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Sudden sharp pain in back: Spinal Stenosis | Spine Center | Condition


What’s going on with my uterus? 3 conditions related to pelvic pain and bleeding | Women’s Health

2. Endometrial polyps

Endometrial polyps are abnormal overgrowths of the cells that line the uterus and extend into the uterine cavity. The majority are benign, but cancer can be found in them too. Uterine polyps are rare in women younger than 20, typically affecting premenopausal and postmenopausal women. Women who are obese and those who take tamoxifen, a common drug prescribed after breast cancer, also are at increased risk of developing polyps.

Abnormal bleeding is the most common symptom, which can mean:

  • Bleeding after menopause
  • Bleeding between periods
  • Bleeding after sex
  • Overly-heavy periods

We can identify polyps through transvaginal ultrasound, which entails placing a small device in the vagina that emits sound waves, creating an image of the uterus and showing us the growths. Alternatively, we can use hysteroscopy, which involves placing a small, thin camera into the uterus so we can look for polyps. Removing symptomatic polyps generally is recommended to treat the problems and diagnose any concerning cells. The surgeon will use a small, thin instrument and a hysteroscope to identify and remove polyps with little to no pain.

3. Adenomyosis

Adenomyosis is the enlargement of the uterus due to tissue that normally lines the uterus growing into the muscular wall of the organ. The cause of adenomyosis is unknown, but we usually see it in women in their later reproductive years. In the past, researchers have estimated that 20 percent of women develop adenomyosis. An exact percentage has not been determined, however, because a definitive diagnosis can be made only by microscopic examination of the uterus following a hysterectomy.

Symptoms of adenomyosis can include:

  • Heavy bleeding
  • Pain during periods
  • Pain during sex
  • Pelvic pressure or bulkiness 

Treatment options include hormone medications, such as birth control pills, progesterone, or intrauterine devices (IUDs). Endometrial ablation is an effective surgical option, or a hysterectomy might be recommended if medication doesn’t work.

Leading experts in treatment

At UT Southwestern, we customize treatment to each patient’s needs, including offering medication or minimally invasive treatments whenever possible. This allows patients to avoid undergoing open surgeries, which are more extensive and require longer recovery times.

Women shouldn’t hesitate to visit a doctor if they experience abnormal bleeding or pelvic pain. Fighting through symptoms is unnecessary – especially with the wide variety of ways to diagnose and treat the conditions. To find out what treatment is best for you, call 214-645-8300 or request an appointment online.

What Causes Sharp Lower Back Pain?

Severe pain in your lower back typically occurs due to a problem in your spine or hip but may also originate from your internal organs. This blog provides a guide to the accompanying symptoms and potential causes of acute, severe lower back pain.

Lower Back Strain Video


Lower back strain is a common cause of sharp lower back pain. Watch: Lower Back Strain Video

Range of symptoms that may accompany sharp pain the lower back

Acute pain in your lower back may be limited to one or both sides. You may also feel that the pain originates from a particular spot on the left or right side of your lower back. Sharp lower back pain typically includes one or more of the following symptoms and characteristics:

  • Decrease in motion. Severe lower back pain is typically associated with increased tension and spasm in the surrounding muscles, causing stiffness and a decreased range of motion.
  • Radiate through nerves. If your lower back problem originates from your spinal nerve roots, a shooting pain may radiate into your leg through the affected nerve.
  • Cause neurologic deficits. Lower back pain that is caused by irritation or compression of nerves may be associated with neurologic symptoms, such as numbness, tingling, a pins-and-needles sensation, and a general feeling of weakness in the leg(s).

These symptoms may be aggravated or relieved by specific postures or activities, such as sitting, standing, walking, and lying down. While spinal pain typically resolves in a few days to weeks, the symptoms can become debilitating, significantly affecting your daily activities.


Common musculoskeletal causes of severe lower back pain

The most common causes of acute lower back pain include a sudden or repetitive injury to one or more structures that support your back, such as muscles, ligaments, joints, and intervertebral discs.

Muscle strain

A pulled muscle (muscle strain injury) can send intense flareups of pain, spasm, and stiffness across your lower back. This injury may also be localized and cause sharp pain in the left or right side of your lower back. Common symptoms of a muscle strain injury in your lower back include:

  • Acute, shooting pain that intensifies with movement
  • Difficulty in standing or walking
  • Sharp pain while going from a sitting-to-standing or standing-to-sitting position

The pain is typically relieved when you recline with support and elevate your legs or lie down and elevate your knees. Following the PRICE protocol may also help relieve pain and heal the injured muscle.

See Pulled Back Muscle Treatment

Lumbar herniated disc

Your spinal discs serve as shock absorbers between your vertebrae, support your upper body, and allow a wide range of lower back movements. If your lower spinal disc(s) herniates, it may leak its inner contents, irritating or compressing a nearby spinal nerve root.1 The resulting cascade of inflammatory events causes a variety of symptoms, such as:

  • Acute lower back pain and stiffness
  • Increased pain during certain activities, such as lifting heavy objects or strenuous exercise
  • Burning feeling in the buttock, thigh, and/or calf
  • Sharp pain or a dull ache along the outer side or under the foot
  • Weakness, numbness, and tingling in the leg

When these symptoms originate from your sciatic nerve roots (L4 to S3), it’s called sciatica.2

Herniated disc symptoms may be relieved by taking anti-inflammatory medications and performing specific types of lumbar extension exercises, which may also help heal the disc. More intense medical treatment(s) may be required when significant neural compression occurs with severe symptoms.

Read more: Lumbar Herniated Disc: What You Should Know

Piriformis syndrome

This pain syndrome affects the piriformis muscle, located deep in your buttock. If you have piriformis syndrome, your buttock and hip become painful, and this pain may be referred to your lower back.3 Common symptoms include:

  • Sharp, searing pain in the buttock that increases while sitting for a long time
  • Acute lower back pain and stiffness
  • Warm sensation or a burning feeling along the back of your thigh

Piriformis syndrome pain may be relieved by taking pain-relieving medication. In severe cases, muscle relaxants (obtained through a prescription) may help relieve muscle stiffness and pain. Long term management usually includes piriformis muscle stretch and physical therapy.

