What are the common symptoms of low back pain. How can you identify the underlying causes of lumbar discomfort. Which treatments prove most effective for alleviating lower back issues.

Understanding the Anatomy of Low Back Pain

The lumbar region, commonly referred to as the low back, begins just below the ribcage. This area of the spine bears significant responsibility in supporting the upper body and facilitating movement. Due to its complex structure and the demands placed upon it, the low back is particularly susceptible to injury and discomfort.

What exactly comprises the lumbar region? The lumbar spine consists of five vertebrae, labeled L1 to L5, which are separated by intervertebral discs. These discs act as shock absorbers and allow for flexibility in the spine. Surrounding these structures are muscles, ligaments, and nerves that work together to enable movement and stability.

Key Components of the Low Back

• Vertebrae (L1-L5)
• Intervertebral discs
• Spinal cord and nerve roots
• Muscles and ligaments
• Facet joints

How does the anatomy of the low back contribute to pain? The intricate network of structures in the lumbar region means that damage or irritation to any component can result in pain. For instance, a herniated disc can compress nearby nerves, while strained muscles can cause localized discomfort.

Recognizing the Symptoms of Low Back Pain

Low back pain manifests in various ways, ranging from a dull ache to sharp, shooting sensations. The nature and severity of symptoms can provide valuable clues about the underlying cause of the pain.

How can you differentiate between acute and chronic low back pain? Acute pain typically comes on suddenly and lasts for a few days to a few weeks, often resolving on its own. Chronic pain, on the other hand, persists for more than three months and may require more intensive treatment.

Common Symptoms of Low Back Pain

• Dull, aching pain
• Sharp or stabbing sensations
• Muscle spasms or tightness
• Difficulty standing up straight or moving
• Pain that radiates down the leg (sciatica)

When should you seek medical attention for low back pain? It’s advisable to consult a healthcare professional if your pain persists beyond 72 hours, occurs after a fall or injury, or is accompanied by other symptoms such as fever, bowel or bladder problems, or leg weakness.

Exploring the Common Causes of Low Back Pain

Low back pain can stem from various sources, ranging from acute injuries to chronic conditions. Understanding the potential causes can help in determining the most appropriate course of treatment.

How do everyday activities contribute to low back pain? Many common causes of low back discomfort are related to lifestyle factors and daily habits. These can include poor posture, improper lifting techniques, and prolonged periods of sitting or standing.

Frequent Causes of Low Back Pain

1. Muscle strain or sprain
2. Herniated or bulging discs
3. Spinal stenosis
4. Degenerative disc disease
5. Osteoarthritis
6. Sciatica
7. Spondylolisthesis

Can underlying medical conditions lead to low back pain? Certain chronic conditions can indeed contribute to persistent low back discomfort. These include fibromyalgia, ankylosing spondylitis, and osteoporosis. In some cases, low back pain may even be a symptom of more serious conditions such as infections or tumors, although these are relatively rare.

The Impact of Lifestyle on Low Back Health

Our daily habits and lifestyle choices play a significant role in the health of our low back. From the way we sit at work to the activities we engage in during our leisure time, many factors can influence the likelihood of experiencing low back pain.

How does prolonged sitting affect low back health? Extended periods of sitting, particularly with poor posture, can place excessive stress on the lumbar spine. This can lead to muscle imbalances, weakened core muscles, and increased pressure on the intervertebral discs.

Lifestyle Factors Influencing Low Back Pain

• Sedentary behavior
• Obesity
• Smoking
• Poor sleep habits
• High-stress levels
• Improper lifting techniques

What role does physical activity play in preventing low back pain? Regular exercise, particularly activities that strengthen core muscles and improve flexibility, can significantly reduce the risk of low back pain. However, it’s important to engage in appropriate activities and avoid overexertion, which can lead to injury.

Diagnosing the Root Cause of Low Back Pain

Accurate diagnosis is crucial for effectively treating low back pain. Healthcare professionals employ various methods to identify the underlying cause of discomfort and determine the most appropriate course of treatment.

What information should you provide to your doctor when discussing low back pain? Be prepared to describe the nature and location of your pain, when it started, any related symptoms, and your medical history. This information can help your doctor make an accurate diagnosis.

Common Diagnostic Tools for Low Back Pain

• Physical examination
• Medical history review
• X-rays
• MRI scans
• CT scans
• Blood tests

Are imaging tests always necessary for diagnosing low back pain? Not always. In many cases, a thorough physical examination and medical history are sufficient for diagnosis. Imaging tests are typically reserved for cases where the pain is severe, persistent, or accompanied by other concerning symptoms.

