to the effects of drugs, if not for one circumstance. These methods are very difficult to standardize in order to create a clinical trial design similar to that used in drug trials and trusted by the medical community. But neurologists often have to prescribe physiotherapy and other additional treatment for back pain, although we understand that this patient has enough medication. The reason is that adherence to treatment for dorsopathy is quite high, and for psychological comfort or conviction that they are “treated properly”, many of my patients do not have enough pills alone. It seems to them that it is necessary to connect other methods, including those that helped their relatives and friends. In such cases, it is very difficult to convince the patient, and I recommend him some additional methods, including physiotherapy, but those where I am sure of their safety, as well as that the patient will receive such assistance in licensed medical institutions.

Medical Bulletin “School of the Clinician”

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Back pain – which specialist to contact Khabarovsk

Back pain is a fairly common and even everyday problem. According to statistics, four out of every five people suffer from back pain at least once in their lives. At the same time, the number of visits to doctors not only by the elderly, but also by young people aged 25-35 years with complaints of pain in the lower back, in the area of ​​​​the shoulder blades or the spine only increases from year to year.

When experiencing pain, each person asks two questions: is it worth going to the doctor? And which specialist should I contact?

Symptoms, factors and causes of back pain

Back pain can be caused by various causes. Sometimes, short-term bouts of pain or general discomfort may hide the prerequisites for a serious illness, which in the future may affect a person’s quality of life. Therefore, experts recommend contacting a medical institution in any of the following cases:

  • pain lasts for several days and does not decrease in intensity;
  • you have previously treated similar conditions;
  • recurring, well-localized attacks of pain;
  • painful sensations are exacerbated by any physical exertion;
  • discomfort is felt in any position and even in sleep;
  • the appearance of edema or swelling at the site of pain;
  • manifestation of other associated symptoms (fever, weakness, diarrhea, numbness and tingling).

Without proper treatment, back pain can become repetitive, with periods of short-term relief followed by recurring pain. In this case, exacerbation of pain can provoke hypothermia, infections, being in an uncomfortable position, excessive physical exertion.

Direct causes of back pain can be:

  • previous trauma, birth defects;
  • neurological diseases: osteochondrosis, scoliosis, spondylosis;
  • kidney disease: urolithiasis, pyelonephritis;
  • endocrine diseases: osteoporosis;
  • diseases of the respiratory system: pleurisy;
  • other diseases of internal organs, vessels and soft tissues.

This variety of causes and symptoms can make it difficult to choose a specialist.

Which doctor to contact for back pain

The back is one of the most important parts of the human body, since the relationship between the anatomy of the chest and abdominal cavity creates special conditions for pain manifestations, and discomfort in the spine can easily be confused with problems in others organs.

The correct answer to the question of which doctor should be consulted when the back and spine hurts will be helped by an appointment with a therapist. This specialist has sufficient knowledge and skills to prescribe tests or hardware studies, identify the causes of violations and refer to a narrower specialist for the diagnosis and treatment of specific diseases of the back, spinal column or internal organs.

Patients with back pain are first referred by their therapists to a neurologist who specializes in diseases of the central and peripheral nervous system, as well as processes caused by changes in the functioning of the brain and spinal cord.

It is advisable to visit a neurologist for symptoms caused by problems with the neck, thoracic region, lower back: headaches and dizziness, impaired coordination and speech, convulsions, memory problems, decreased visual acuity and hearing, weakness and loss of consciousness.

To check the condition of the spine and identify the true cause of the ailment, the neurologist prescribes a comprehensive examination, consisting of a blood test to confirm the inflammatory process and hardware diagnostics:

  • X-ray of the spine;
  • Ultrasound of vessels and brain;
  • computed (CT) and magnetic resonance imaging (MRI).

Treatment and prevention of back pain

There are different methods of treating back pain. The most suitable of them, taking into account the clinical features and lifestyle of the patient, is chosen directly by the neurologist. The specialist may prescribe:

  • physiotherapy;
  • manual therapy;
  • massage, muscle relaxation;
  • exercise therapy or traction (stretching) of muscles;
  • drug therapy.

Only in the absence of a visible effect from one of the above measures and a further deterioration in the general condition, the specialist turns to surgical methods of treatment.

In the presence of heredity or a predominantly sedentary lifestyle, to reduce the risk of occurrence and exacerbation of diseases that cause back pain, neurologists recommend:

  • start the day with exercises, spend time walking;
  • monitor posture, properly organize the workplace during sedentary work;
  • sleep on a comfortable bed with a hard mattress;
  • avoid heavy lifting, do not carry the bag in one hand when shopping;
  • monitor nutrition and control body weight.