Read more about Piriformis Syndrome Treatment

Sacroiliac joint dysfunction

Sacroiliitis, a condition that causes inflammation and dysfunction of your sacroiliac (SI) joint, which connects the bottom of your spine to your pelvis on each side may cause4:

  • Sharp, stabbing, or shooting pain felt directly over your affected joint – on the right or left side of your lower back and buttock
  • Burning sensation along the back of your thigh
  • Positional flare-ups that may occur when you move from standing to sitting, climb stairs, or lie on the affected side

Pain-relieving medications in combination with postural correction and sacroiliac joint exercises may help reduce the acute symptoms. Medical treatments, such as radiofrequency ablation may be required if the joints are severely inflamed and irritate nearby nerve tissues.

See Treatment Options for Sacroiliac Joint Dysfunction

While these are relatively common patterns, the actual presentation of these conditions can vary significantly, making it difficult to self-diagnose the root cause of pain. It is also possible for severe lower back pain to occur with no identifiable cause. This condition is called nonspecific lower back pain.5


Acute back pain due to inflammation of internal organs

Pain in your lower back may occur due to the inflammation or irritation of an internal organ or may be a sign of infection. Organs of the mid-back, abdominal, or pelvic regions can cause pain specifically in the right or left side of your lower back or be generalized throughout the area.

Common examples of lower back pain stemming from internal organs include:

  • Kidney stones. Acute lower back pain may be felt when a kidney stone moves inside the kidney or the ureter, a thin tube connecting the kidney to the bladder. The pain is typically localized to the left or right side depending on the kidney that’s affected.
  • Kidney infection. Kidney infections usually start as urinary tract infections (UTI), causing inflammation and pain on the left or right lower back area, depending on the kidney affected.
  • Ulcerative colitis. Persistent inflammation of the large intestine (colon) can cause abdominal cramping and sharp back pain on one or both sides of the lower back and abdomen.
  • Pancreatitis. A lower left back pain may be due to inflammation of the pancreas, which also causes upper abdominal pain at the same time.
  • Appendicitis. An inflamed appendix can cause a sharp pain in the lower right abdomen and back.

Women may develop lower back pain from specific conditions, such as uterine fibroids and endometriosis, and pregnancy.

View Slideshow: 7 Ways Internal Organs Can Cause Lower Back Pain

Caring for your lower back pain can help reduce the symptoms and improve function in your back and legs. While lower back pain typically subsides in a few weeks, some underlying problems may cause your pain to become chronic, lasting for months.

See Back Care for Lower Back Pain

Consult your doctor for an accurate diagnosis of your lower back problem to help understand if your pain originates from your lower spine and/or hip or form an internal organ. A doctor can conduct relevant medical tests to diagnose your pain and formulate an effective treatment plan.

Learn more:

Causes of Lower Back Pain

Non-Surgical Treatments for Lower Back Pain


Upper and Middle Back Pain


Is this topic for you?

This topic provides an overview of upper and middle back pain. If you have low back pain or neck pain, see the topic Low Back Pain or Neck Pain.

What is upper and middle back pain?

Upper and middle back pain can occur anywhere from the base of your neck to the bottom of your rib cage.

Your ribs attach to a long, flat bone in the center of the chest called the sternum and attach to and wrap around your back. If a nerve in this area is pinched, irritated, or injured, you may also feel pain in other places where the nerve travels, such as your arms, legs, chest, and belly.

The upper and middle back (called the thoracic spine) has:

  • 12 vertebrae. These bones attach to your rib cage. They make up the longest part of your back.
  • Discs that separate each vertebra and absorb shock as you move.
  • Muscles and ligaments that hold the spine together.

See a picture of the spine.

Upper and middle back pain is not as common as low back pain or neck pain, because the bones in this area of the back don’t flex or move as much as the bones in your lower back or neck. Instead, they work with the ribs to keep the back stable and help protect vital organs, such as the heart and lungs.

What causes upper and middle back pain?

Upper and middle back pain may be caused by:

  • Overuse, muscle strain, or injury to the muscles, ligaments, and discs that support your spine.
  • Poor posture.
  • Pressure on the

    spinal nerves
    from certain problems, such as a herniated disc.

  • A fracture of one of the vertebrae.
  • Osteoarthritis
    caused by the breakdown of cartilage that cushions the small facet joints in the spine.

  • Myofascial pain
    that affects the connective tissue of a muscle or group of muscles.

In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.

What are the symptoms?

Common symptoms of upper and middle back pain are:

  • A dull, burning, or sharp pain.
  • Muscle tightness or stiffness.

More serious symptoms that need to be treated right away include:

  • Weakness in your arms or legs.
  • Numbness or tingling in your arms, legs, chest, or belly.
  • Loss of bowel or bladder control.

How is upper and middle back pain diagnosed?

Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. Then he or she will do a physical exam. Your doctor may also order an imaging test, such as an X-ray or an MRI, to find out if something such as a broken bone or a herniated disc is causing your pain.

You may need more tests to check for other possible causes for your pain.

How is it treated?

In most cases, people with mild to moderate back pain can manage their symptoms with:

  • Over-the-counter pain medicines
    , such as acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin).

  • Heat or ice.
  • Exercise.
  • Manual therapy
    , such as massage, mobilization, or spinal manipulation.

But if your pain gets worse and you’re having a hard time doing your daily activities, you may need to take a prescription pain medicine. Surgery is seldom used to treat upper and middle back pain.

How can you care for yourself at home?

There are several things you can do at home to help reduce your pain. For example:

  • Rest. If your back hurts a lot, take a break. But try not to let too much time pass before you get moving again. Instead, return to your activities slowly.
  • Use over-the-counter pain medicines, such as acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin). These can reduce pain and swelling. Be safe with medicines. Read and follow all instructions on the label.
  • Use a heating pad or ice pack. Heat can reduce pain and stiffness. Ice can help reduce pain and swelling.
  • Exercise. Exercises that stretch and strengthen the muscles in your back, shoulders, and stomach can help improve your posture, decrease your chance of injury, and reduce pain.
  • Practice good posture. Be sure to stand or sit tall. Don’t slump or slouch.
  • Learn ways to reduce stress. You might try deep breathing and relaxation exercises or meditation.


In most cases, upper and middle back pain is caused by:

  • Overuse, muscle strain, or injury to the muscles, ligaments, and discs that support your spine.
  • Poor posture.
  • Myofascial pain
    that affects the connective tissue of a muscle or group of muscles.

For example, some people hurt their backs when they:

  • Slump or slouch when they sit or stand.
  • Play sports or do yard work.
  • Get jolted in a car accident.
  • Get hit hard in the back.
  • Lift something too heavy.

Conditions that put pressure on the spinal nerves also can cause pain. These include:

  • Osteoarthritis
    . This occurs when the cartilage that cushions the small facet joints in the spine breaks down. When this happens, the back bones rub together and cause damage and pain. Osteoarthritis is caused by the normal wear and tear of the cartilage as you age.