Effective Treatment Strategies for Low Back Pain

The treatment of low back pain often involves a multifaceted approach, combining various strategies to alleviate discomfort and address the underlying cause. The specific treatment plan will depend on the nature and severity of the pain, as well as individual patient factors.

How soon should you expect relief from low back pain treatments? The timeline for improvement can vary significantly depending on the cause and chosen treatment. Some people experience relief within a few days, while others may require several weeks or months of consistent treatment.

Common Treatment Approaches for Low Back Pain

1. Rest and activity modification
2. Physical therapy and exercise
3. Medications (over-the-counter and prescription)
4. Hot and cold therapy
5. Manual therapies (chiropractic care, massage)
6. Acupuncture
7. Injection therapies
8. Surgery (in severe cases)

What role does physical therapy play in treating low back pain? Physical therapy is often a cornerstone of low back pain treatment. It can help improve strength, flexibility, and posture, while also teaching proper body mechanics to prevent future injuries.

The Role of Exercise in Managing Low Back Pain

Exercise plays a crucial role in both preventing and managing low back pain. Regular physical activity can strengthen the muscles that support the spine, improve flexibility, and enhance overall back health.

How soon after experiencing low back pain should you start exercising? While it’s important to avoid aggravating the injury, gentle movement and specific exercises can often be beneficial even in the early stages of low back pain. Always consult with a healthcare professional before starting any new exercise regimen.

Beneficial Exercises for Low Back Pain

• Core strengthening exercises
• Low-impact aerobic activities
• Stretching and flexibility exercises
• Yoga and Pilates
• Aquatic exercises

Can exercise help prevent recurrent episodes of low back pain? Yes, maintaining a regular exercise routine can significantly reduce the risk of future low back pain episodes. Focus on exercises that improve core strength, flexibility, and overall fitness.

Alternative and Complementary Therapies for Low Back Pain

In addition to conventional medical treatments, many people find relief from low back pain through alternative and complementary therapies. These approaches can often be used in conjunction with traditional treatments to provide comprehensive pain management.

How effective are alternative therapies in treating low back pain? The effectiveness of alternative therapies can vary widely among individuals. While some people report significant benefits, scientific evidence supporting these treatments is often limited. It’s important to discuss any alternative therapies with your healthcare provider before trying them.

Popular Alternative Therapies for Low Back Pain

• Acupuncture
• Massage therapy
• Chiropractic care
• Mindfulness and meditation
• Herbal remedies
• Biofeedback

Are there any risks associated with alternative therapies for low back pain? While many alternative therapies are generally safe, they can carry risks, especially if not performed correctly or if used inappropriately. Always seek treatment from qualified practitioners and inform your primary healthcare provider about any alternative therapies you’re considering.

Low back pain is a complex condition that can significantly impact quality of life. By understanding its causes, recognizing symptoms, and exploring various treatment options, individuals can take proactive steps towards managing and preventing low back discomfort. Remember, while many cases of low back pain resolve on their own, persistent or severe pain should always be evaluated by a healthcare professional to ensure proper diagnosis and treatment.

Low Back Pain Pictures: Symptoms, Causes, Treatments

Medically Reviewed by Tyler Wheeler, MD on January 25, 2022

The low back, also called the lumbar region, is the area of the back that starts below the ribcage. Almost everyone has low back pain at some point in life. It’s one of the top causes of missed work in the U.S. Fortunately, it often gets better on its own. When it doesn’t, your doctor may be able to help with several effective treatments.

These might range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Pain that comes on suddenly is “acute.” It might happen during sports or heavy lifting. Pain that lasts more than 3 months is considered “chronic.” If your pain is not better within 72 hours, you should consult a doctor.

See a health care professional any time you have back pain after a fall or injury. The same goes if you have back pain with bowel or bladder control problems, leg weakness, fever, or pain when coughing or peeing.  

Muscle strain is often the cause of back pain from heavy lifting or vigorous exercise. But sometimes it’s due to small jelly-filled disks meant to protect the space between vertebrae. When one of these disks bulges or breaks, it can push on a nerve. When it’s the sciatic nerve, pain runs from the buttock down one leg. This is sciatica.

If your job involves lifting, pulling, or anything that twists the spine, it may contribute to back pain. However, sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or you tend to slouch.

Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.

Overdoing it at the gym or golf course is one of the most common causes of overextended muscles leading to low back pain. You’re especially vulnerable if you tend to be inactive during the work week and then spend hours at the gym or softball field on the weekend.

Moms were right when they said, “Stand up straight!” Your back supports weight best when you don’t slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.

The spine’s vertebrae are cushioned by gel-like disks that are prone to wear and tear from aging or injuries. A weakened disk may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disk and can cause intense pain.