  • A fracture of the vertebrae, which can occur when a lot of force is put on the spine. This force can be from a car or bike accident or a direct blow to the spine. A compression fracture occurs when an injury to the bones in the spine causes them to break and collapse (compress) on each other, such as from a fall. In people who have osteoporosis, which makes the bones brittle and weak, a spinal bone can also break and collapse from only a minor injury or simply moving the wrong way.
  • An odd-shaped spine, such as with scoliosis or kyphosis. This can make your back hurt. When you look at a normal spine from the back, it is usually straight. But when a person has scoliosis, the spine curves from side to side, often in an S or C shape. It may also be twisted. When a person has kyphosis, the upper spine is rounded and looks like a hump. In bad cases of scoliosis or kyphosis, a person may have a hard time breathing.
  • A herniated disc
    . This occurs when one of the small, spongy discs that cushion your spine bulges or breaks open and presses on the nerves in the spine. A herniated disc may be caused by normal wear and tear of the disc as you age. Or it may be brought on by activities that you do over and over again that cause a lot of vibration or motion (such as using a jackhammer) or by a sudden heavy strain or increased force to your back. In most cases, a herniated disc occurs in the lower back or neck. It can occur in the upper or middle back, but this is rare. See a picture of a herniated disc.

  • Spinal stenosis
    . The spinal cord runs through an opening in the bones called the spinal canal. Spinal stenosis occurs when that opening narrows. In some cases, bone, ligament, and disc tissue grows into the spinal canal and presses on the nerves that branch out from the spinal cord. The tissue can also squeeze and irritate or injure the spinal cord itself. In most cases, spinal stenosis occurs in the lower back and neck. It can occur in your upper or middle back, but this is rare.

  • Degenerative disc disease
    . This is not really a disease but a term used to describe the normal changes that occur in your spinal discs as you age. Over time, the discs in your spine break down, or degenerate. A loss of fluid in the discs or tiny tears or cracks in the outer layer of the discs can occur over time. The breakdown of the discs can cause back or neck pain, arthritis, spinal stenosis, or a herniated disc. A sudden injury to your back, such as from a fall or a car accident, may also start this process. This problem can occur anywhere on your spine. But in most cases, it occurs in the discs in the lower back and neck.

In rare cases, upper and middle back pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.


In general, symptoms of upper and middle back pain may:

  • Feel like a dull, burning, or sharp pain.
  • Be felt at a single point or over a broad area.
  • Start suddenly or slowly get worse.
  • Be constant or come and go.
  • Occur with muscle tightness or stiffness.
  • Get worse when you do certain activities or move and sit in a certain way.

More serious symptoms that need to be treated right away include:

  • Weakness in your arms or legs.
  • Numbness or tingling in your arms, legs, chest, or belly.
  • Loss of bowel or bladder control.

When To Call a Doctor

In most cases, back pain gets better with home treatment. So unless you have signs of a severe illness, injury, or heart attack, you can give your back pain some time to work itself out before you call your doctor.

or other emergency services immediately if:

  • Back pain occurs with chest pain or other symptoms of a heart attack. Symptoms of a heart attack include:
    • Chest pain or pressure, or a strange feeling in your chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in your back, neck, jaw, upper belly, or one or both shoulders or arms. See a picture of areas where symptoms may be felt.
    • Feeling dizzy or lightheaded.
    • A fast or uneven heartbeat.
  • A person has signs of damage to the spine after an injury (such as a car accident, fall, or direct blow to the spine). Signs may include:
    • Being unable to move part of the body.
    • Severe back or neck pain.
    • Weakness, tingling, or numbness in the arms, legs, chest, or belly.

Call your doctor now if:

  • You have a new loss of bowel or bladder control.
  • You have new numbness in your legs or numbness in your legs that is getting worse.
  • You have new weakness in your legs or weakness in your legs that is getting worse. (This could make it hard to stand up.)
  • You have new or increased back pain with fever, painful urination, or other signs of a urinary tract infection.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won’t need treatment. If you get worse, you and your doctor will decide what to do next. If your back pain is mild to moderate, it probably will get better on its own. You can try home treatment to relieve your symptoms. If you don’t feel better in 1 to 2 weeks, call your doctor.

Be sure to call your doctor right away if you start to have other symptoms or you have:

  • Numbness.
  • Weakness.
  • Fever.
  • Urinary symptoms, such as pain when you urinate.
  • Pain that is getting worse.
  • Pain that you can’t manage at home.

Who to see

Health care professionals who often diagnose the cause of back pain include:

If your back pain is severe or long-lasting, health professionals who can treat you include:

You can also get care from:

Exams and Tests

Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. Then he or she will do a physical exam. Your doctor may also order an imaging test to find out if something such as a broken bone or a herniated disc is causing your pain.

The type of imaging test you have depends on what kind of problem your doctor suspects. You may have one or more tests, such as:

  • An X-ray to look for injuries or diseases that affect the discs and joints of the spine.
  • An MRI to look for injuries and diseases that affect the discs and nerves of the spine, such as a herniated disc, a pinched nerve, or a tumor. It can also show whether any part of the spinal canal has narrowed.
  • A CT scan to look for a tumor, a fracture, a herniated disc, narrowing of the spinal canal, or an infection. It can also show whether osteoporosis is the cause of a compression fracture.
  • A bone scan to look for damage to the bones, a tumor, or infection, or to find the cause of unexplained back pain.
  • An electromyogram and nerve conduction study to check how well the spinal cord, nerve roots, and nerves and muscles that control your arms and legs are working. It can help find out what is causing pain, numbness, or weakness in the arms or legs.

More tests may be done to check for other possible causes for your pain.

Treatment Overview

There are many treatments for upper and middle back pain. What works for someone else may not help you. Work with your doctor to find what is best for you.

Treatment for upper and middle back pain is based on:

  • How bad your symptoms are.
  • How much your symptoms prevent you from doing your daily tasks.
  • How well other treatments have worked.

Treatment for mild to moderate pain

In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with:

  • Over-the-counter pain medicines
    , such as acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin), to reduce pain. But if these don’t get rid of your pain, you may need a prescription pain medicine that is stronger.

  • Heat or ice to reduce pain and stiffness.
  • Exercise to stretch and strengthen the muscles of your back, shoulders, and stomach.
  • Physical therapy
    to help increase your flexibility, strength, and balance. Your physical therapist may teach you an exercise program so you can do it at home.

  • Massage
    to help reduce muscle tension and pain for a short time and to improve blood flow.

  • Spinal manipulation
    to help relieve pain and improve function. It can range from massage and slow pressing to a quick thrust.

  • Acupuncture
    . It involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief.

  • Capsaicin
    cream may help relieve pain.footnote 1 Capsaicin is a substance contained in cayenne peppers. Capsaicin cream is applied directly to the skin over the painful area.

Treatment if back pain gets worse

If your back pain doesn’t get better or it gets worse, your doctor may recommend:

  • Prescription medicines, such as opioids, to help reduce pain.
  • Muscle relaxants to help reduce pain and muscle tension and improve mobility. These can help with severe muscle spasms that happen when the back pain starts (acute phase).
  • Antidepressants, such duloxetine, to help treat long-lasting (chronic) back pain.
  • Steroid shots
    to help reduce swelling and relieve pressure on nerves and nerve roots. But there is little evidence showing that these shots can help control back pain.

In some cases, a back brace may be used to support the bones in the spine after a fracture.

Surgery is seldom used to treat upper and middle back pain. If your doctor recommends surgery, the type will depend on the problem you have. Surgery choices may include:

  • Kyphoplasty or vertebroplasty
    . Bone cement is injected through a needle into the broken vertebrae to try to stabilize the bone. These surgeries are not done very often, because most fractures heal on their own. And there is no evidence that kyphoplasty or vertebroplasty are better than nonsurgical treatment.footnote 2

  • Herniated disc removal
    . It removes the portion of the disc that is herniated and pushing into the spinal canal. In most cases, herniated discs that occur in the upper and middle back are small and don’t need surgery. But you may need surgery for a large herniated disc that presses on the spinal cord.

  • Spinal decompression for stenosis. It widens the spinal canal that has narrowed, and it relieves pressure on the spinal cord or nerves. This procedure is not done very often, because spinal stenosis in the upper and middle back is rare.

Home Treatment

There are several things you can do at home to help reduce your pain. For example:

  • Rest. If your back hurts a lot, take a break. But try not to let too much time pass before you get moving again. Instead, return to your activities slowly, and avoid things that make your pain worse. Studies show that bed rest doesn’t relieve back pain better than staying active. And bed rest of more than a couple of days can make your back pain worse and lead to other problems, such as stiff joints and muscle weakness.
  • Use

    over-the-counter pain medicines
    , such as acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin). These can reduce pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

  • Use a heating pad or ice pack. Heat can reduce pain and stiffness. Ice can help reduce pain and swelling. You might want to switch back and forth between heat and cold until you find what helps you the most.
  • Exercise. Ask your doctor or a physical therapist about what kinds of exercises you can do to stretch and strengthen the muscles in your back, shoulders, and stomach. These muscles help support your spine. Strong muscles can help improve your posture, keep your body in better balance, decrease your chance of injury, and reduce pain.
  • Practice good posture
    . Poor posture puts stress on your back. Be sure to stand or sit tall, with your shoulders and your stomach pulled in to support your back. Don’t slump or slouch.

Here are some other things you can do to feel better:

  • See a counselor. Cognitive-behavioral therapy can show you how to change certain thoughts and behaviors to control your pain. For more information, see the topic Stop Negative Thoughts: Choosing a Healthier Way of Thinking.
  • Learn ways to reduce

    . Stress can make your pain feel worse. You might try deep breathing and relaxation exercises or meditation.

  • Eat nutritious foods. Getting plenty of calcium and vitamin D may help prevent osteoporosis, which can lead to compression fractures and back pain. For more information, see the topic Healthy Eating.
  • Don’t smoke. Smoking decreases blood flow and slows healing. If you need help quitting, see the topic Quitting Smoking.
  • Take extra care when you lift. When you must lift, bend your knees and keep your back straight. Avoid twisting. Keep the load close to your body.
  • Use a
    pain diary . Write down how your moods, thoughts, sleep patterns, activities, and medicines affect your pain. Having a record of your pain can help you and your doctor find the best ways to treat your pain.



  1. Gagnier JJ, et al. (2016). Herbal medicine for low back pain: A Cochrane review. Spine, 41(2): 116–133. DOI: 10.1097/BRS.0000000000001310. Accessed June 17, 2016.
  2. Esses SI, et al. (2011). The treatment of symptomatic osteoporotic spinal compression fractures. Journal of the American Academy of Orthopaedic Surgeons, 19(3): 176–182. Also available online: http://www.aaos.org/research/guidelines/guide.asp.

Other Works Consulted

  • Hansen TJ (2015). Thoracic compression fracture. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 211–216. Philadelphia: Saunders.
  • Mercier LR (2008). The back. In Practical Orthopedics, 6th ed., pp. 143–184. Philadelphia: Mosby Elsevier.


Current as of:
November 16, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine

Current as of: November 16, 2020

Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine

Sharp Low Back Pain: Causes and Risk Factors

Sharp low back pain can occur due to a sudden injury, such as a spinal fracture or sprain, or to issues like sciatica or degenerative damage of the vertebral discs. When the precise cause of sharp low back pain cannot be identified, it is described as “non-specific” back pain.

Low back pain that’s sharp and severe tends to come on suddenly and can be acute—sometimes lasting for no longer than three months.

Low back pain is a common complaint: An estimated 80% of adults experience an episode of low back pain at some point in their lives. It usually resolves on its own within a few days or weeks.

Verywell / Gary Ferster

Sharp, piercing pain is usually associated with simple, seemingly benign movements such as twisting or lifting something heavy.

Causes include:

  • Muscle strain
  • Lumbar sprain
  • Facet joint pain
  • Spinal fracture
  • Sacroiliac (SI) joint dysfunction
  • Disc damage

Several lifestyle factors may increase or decrease your risk of developing sharp low back pain.

Muscle Strain

A strain is an injury in which tendon or muscle fibers are overstretched or torn, triggering inflammation. When the low back is affected, the pain often emanates from the buttocks and may extend down the back of one or both legs.

Other symptoms of muscle strain include:

Lumbar Sprain

A lower back sprain, also called a lumbar sprain, occurs when ligaments—the tough bands of tissue that connect bones to bones—are injured.

Sprains can result from stretching or tearing a ligament from its attachment, often due to an injury such as a fall or an action that displaces the surrounding joint from its normal alignment.