Several chronic conditions can lead to low back pain.

• Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.
• Ankylosing spondylitis inflames the joints of the spine, and sometimes the shoulders, hips, ribs, and other areas too. It causes chronic back pain and stiffness. In serious cases, spinal vertebrae start to fuse (grow together).
• Fibromyalgia causes widespread muscle aches, including back pain.

Most people experience back pain first when they’re in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

• Being overweight
• Being sedentary
• Lifting heavy stuff on the job

To help your doctor diagnose the source of low back pain, be specific in describing the type of pain, when it started, related symptoms, and any history of chronic conditions.  Your doctor will probably not need to order X-rays, CT or MRI scans before starting treatment.

Back pain due to muscle strain will usually get better on its own, but you can take steps to make yourself more comfortable. A heating pad or warm baths may provide temporary pain relief.

When your back hurts, you may not feel like getting out of bed. But if the problem is muscle strain, doctors recommend returning to your normal activities as soon as possible. Studies suggest that any more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility.

If back pain doesn’t go away in 3 months, there’s evidence that yoga can help. In one study, people who took 12 weeks of yoga classes had less back pain than those who got a book about back pain. The benefits lasted several months. Just make sure you get expert instruction so you don’t hurt yourself. 

Chiropractors and some osteopathic doctors may try to move the joints of your spine to treat low back pain. They apply pressure with their hands to bones and surrounding tissues. This treatment is not appropriate for everyone, so be sure to tell your provider about all your symptoms and health issues.

Massage may relieve chronic low back pain, especially when combined with exercise and stretching. Researchers noted patients who did all three were able to move around easier and had less short-term and long-term pain.

Can acupuncture treat back pain? The evidence is mixed for people with short-term back pain. Research showed that these people benefited from sham acupuncture as much as from real acupuncture. However in other studies, people with chronic or long-lasting backpain did show improvement after receiving acupuncture treatments.

Mild back pain often feels better with over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen. Pain-relieving creams may be helpful for muscle aches. For severe pain or chronic pain, your doctor may recommend prescription medication.

If simpler therapies and medications aren’t helping, your doctor may recommend injections to the back. One procedure, called a nerve root block, targets irritated nerves. Injections for back pain usually contain steroid medication.

If long-lasting back pain is interfering with your daily life, and other treatments have not provided relief, you may be a candidate for surgery. Depending on the cause of your pain, a surgeon may remove a herniated disc, widen the space around the spinal cord, and/or fuse two spinal vertebrae together.

If back pain has left you inactive for a long time, a rehabilitation program can help you strengthen your muscles and get back to your daily activities. A physical therapist can guide you through stretches, strength exercises, and low-impact cardio that will help you be fitter without straining your back.

Strength training can help your lower back. In flexion exercises, you bend forward to stretch and strengthen the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. If you have back pain, talk to your doctor or physical therapist about exercises that are safe for you.  

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

• Stay at a healthy weight.
• Exercise regularly.
• Lift with your legs, not your back.
• Make sure your work station position isn’t contributing to your pain.

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14)          Lluís Real / age fotostock
15)          Reza Estakhrian / The Image Bank
16)          Gabriela Medina / Blend Images
17)          Nacivet / Photographer’s Choice
18)          iStockphoto
19)          Steve Pomberg / WebMD
20)          Zephyr / Photo Researchers, Inc.
21)          Apogee / Photo Researchers
22)          altrendo images
23)          Thomas Schmidt / Riser
24)          Andersen Ross / Brand X Pictures

REFERENCES:

National Institute of Neurological Disorders and Stroke: “Low Back Pain Fact Sheet.”
American Academy of Family Physicians: “Lower Back Pain.”
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Back Pain.”
American Academy of Orthopaedic Surgeons: “Low Back Pain.”
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Bratton, R. Am Fam Physician, November 1999.

Verhagen, AP. Eur Spine J, September 2016. 

Lizhou, L. Evid Based Complement Alternat Med, 2015. 

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Surprising Reasons Your Back Hurts

Medically Reviewed by Minesh Khatri, MD on April 24, 2022

You might expect a sore back to keep you up at night. But sleep problems can also lead to back pain or make it worse. One study found you’re 1½ times more likely to get back pain if you have insomnia. (That means it’s hard to get to sleep, or stay asleep.) Researchers aren’t sure exactly why. But insomnia can make you more sensitive to pain. Stress might play a part, too. Try:

• Better sleep habits
• Relaxation techniques
• Therapy

If you’re like most Americans, you take 3,000-4,000 steps a day. Foot pain, flat feet, or other problems can throw off your stride. That can lead to strain on other parts of your body. Does your backache kick in when you stand up or start to walk? If so, check with a foot specialist to see if your tootsies might be to blame.