A sprain can range from a mild ligamentous stretch to a complete tear. Common symptoms experienced after a sprain are:

  • Bruising
  • Swelling
  • Instability
  • Painful movement
  • Painful muscle spasms

Facet Joint Pain

Facet joints are located behind the vertebrae and help to protect the spine from extreme movements in any direction.

They can be injured by a sudden jolt, such as whiplash, in which the spine is pulled out of alignment. Even the simple action of bending over to tie a shoelace can trigger facet joint pain.

Facet joints also are susceptible to degenerative arthritis (osteoarthritis), in which the cartilage around the joint that provides protective cushioning between vertebrae wears out. When the bones rub against each other, it causes pain.

The sharp pain caused by facet joint injury or degeneration can radiate from the lower back down to the buttocks and upper legs or up to the shoulder blades.

Facet joint pain can make it feel like your spine has “locked up” and may even make you unable to move for a few minutes.

Spinal Fracture

One type of spinal fracture—a compression fracture—occurs when vertebrae collapse under a load of an external force. This is common in traumatic spinal injuries or due to a bad fall when a vertebra is squeezed or crushed.

In older adults, loss of bone density associated with osteoporosis can increase the risk of these fractures, which may not cause symptoms right away.

Spinal fractures tend to cause sharp low back pain when you’re standing.

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints are located on either side of the lower back between the sacrum and the pelvic bones. They’re shock absorbers, decreasing stress on the pelvis and spine.

When you stand or walk, the SI joints help transfer the load from your upper body to the lower body.

Repetitive stress from daily movement or injury can wear down the cartilage around the SI joints, causing low back pain and limiting motion in the lower back or hips.

The intensity of sacroiliac pain is typically related to the extent of joint damage. When the cartilage is damaged or worn away, the bones begin to rub against each other. 

Movements or positions that stress the joints—standing up from a chair, walking upstairs, bending, and twisting—can worsen pain in the lower back and hips. That pain may radiate to the buttocks, groin, thigh, or below the knee.

SI joint pain also can be caused by:

  • Running, jogging, and other activities involving continuous and repetitive pounding
  • Injury or trauma to the ligaments surrounding SI joints
  • Spinal surgery
  • Uneven leg length that affects walking patterns
  • Pregnancy

In the case of pregnancy, the SI joint-associated pain is due to extra weight, ligament laxity, and hormone changes—issues that usually resolve after the baby is delivered.


Sciatica occurs when there’s pressure on or damage to the sciatic nerve, which starts in the lower back and runs down the back of each leg.

The sciatic nerve controls the muscles in the back of the knee and lower leg, and makes it possible to feel sensation in the back of your thigh, lower leg, and even the soles of your feet.

When the sciatic nerve is compressed, you may feel a burning sensation and pain. If the nerve is pinched, you may also feel numbness and weakness in your leg due to an interruption of the nerve signal.

In some cases, sciatica may be caused by a tumor or cyst that is pressing on the nerve or nerve roots.

Disc Damage

Sharp low back pain from a herniated or ruptured disc can occur when the intervertebral discs become compressed and bulge outward, also described as a slipped disc.

When a disc slips, all or part of it exerts pressure on surrounding nerves or the spinal cord. A disc can also rupture due to an injury or strain.

Because they act as a cushion, intervertebral discs facilitate a full range of lower back movements, such as flexing, bending, or twisting. However, disc deterioration reduces that cushioning and leads to sharp pain. It also can cause some people to lose several inches of height.

Annular tears (tears of the ligament) that occur in the outer layer of the intervertebral disc can also cause acute low back pain. The pain can be severe, even if there is only a small amount of tissue damage.

Lifestyle Risk Factors

Lifestyle factors that can increase your risk of sharp low back pain include:

  • Excess body weight
  • Repetitive bending or twisting of the lower back
  • Lifting heavy objects the wrong way
  • Sitting or standing for hours in the same position
  • A generally sedentary lifestyle

Some research suggests smoking may also up your risk of sharp low back pain.

A Word From Verywell

Low back pain is one of the most common medical conditions in the United States. Often, if you have a sprain or strain, the pain will resolve itself.

However, it can be caused by a serious injury, so it is important that you see a doctor. As you are recovering, seek medical guidance to ensure that you are reducing any of your risk factors for low back pain.

Back pain – Symptoms and causes


Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide.

Fortunately, you can take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional. Surgery is rarely needed to treat back pain.

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Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking.

When to see a doctor

Most back pain gradually improves with home treatment and self-care, usually within a few weeks. Contact your doctor if your back pain:

  • Persists past a few weeks
  • Is severe and doesn’t improve with rest
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

  • Causes new bowel or bladder problems
  • Is accompanied by a fever
  • Follows a fall, blow to your back or other injury


Low back pain caused by spinal degeneration and injury.

Click here for an infographic to learn more

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:

  • Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back can cause painful muscle spasms.
  • Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
  • Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  • Osteoporosis. Your spine’s vertebrae can develop painful fractures if your bones become porous and brittle.

Risk factors

Anyone can develop back pain, even children and teens. These factors might put you at greater risk of developing back pain:

  • Age. Back pain is more common as you get older, starting around age 30 or 40.
  • Lack of exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
  • Excess weight. Excess body weight puts extra stress on your back.
  • Diseases. Some types of arthritis and cancer can contribute to back pain.
  • Improper lifting. Using your back instead of your legs can lead to back pain.
  • Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
  • Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.


You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics.

To keep your back healthy and strong:

  • Exercise. Regular low-impact aerobic activities — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities you might try.
  • Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
  • Maintain a healthy weight. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain.
  • Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

Avoid movements that twist or strain your back. Use your body properly:

  • Stand smart. Don’t slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
  • Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
  • Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Buyer beware

Because back pain is so common, numerous products promise prevention or relief. But there’s no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs can help.

In addition, there doesn’t appear to be one type of mattress that’s best for people with back pain. It’s probably a matter of what feels most comfortable to you.

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Aug. 21, 2020

Sudden, Sharp Pain in Your Back or Lower Abdomen?

Kid­ney and ureter­al stones are com­mon, in fact, 1 in every 10 peo­ple will devel­op a stone at some point in their life­time. These stones form when urine becomes too con­cen­trat­ed, caus­ing salts and min­er­als to build up in your kid­neys and form hard deposits.