Gamers tend to spend lots of time seated, with their heads tilted forward and their shoulders slumped. Poor posture and hours of sitting can lead to muscle strain and stiffness. One easy fix: Set a timer for 20- or 30-minute breaks to remind yourself to stand up and move around. And instead of slouching on the sofa, sit on a therapy ball.

After you have an injury or surgery around the nerves in your back, scar tissue grows. This thick, tough stuff helps the nerve heal. But when you move, the scar can tug on the sensitive area. Scarring also can also block blood supply to the nerve. Both can set off back pain. Your doctor may treat scarred nerves with electric pulse therapy, which diverts pain signals. Or you might need surgery.

One study found that women who gave birth by cesarean section with epidural anesthesia were more likely to have lower back pain later. Labor can put your body into strained positions. An epidural cancels pain, so you could lie for a long time in an awkward pose you can’t feel. This can damage your back and lead to pain. Also, you must limit activity for a while after a C-section. That can weaken your abs — another cause of back pain.

Smokers are almost 3 times more likely to get lower back pain. Tobacco slows the flow of blood to your tissues and bones. This can lead to a painful breakdown in the disks of your spine. Since smoking also slows healing, the ache may linger. Researchers also think nicotine makes pain feel worse. Ask your doctor about ways to quit smoking.

Studies have found a link between height and back problems. One found that women at least 5 feet, 7 inches tall were 20% more likely to have lower back pain than shorter women. The risk also rose for tall men, especially those over 6-foot-1, but less sharply. Hormones, or the way a taller body moves, could be to blame. So could posture problems that happen when you often stoop to get into a car or lean over to talk to shorter folks.

They might be trendy, but tight pants can cramp your style — and hurt your back. A study of men who first wore slacks that fit, then switched to smaller sizes, found the snug pants changed their movements and posture. Tight clothing leads to awkward moves in your lower spine and pelvis. It can make you slump when you sit, too. This weakens the muscles that keep your spine in line.

Urinary tract infections (UTIs) happen when bacteria from your rectum or skin get into your urinary tract and infect it. Most are bladder infections. Kidney infections are more rare, but also more serious. They can cause lower back pain along with:

• Fever
• Chills
• Nausea

Doctors use antibiotics to clear up UTIs, which are most common in women and girls.

It’s a thing. Fat wallet syndrome made its debut in the mid-1960s, when men began to stuff credit cards into their wallets — then sit on them. When you perch on a pocket bulging with cash, cards, and papers, muscles in your buttocks get strained. So do your sciatic nerves. This can trigger lower back pain. A slim, uncluttered wallet in your front pocket can solve the problem.

Flip-flops — who doesn’t love them? Your back, for one. As you shuffle along, your feet strike the ground flat, with little cushioning to absorb the impact. This not only changes your natural stride but can hurt your feet. The stress and pain can move up into your legs, hips, and lower back. Even casual summer sandals should protect and support your feet.

IMAGES PROVIDED BY:

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2. Getty Images
3. Getty Images
4. Getty Images
5. Getty Images
6. Getty Images
7. Getty Images
8. Getty Images
9. Getty Images
10. Getty Images
11. Getty Images

SOURCES:

PLoS One: “Increased Insomnia Symptoms Predict the Onset of Back Pain among Employed Adults.”

Podiatry Today: “When Lower Extremity Dysfunction Contributes To Back Pain. “

American College of Foot and Ankle Surgeons: “That Pain in Your Back Could be Linked to Your Feet.”

Mayo Clinic: “10,000 steps a day: Too low? Too high?” “Good posture tips.”

Cleveland Clinic: “Kids Complaining of Back Pain? Here’s Why You Should Limit Their Screen Time,” “How to Beat Insomnia When You Have Chronic Pain,” “Why Smoking Will Worsen Your Chronic Pain.”

University of Michigan Comprehensive Musculoskeletal Center: “Scarred Nerves.”

Medicine (Baltimore): “Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia.”

Cedars-Sinai: “Overcoming postpartum pain.”

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American Journal of Epidemiology: “Associations of Body Mass Index and Body Height With Low Back Pain in 829,791 Adolescents. “

Journal of Physical Therapy Science: “Effect of wearing tight pants on the trunk flexion and pelvic tilting angles in the stand-to-sit movement and a seated posture.”

CDC: “Urinary Tract Infection.”

International Journal of Medical Research & Health Sciences: “Fat Wallet Syndrome: An Epidemic among Men.”

Journal of the American Podiatric Medical Association: “Comparative Analysis of Human Gait While Wearing Thong-Style Flip-Flops Versus Sneakers.”

American Chiropractic Association: “Healthy Summer Footwear.”

American Academy of Orthopaedic Surgeons: “Shoes: Finding the Right Fit.”

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diagnostic and treatment approaches

Introduction

The purpose of this article is to review the treatment of acute pain syndromes in the lower back (lower back).

Given the specifics of the relationship between acute and chronic pain, let’s first consider these concepts. The World Association for the Study of Pain (IASP) has defined pain as an unpleasant sensory and emotional experience resulting from tissue damage [1]. Acute pain is described as pain that occurs after injury and is limited in time (less than 1 month), it usually has an identifiable temporal and causal relationship with injury or disease. Chronic pain usually persists even after the end of the injury and often may not have an anatomical substrate [2]. It is customary to call acute pain that lasts no more than 1 month, from 1 to 3 months the pain is considered subacute, and starting from 3 months the pain syndrome becomes chronic. There is a growing debate about the relationship between acute and chronic pain. At the same time, a number of studies emphasize that for effective treatment it is important to eliminate the link between acute and chronic pain.

Before proceeding to a differentiated consideration of each of the types of pain, it is necessary to recall the general information about the perception of pain.

The perception of pain is represented by a complex nociceptive system located in different parts of the nervous system. The information transmission pathway starts from the peripheral nerves and runs through the spinal ganglion to the spinal cord, brainstem, thalamus, and cerebral cortex. This is a complex system, which is significantly influenced by emotional components. At the same time, acute pain is a normal response to tissue damage, and signal transmission and conduction always occur along classical nociceptive pathways [4]. A long-term pain syndrome leads to functional changes in the system, after which even a normal, non-painful impulse can be perceived as pain.

The relationship between acute and chronic pain is fairly well established, but few randomized controlled trials have addressed the causes and timing of the transition between the two pain states, especially in terms of prevention and therapy. When such studies were conducted, they were mainly concerned with the assessment of postoperative pain. It has been found that early analgesic interventions can reduce the incidence of chronic pain after surgery. Epidural analgesia started before thoracotomy and continued postoperatively results in a significant reduction in the number of patients reporting pain after 6 months compared with patients who received intravenous opioids as postoperative analgesia (45% vs. 78%, respectively) [5] . In patients undergoing colon resection, continuous epidural analgesia resulted in a reduced risk of persistent pain during the 1st year after surgery compared with conventional analgesia [6]. We are talking about the fact that the timely impact on acute pain had the effect of reducing the prevalence of chronic pain syndrome.

Thus, the division into acute and chronic pain occurs during the period of existence of pain sensation, when the functional restructuring of nociceptive systems is carried out. In this regard, approaches to the treatment of these conditions should differ significantly.

To provide patients with safe, effective and personalized treatment, an accurate assessment of acute pain is essential. At the same time, pain should be assessed within the framework of a biopsychosocial model, according to which the formation of pain sensation is simultaneously influenced by physiological, psychological and environmental factors.

Prevalence of pain in the lower back

Pain in the lower back is one of the most common reasons for patients to visit a neurologist. So, by the age of 60, 8 people out of 10 have experienced at least one episode of back pain, 14% of the adult population experience episodes of back pain every year, 2% of the population become disabled due to the development of chronic back pain [7].

According to a recent review [8], the prevalence of chronic low back pain appears to vary with age. Thus, it is 3-4 times higher in persons over 50 years of age compared with patients aged 18 to 30 years. This review also notes that women, people with low economic status and low education, and smokers have a higher prevalence of low back pain compared with men, people with high economic status, good education, and non-smokers. .

There is evidence [9, 10] that the prevalence of chronic low back pain increases over time. This may be due to changes in lifestyle and working conditions. Thus, the intensive use of computers, as well as other technologies at work and at home, has increased the prevalence of a sedentary lifestyle, a risk factor for chronic and acute low back pain [11, 12]. A well-known risk factor for the development of chronic back pain is obesity, which contributes to the overload of the articular structures of the lumbosacral spine and the development of their predisposition to degeneration [9]. The increase in the prevalence of low back pain among people aged 30 to 60 years may also be due to occupational and domestic exposures that lead to overload of the lumbar spine.

A number of studies [9, 10, 13-15] show that low back pain decreases after age 70, which may be due to a decrease in exposure to occupational and everyday factors. However, its prevalence in this age group remains higher than in young people (20-30 years old).

Most episodes of low back pain are believed to be of short duration, and 80 to 90% of these episodes resolve in about 6 weeks, regardless of treatment. However, studies conducted in the late 1990s [16] showed a prevalence of chronic low back pain after an episode of acute pain ranging from 35% to 79%, assessed over 3, 6, or 12 months.