You may be at a high­er risk of devel­op­ing a stone if:

  • You aren’t drink­ing enough water or tak­ing enough bath­room breaks through­out the day
  • You are inac­tive or overweight
  • You fre­quent­ly drink alcohol
  • You have a chron­ic health con­di­tion like dia­betes or hypertension

Com­mon stone symp­toms include:

  • Sharp, cramp­ing pain in the back, side, or low­er abdomen
  • Blood in your urine
  • Painful uri­na­tion
  • Increased urgency to urinate
  • Nau­sea and/​or vomiting

If you sus­pect you have devel­oped a stone, our Imme­di­ate Care Cen­ters, led by board-cer­ti­fied Emer­gency Med­i­cine physi­cians, are avail­able to pro­vide care for you today.

If you are diag­nosed with a stone, our Imme­di­ate Care Cen­ter team will deter­mine how to man­age your symp­toms, and what treat­ment option is most appro­pri­ate for you. In some cas­es a stone can be passed sim­ply by increas­ing your water intake and tak­ing pain med­ica­tions, as pre­scribed, if need­ed. When the stone is larg­er, it may become lodged in the uri­nary tract, or if an infec­tion is present, surgery may be nec­es­sary to remove the stone.

Pass­ing a kid­ney stone can be painful, but typ­i­cal­ly does­n’t cause any long-term dam­age if they are diag­nosed and treat­ed quick­ly. Should surgery be rec­om­mend­ed for you, our high­ly-skilled urol­o­gists are able to per­form surgery on an out­pa­tient basis, at our Sur­gi­cal Cen­ter in Lom­bard, often in as lit­tle as 48 – 72 hours from the time of your diagnosis.

Learn more about the con­di­tions treat­ed, hours and loca­tions for our Imme­di­ate Care Centers.

Lower Back Pain Causes: 8 Reasons for Sudden & Chronic Pain

Sometimes, you know exactly why your back is hurting. Maybe you lifted something awkwardly and felt the pain right away. Or maybe your doctor has been warning you for years that your bad posture would lead to lower back pain.

But other times, the source of back pain can feel like a mystery.

“Your lumbar spine, located in your lower back, plays a crucial role in supporting the weight of your upper body. It’s also responsible for everyday movements, such as bending, twisting and coordinating the muscles in your hips, pelvis legs and feet,” says Dr. Kenneth Palmer, orthopedic surgeon specializing in spine surgery at Houston Methodist. “Due to heavy use, the bones, muscles, ligaments, disks and nerves found in your lumbar spine are quite susceptible to both injury and wear and tear over time — causing pain in the lower back.”

Lower back pain symptoms include:

  • Dull ache in your hips and/or pelvis
  • Muscle spasms or tightness
  • Sharp, tingling pain that starts in your lower back and travels down one leg (also known as sciatica)
  • Pain that worsens with sitting and quickly improves while walking
  • Pain that is noticeably worse in the morning

“Typically, a person experiences some combination of these symptoms, which can develop suddenly or over time. In some cases, lower back pain can feel like it comes and goes — flaring up now and then, but generally getting progressively worse over time,” explains Dr. Palmer.

In addition, Dr. Palmer points out that lower back pain symptoms can vary by person, as well as the underlying cause of the pain.

Speaking of the various causes of lower back pain…

The most common causes of lower back pain are a strain or sprain

Whether you notice it or not, your lumbar spine gets put to work throughout the entire day.

Amid all of this work and motion, a lower back sprain or strain can result from an acute injury, such as one experienced while falling, lifting something too heavy or playing sports. A sprain or strain can also develop over time due to repetitive movements or poor posture.

“Straining a muscle or spraining a ligament are the most common causes of lower back pain,” says Dr. Palmer. “While they can be serious, these common causes of lower back pain aren’t long-lasting — taking anywhere from a few days to heal or, at most, a few months.”

Your doctor can help you determine the particular course of self-care that can help heal your lower back pain.

“The treatment for a pulled back muscle or strained back ligament is fairly simple and can include pain and anti-inflammatory medications, muscle relaxers, ice to help reduce inflammation, heat to promote healing, and avoiding strenuous activity until the pain recedes,” explains Dr. Palmer. “The best course of care will depend on the severity of your injury as well as your overall core and lower body strength.”

If your lower back pain persists despite treatment, it may be time to consider other causes of lower back pain.

Common causes of chronic lower back pain

“Chronic lower back pain is less likely to be caused by injury to your muscles and ligaments and more likely to be due to issues with the lumbar disks, nerves, joints or vertebrae,” says Dr. Palmer. “There are several potential causes of chronic pain in the lower back.”

In general, osteoarthritis (the most common type of arthritis) and degenerative disk disease (the natural wear and tear of spinal disks) are the underlying cause of many types of chronic lower back pain. However, lower back pain can also be caused by accident-related trauma and acute stress.

Herniated disk

“An adult’s thoracic and lumbar spine is made up of about 17 bones (vertebrae) stacked on top of one another. Between each set of vertebrae lies a cushiony disk, which helps absorb the pressure placed on these bones,” explains Dr. Palmer.

Each disk is made up of an outer rind and an inner gel.

A herniated lumbar disk occurs when the inner gel of one of the five disks in your lumbar spine slips or squishes beyond the outer rind, allowing this inner gel to press on surrounding nerves — causing pain. This slippage can be due to trauma or gradual, age-related wear and tear.

Facet joint damage

The joints connecting the five vertebrae that make up your lower back, called the facet joints, experience large loads of compressive force and stress. Over time, breakdown of the cartilage in your facet joints can lead to lower back pain.

“Whether due to poor posture or repeated overuse, facet joint damage is often caused by osteoarthritis and can lead to inflammation, stiffness, muscle spasming and pain,” explains Dr. Palmer. “In addition, when damage to a facet joint impinges a nearby nerve, it can lead to sciatica.”

Compression fracture

“A spinal compression fracture occurs when a vertebra in your lumbar spine essentially collapses in on itself. This is often due to osteoporosis, but can also be the result of trauma,” says Dr. Palmer.

This collapse can cause severe pain, and individuals suffering a lumbar compression fracture often experience sudden pain and limited spinal mobility.

Spinal stenosis

Lumbar spinal stenosis occurs when the spinal canal in your lower back narrows, placing pressure on nearby nerve roots. It can be caused by the formation of bone spurs, thickening of a nearby ligament or degeneration of a lumbar disk or joint.

“When nerve roots become compressed, it can be very painful,” says Dr. Palmer. “And spinal stenosis doesn’t just cause lower back pain, it can result in sciatica, pain that radiates down the lower extremities.”


If a lumbar vertebra slips forward — over the top of the vertebra below — it places a lot of compressive force on the lumbar disk that is separating the two vertebrae. As the lumbar disk deteriorates, it can cause lower back pain. Additionally, if the lumbar disk flattens from this force, it can lead to nerve compression and sciatica.