Risk factors for low back pain include a person’s physical characteristics, sociodemographic characteristics, habits, and psychosocial factors. Therefore, when selecting effective treatment regimens for such pain, it is extremely important to take into account these factors and the overall change in lifestyle.

Causes of pain in the lower back

Pain in the lower back is usually divided into specific (infectious, dysmetabolic, inflammatory, oncological causes) and non-specific .

With specific pain, we are talking about serious diseases that determine its manifestation. Symptoms of such diseases are commonly referred to as “red flags”. This may be an infection, trauma, osteoporosis, taking corticosteroids, a history of malignant neoplasms; age also matters – usually over 50; treatment failure, etc. [17]. In these cases, it is very important to conduct a complete neurological examination of the patient.

This article focuses on non-specific back pain, which is also often referred to as musculoskeletal pain. Nonspecific pain syndrome in the back can be caused by damage to the vertebrae themselves, intervertebral discs, facet joints, as well as ligaments and muscles of the spine. In this case, pain occurs or increases with mechanical stress and decreases after rest. The most common cause of degenerative lesions of the spine is the pathology of the intervertebral discs without compression of the neural structures. It is associated with irritation of the annulus and/or dural sac. In addition, pain syndrome can be caused by myofascial and muscular-tonic syndromes, which can be either independent or occur against the background of a degenerative process in the intervertebral discs [18]. Facet arthropathy can also cause pain in the lower back. In addition, there is a combination of these reasons. For example, osteoarthritis of the facet joint is thought to be a consequence of the aging process, but there is evidence that it may be associated with degenerative changes in other structures. With degenerative changes in the intervertebral discs, the load on the facet joints increases, which has a significant impact on the development of degenerative changes in the joints themselves with the development of pain.

Acute pain is dominated by nociceptive pain, but patients may also experience neuropathic pain. The neuropathic component of pain appears when nerve endings grow into a fissure of the intervertebral disc. General features of the nature of pain and anamnesis of the disease have been established, which give reason to assume the presence of neuropathic pain [19, 20]. These features include the following: clinical circumstances associated with a high risk of nerve damage; pain descriptors such as burning, shooting and stabbing character; paroxysmal or spontaneous nature of pain, which does not have obvious etiological factors; the presence of dysesthesia (spontaneous or caused by unpleasant abnormal sensations), hyperalgesia (increased response to a usually painful stimulus), allodynia (pain due to a stimulus that usually does not cause pain, such as a light touch) areas of hypesthesia; regional vegetative features (changes in color, temperature and sweating) and phantom phenomena.

Distinguish also dysfunctional pain, in which there is no nociceptive activation, no damage, and pain sensation arises from dysfunction of cerebral structures.

Determining the type of pain, its duration, and the characteristics of the response to pain medications is important for determining the treatment strategy [21, 22]. But at present, the possibility of a combination of different types of pain in a patient is also taken into account. When using this approach, in addition to assessing damage, special attention is paid to the psychosocial portrait of the patient.

Algorithm for the management of low back pain

In addition to general approaches to therapy that take into account the role of physiological, psychological and environmental factors, it is important to take into account the subjective characteristics of the patient in the occurrence of pain [23]. Here, of particular importance is the patient’s awareness of the pain syndrome, which allows him to more thoroughly and accurately assess pain [24], including during treatment [25]. To assess the adequacy of analgesic therapy, regular repeated measurements of pain intensity are important. The frequency of reassessment is determined by the duration and severity of pain, as well as the type of drug or intervention used [26].

Psychosocial and occupational factors (so-called “yellow flags”) associated with an increased risk of transition from acute to chronic pain should be assessed early on to facilitate appropriate interventions. Such factors include the patient’s pessimistic attitude towards the disease, the feeling of incurable pain (catastrophe), guilt and the patient’s belief that the disease is a price for something, the presence of anxiety and depressive disorders, iatrogeny – a negative experience of treatment in the past, fear of formulating a diagnosis. , ineffectiveness of previous therapy, problems in the family and at work [27].

In 2010, the Australian and New Zealand College of Anesthesia and Pain [17] reviewed literature guidelines for the management of patients with low back pain. The following generalizations have been made: 1. Acute low back pain is nonspecific in about 95% of cases; serious causes are rare; often the underlying pratology is asymptomatic and may not be the cause of the pain (Evidence level I). 2. However, it is important to evaluate the patient for red flags in order not to miss a specific pain syndrome (Evidence level III-2). 3. Advice to stay active, “activity-oriented” printed and verbal information, and cognitive behavioral therapy are helpful in acute low back pain (Evidence I). 4. Psychosocial and occupational factors (“yellow flags”) seem to be associated with the progression of back pain from acute to chronic; such factors should be assessed at an early stage to facilitate the further management of a patient with low back pain (Evidence level III-2).

In addition, the above-mentioned [17] experts made recommendations for the management of patients with low back pain based on the results of evidence-based medicine: 1) the management plan for patients with acute non-specific pain should include an assessment of the patient’s condition (history and physical examination), recommendations (information for patients about their condition, instructions for resuming normal activities, medication for pain), as well as pain assessment points for possible revision of the treatment plan; 2) information should be provided to patients in a credible but neutral manner, avoiding disturbing information to eliminate inappropriate expectations, fears or erroneous beliefs; 3) non-steroidal anti-inflammatory drugs NSAIDs can be used as a medical treatment for acute non-specific pain in the lower back; 4) oral opioids (preferably short-acting) can be used at regular intervals to relieve severe acute musculoskeletal pain, but the need for such treatment needs to be seriously evaluated; 5) adjuvant agents such as antiepileptic drugs, antidepressants and muscle relaxants are not recommended for the routine treatment of acute non-specific pain.

Treatment of acute pain in the lower back

Despite the existence of various possible mechanisms for the formation of pain syndrome, when acute pain occurs in the lower back, NSAIDs come to the fore for medical treatment.

NSAIDs have analgesic, anti-inflammatory and antipyretic effects and are effective analgesics in various acute pain conditions. Many of the effects of NSAIDs can be explained by the inhibition of prostaglandin synthesis in peripheral tissues, nerves, and the central nervous system [28]. However, NSAIDs may have other mechanisms of action independent of the effect on prostaglandins, including effects on basic cellular and neuronal processes. Prostaglandins are produced by the enzyme prostaglandin endoperoxide synthase, which has both cyclooxygenase and hydroperoxidase parts. Two main subtypes of the cyclooxygenase enzyme, COX-1 and COX-2, have been identified; in addition, COX-3 has been found [28–31]. Prostaglandins have many physiological functions, including protection of the gastric mucosa, renal tubular function and intrarenal vasodilation, bronchodilation, endothelial prostacyclin production, which leads to vasodilation and prevents platelet adhesion, and also affects platelet aggregation and vasospasm. These physiological roles are mainly regulated by COX-1, and their inhibition is the basis for the development of many side effects associated with the use of NSAIDs. Tissue damage causes the formation of COX-2, leading to the synthesis of prostaglandins, which cause pain and inflammation, and the induction of COX-2 in the spinal cord plays a role in the mechanisms of central sensitization [30]. NSAIDs are non-selective cyclooxygenase inhibitors that inhibit both COX-1 and COX-2. NSAIDs are reversible enzyme inhibitors.

Side effects of NSAIDs are more common with long-term use. In such cases, renal failure, impaired platelet function, erosion of the gastroduodenal region, gastrointestinal tract, and bronchospasm may develop. However, these side effects are more likely to occur in predisposed patients and in the elderly [32, 33].

Currently, there are a large number of drugs with varying degrees of selectivity, the choice of which depends on the individual characteristics of the patient and his response to the analgesic effect.

One of the effective NSAIDs is nimesulide. It reversibly inhibits the formation of PGE2, both in the focus of inflammation and in the ascending pathways of the nociceptive system, including pathways for pain impulses in the spinal cord. When summarizing more than 200 clinical studies [34, 35], it was found that nimesulide is able to reduce pain associated with inflammation and in some cases it is more effective than other NSAIDs.

Nimesulide also shows marked efficacy in the treatment of pain in the lower back. In one prospective, randomized, double-blind comparative study [36], it was treated in 104 patients with lumbosacral pain. Patients were randomized into groups, one of which was treated with nimesulide for oral administration (100 mg 2 times a day for 10 days), the second with ibuprofen for oral administration (600 mg 3 times a day for 10 days). Both groups showed improvement in all pain parameters measured on the 3rd day of treatment. The authors concluded that nimesulide is more effective than ibuprofen in the treatment of acute low back pain and is well tolerated by patients.

One of the most common adverse events associated with the use of NSAIDs is the occurrence of gastrointestinal complications. J. Castellsague et al. [37] conducted a meta-analysis of the relevant world literature data on the risk assessment of complications from the upper gastrointestinal tract (gastric and duodenal ulcer, perforation, obstruction and bleeding). 16 NSAIDs were evaluated. The highest relative risk (RR) was found with the use of piroxicam, ketorolac and azapropazone, nimesulide had a significantly more favorable profile in this regard: the RR for azapropazone was 18.5, for nimesulide – 3.8. The same researchers in another work [38] obtained evidence of a higher degree of safety of nimesulide compared to other NSAIDs. In addition, A. Conforti et al. [39] analyzed 10,608 reports of serious adverse events associated with NSAIDs. According to this study, nimesulide caused side effects 2 times less than other NSAIDs, and was the cause of only 10.4% of the reported adverse effects.