“One of the more common type of spondylolisthesis, isthmic spondylolisthesis, is caused by a fracture in the small piece of bone, called the pars interarticularis, found adjacent to the facet joint. The fracturing event often happens when a person is young, although the pain isn’t felt until later in life,” says Dr. Palmer. “Spondylolisthesis can also result from degenerative or congenital causes.”


Your spine has a natural curvature, which takes the shape of an ‘S’ when viewed from the side — with your upper back curving backward and lower back curving forward. If your spine curves sideways when viewed from behind, however, it’s called scoliosis — a spinal deformity that can lead to back pain.

“When the spine takes an improper curvature, it makes degeneration of the lumbar joints and disks more likely,” warns Dr. Palmer. “In the majority of cases, scoliosis doesn’t require treatment, but severe curvature can place significant stress on the lower back and lead to pain.”

When to see a specialist for lower back pain

If you’re experiencing lower back pain that’s not responding to rest and self-care, it’s time to consider seeing a spine specialist.

“A spine specialist will likely perform a physical exam as well as one or more imaging scans to diagnose the root cause of your lower back pain. Depending on your diagnosis, he or she will then design a treatment plan aimed at alleviating your pain and preventing it from disrupting the everyday activities you enjoy,” says Dr. Palmer.

90,000 BACK PAIN | orto.lv

Back pain is one of the most common complaints in medicine. Pain can have various causes, for example, tense muscles or muscle spasms, damage to the intervertebral discs, spinal stenosis, arthritis. In most cases, once the load on the back is reduced, the pain goes away within a few weeks. Sometimes warm or cool compresses and pain relievers or anti-inflammatory drugs are needed. If this does not help, it is worth consulting with a vertebrologist (spine specialist).

There are several signs indicating that an urgent need to see a vertebrologist:

  • back pain does not go away within a week;

  • you wake up in pain at night;

  • , simultaneously with back pain, it became difficult to control the work of the intestines and bladder;

  • , along with back pain, fever, increased sweating, chills and other signs of infection develop.

Acute back pain (short-term) Usually severe and burning. Most often, it is localized in the lower back. In some cases, a back injury may be the cause of acute back pain, but more often there is no explanation for such pain. Even if the pain is severe at first, it diminishes significantly or goes away completely within 6-8 weeks. After examining the intensity of the pain, the doctor will suggest the appropriate treatment for you (physiotherapy, physical treatments, massage, taping, etc.).etc.), medicines and blockade.

Chronic back pain (long-term) is felt as a deep, aching, dull or burning pain in a specific part of the back, and may radiate to one or both legs. It may become painful or difficult to carry out normal daily activities. Chronic back pain does not go away for a long time and cannot be relieved by warm or cold compresses or over-the-counter medications. Chronic back pain can have different causes, for example, a previous back injury, damage to the intervertebral disc, stenosis of the spinal canal, spinal deformity, rheumatological diseases, etc.d

Releasing pain can be radiated to various parts of the leg, both above and below the knee. Pain can be a consequence of various diseases of the spine, as a result of which there is irritation or compression of neural structures (spinal cord or nerve roots). Releasing pain can be combined with numbness, itching, muscle weakness, and loss of specific reflexes.

Insensitivity and weakness

Insensitivity occurs when nerve impulses from the skin do not reach the brain.Some areas of the spine, as well as other parts of the body, especially the arms and legs, may become insensitive. Insensitivity indicates damage to the peripheral or central nervous system (in the spinal cord, brain, or peripheral nervous system). In this case, you should immediately consult a doctor.

Weakness occurs when the impulses transmitted by the brain do not reach the muscles. See your doctor to find out the specific cause.

Stiffness and tension in the back , back of the neck, arms and legs usually results from muscle tension.In more than 80% of cases, pain in the back of the neck and back is caused by tense, painful muscles that, due to various types of spinal deformities, have occupied a physiologically incorrect position for years. However, joint stiffness and pain, to which are sometimes added similar symptoms in the back area, can be symptoms of a rheumatologic disorder.

90,000 Acute back pain: causes, prevention and first aid | Medicinal Directory | Health

Please note

Acute back pain can be caused by various reasons.It can be provoked by problems with muscles or ligaments: sprains, spasms, excessive strain after lifting something heavy, turning unsuccessfully, or being in an uncomfortable, forced position for a long time.

Another common cause is problems with the spine: osteochondrosis, herniated intervertebral disc, arthrosis of the facet joints. Changes in the natural “geometry” of the spine can lead to pinching of the nerve roots and severe pain.

First aid

What if you have an acute back pain?

First of all – go to bed, on a hard or semi-hard mattress, on your back.This position provides peace of mind to the muscles of the back and intervertebral discs, due to which the muscles relax, the spasm decreases somewhat and the pain subsides.

Spread the affected area with an ointment with an analgesic or warming effect.

If pain persists after that, take a non-steroidal anti-inflammatory drug. Such funds provide a quick analgesic effect. However, remember: you cannot take them in large quantities – they have many side effects. Before going to the doctor, such medications can be used only as needed, when the pain becomes difficult to bear.

Muscle relaxants, which are drugs that relax muscles, can also relieve pain. But their use is possible only under the supervision of a physician.

See a doctor!

Most often, back pain disappears in 10-14 days. But, even if you are already feeling well, you need to consult a doctor and find out the cause of its occurrence. The insidiousness of back pain is that if the factor that causes it is not eliminated, it returns. According to statistics, within a year after the first attack, 50% of patients experience a second, and for many, the pain becomes chronic.

In addition, back pain on the background of osteochondrosis or muscle spasm – although unpleasant, but not the most dangerous option. The back may hurt due to a vertebral fracture, tumors, inflammatory lesions of the intervertebral discs, due to impaired renal function. Therefore, specialist advice is necessary.


For a long time, doctors in acute back pain recommended adhering to strict bed rest for several days. Today the approach is different: on the first day you really need to lie down, but then the lack of movement is harmful, if possible you need to get up.And also – to do gymnastics, which improves the blood supply to the muscles of the back, allows you to keep the muscle corset in good shape.

Exercises should be performed lying on your back, with a small amplitude, without tension and sudden movements. Each – 8-10 times.

Bend your left knee. Bend and unbend your right leg at the knee, sliding your heel along the bed. Change your legs.

The starting position is the same. Now, the right leg, without bending, needs to be taken to the side. Do the same with your left foot.

Lying on your back, bend both legs at the knees, feet rest on the bed. Take your knees to the sides one by one.