D. Sanchez-Matienzo et al. [40] studied the hepatotoxicity of NVPS and nimesulide, in particular, the authors analyzed 185,253 reports from practitioners. When analyzing absolute data, the total number of reports of hepatotoxic reactions with diclofenac was 990, ibuprofen – 590, nimesulide – 152. At the same time, liver failure was recorded in 21 patients receiving diclofenac, 32 receiving ibuprofen, and 4 receiving nimesulide. Therefore, complications from the liver when using nimesulide are rare, and their absolute number is small compared to that for other NSAIDs.

At an international meeting held in Vienna on November 4, 2014 [41], it was concluded that nimesulide is well tolerated when used exactly as directed, and although the overall safety profile of nimesulide is similar to that of other NSAIDs, the risk of gastrointestinal intestinal complications in the treatment with nimesulide are less than with the use of many other drugs in this group. The incidence of liver reactions when using nimesulide is approximately 0.1 per 100,000 treated patients, which corresponds to the frequency of similar cases of other NSAIDs. It was concluded that the use of nimesulide in acute pain is particularly useful in the treatment of various forms of acute inflammatory pain, such as musculoskeletal pain and pain in the lower back.

Conclusion

Thus, pain in the lower back is an actual problem of modern medicine. The incidence of chronic low back pain is on the rise due to lifestyle changes to put more stress on the spine as a result of increased time spent sitting. Chronic pain syndrome is directly related to acute back pain, so it is especially important to treat acute pain syndromes correctly and in a timely manner. When treating patients with low back pain, it is important to keep the red flag system in mind in order not to miss a specific pain syndrome. In addition, one should not forget about the great importance of psychosocial factors in the formation of pain.

The author declares no conflict of interest.

Pain in the lower back – modern approaches to diagnosis and treatment.

Muscular pain often resolves on its own, but warm compresses or a warm bath may also help. Interestingly, it is not recommended to stay in bed for a long time, a maximum of a day or two. Prolonged stay in bed with back pain of muscular origin only intensifies the pain syndrome, as the muscle tone and the ability of the back muscle corset to relax are reduced.

One of the effective ways to overcome back pain is yoga. Studies have been conducted, according to which people doing yoga for 12 weeks had less pain than a control group of patients who did not do yoga.

For those who find yoga too difficult, physiotherapy exercises are suitable. A special set of exercises helps to reduce pressure on the vertebrae in the area of ​​pain, increase blood circulation in the affected area, which creates the preconditions for improved nutrition, restores the mobility and flexibility of the spine, and strengthens the muscle corset.

Massage and manual therapy is another way to relieve back pain. The essence of manual techniques is to release the pinched nerves from compression due to pressure on the ligamentous apparatus of the spine, surrounding tissues and on the vertebrae themselves. Massage can reduce the intensity of back pain, especially when combined with stretching and various exercises.

Reflexology and acupuncture. The effectiveness of this method is somewhat controversial in the medical community, but there are studies that prove that this method is effective in reducing the severity of long-term chronic pain.

In conclusion of the review of non-pharmacological methods of treating back pain, I would like to note the following: studies have reliably proven that the use of these methods in various combinations significantly speeds up the recovery process.

Pharmacological methods. To reduce back pain of mild to moderate severity, modern effective non-steroidal anti-inflammatory drugs (meloxicam, xefocam) can be used. It is important to remember that long-term use of these drugs can adversely affect the gastric mucosa, causing erosion and ulcers.

In case of intense pain, therapeutic blockades (paravertebral, facet joints, myofascial, trigger points) are performed with a local anesthetic and a long-acting corticosteroid.

The essence of the method is to remove the neural transmission of pain sensations through the action of drugs on the areas of pain. In especially severe cases, when none of the methods helps, you can resort to neurosurgical intervention. As a rule, such a need arises if the nerve root is compressed by the intervertebral disc.

To avoid back pain, follow these tips:

• Watch your weight
• Exercise regularly, including back exercises
• If you lift weights, use your leg muscles, not your back , for this the back must always be straight.
• Make sure that the posture you take at work does not cause pain
• Always distribute the load evenly on both sides of the spinal axis, if necessary, use backpacks instead of shoulder bags
• Do not neglect the advice of a doctor if you experience episodes of back pain.