Starting position – as in the previous exercise. If possible, pull your right bent leg towards your stomach, then your left.

Place a soft roller or wide, not too soft pillow under your feet. Lying like this, alternately raise your arms up, and then to your head.

With a roller under your feet, without bending your knees, alternately raise your legs as far as possible.

See also:

Acute back pain in the practice of a neurologist | Ekusheva E.V., Voitenkov V.B.

The article is devoted to the problem of acute back pain in the practice of a neurologist

Acute back pain is one of the leading reasons for seeking medical attention. In the International Classification of Diseases of the 10th revision, this pathological condition is designated as “dorsopathy”, however, in the modern scientific literature in recent years, the term “nonspecific back pain” is more often used.
The relevance of therapy for this condition is determined by its widespread prevalence, pronounced maladjustment and a decrease in the quality of life in people of working age, which leads to significant socio-economic damage in most developed countries of the world. In particular, pain in the lower back is noted up to 80% in the population, impairing the quality of life in patients under 45 years of age [1]. In the United States, back pain is the 5th most common cause of hospitalization and the 3rd most common indication for surgical treatment [1, 2].
In 80–90% of patients with adequate and timely therapy, acute back pain regresses within 2–3 months. [3, 4]. Chronization of dorsopathy is observed in 10–20% of patients of working age; it is this group of patients that is characterized by an unfavorable prognosis for recovery [4]. It should be noted that up to 80% of all health care costs are spent on the treatment of chronic back pain, which is 3 times higher than the cost of therapy for cancer patients [5].
The epidemiology of pain in the lumbosacral region has been studied much better, which is partly due to the lower prevalence of BS in the cervical and thoracic spine.It has been shown that isolated pain in the upper back is observed only in 15% of patients [6]. At the same time, the most common in clinical practice (up to 85% of patients with back pain) are musculoskeletal BSs caused by irritation of the annulus fibrosus receptors, musculo-articular structures of the spine and not associated with root damage [6]. However, they can also be observed in the case of reflex BS with root damage.
The issues of pharmacological effects in back pain are among the most studied in modern evidence-based medicine.Nevertheless, the constantly growing arsenal of funds and the increase in the number of patients (going in parallel with the growing aging of the population of developed countries) dictate the need to analyze the available data on this topic. Thus, according to a recent meta-analysis of the literature, acetaminophen is ineffective in the treatment of lower back pain, the effectiveness of NSAIDs in the treatment of this condition was lower in modern conditions than previously described, and the use of benzodiazepines in acute radiculopathy did not give an adequate clinical result [7].

Basic principles of management of patients with acute back pain

The tactics of managing patients with acute dorsopathy is as follows: exclusion of potentially dangerous diseases and / or conditions for the onset of BS; timely and effective relief of BS, contributing to the restoration of the patient’s activity, adequate expansion of the motor regimen and prevention of chronicity of the disease.
An important stage in the treatment of a patient with acute back pain is the exclusion of the specific or secondary nature of the pathological process, which may be based on serious, sometimes life-threatening diseases (Table 1).one).

When analyzing the existing BS, it is necessary to remember that back pain can be completely psychogenic in nature, leading to a significant violation of social adaptation, difficulty in professional activity. Among the possible criteria indicating the absence of an organic cause of back pain and / or its psychogenic nature, the following are considered: pain at the apex of the tailbone; pain and numbness “in the whole leg”, a feeling that “legs are giving way”, as well as a decrease in the severity of the Lasegue symptom when the patient’s attention is distracted [8].
It should be noted that there is no strict parallelism between the presence of back pain and the results of a paraclinical examination of the spine. There is no doubt about the diagnostic significance of the results of radiography and neuroimaging methods for back pain, but these methods allow mainly assessing anatomical rather than pathophysiological changes [9]. In particular, imaging methods with a high frequency reveal degenerative-dystrophic changes in the spine even in patients without back pain and the presence of any neurological symptoms, for example, according to MRI of the lumbar spine, asymptomatic hernias of intervertebral discs are detected in persons under 40 years of age. 30-40% of cases, and in people over 60 years old – in 100% [9].On the other hand, the presence of signs of degenerative-dystrophic lesions of the spinal tissues in patients with nonspecific back pain does not correlate either with the nature of the pain or with its intensity, therefore, despite the temptation to attribute the radiologically detected signs of osteochondrosis of the spine to the cause of pain, until now there was no convincing evidence of such a link [6]. In this regard, in modern domestic and foreign guidelines for the diagnosis of back pain, X-ray examination is not a necessary link in the primary examination [6, 7, 10].Thus, by themselves, without taking into account the clinical picture, neuroimaging data rarely allow a correct diagnosis, and the patient’s story about his disease is often no less important than the results of neuroimaging studies [11].
Methods of neurophysiological diagnostics often prescribed by neurologists during the initial examination of patients with back pain, primarily electroneuromyography, are of great value in detecting organic disorders of the peripheral nervous system, while their effectiveness in detecting functional disorders is limited [12].With the help of diagnostic transcranial magnetic stimulation, it is possible to study the transit time of the signal along the root or the indicator of “radicular delay”, the change of which allows revealing radiculopathy or damage to the spinal roots [13].
Imaging methods and other instrumental and paraclinical examinations, as well as consultations of relevant specialists, are recommended to be prescribed to patients with back pain in unclear cases, when there are suspicions of a specific nature of pain, which may be a consequence of tumor, inflammatory or traumatic lesions of the spine, infectious processes, metabolic disorders, diseases of internal organs, muscle damage, damage to the nervous system, etc.d.
A thorough clinical assessment of the patient’s status, including the state of his musculoskeletal system, is of leading importance for the correct diagnosis and selection of therapy for nonspecific back pain. In particular, during a neurological examination, it is advisable not to be limited to examining only the back, you should ask the patient to undress, paying attention to the presence and severity of scoliosis; on the position of the pelvis and the length of the legs; for the presence of smoothness of physiological lordosis at the lumbar level [14].The last symptom indicates spasm of the paravertebral muscles at this level, which is confirmed by palpation. Also, when examining a patient, it is important to pay attention to possible rashes on the skin; change in posture, posture, gait, range of motion in the spine, hip joints; on the degree of tension and muscle soreness, the localization of myofascial trigger points. At the same time, mild orthopedic symptoms in severe pain can be a sign of serious concomitant pathology [6].Neurological examination suggests damage to the roots and structures of the spinal cord.
In addition, anamnestic information (including information about the patient’s working conditions and the presence of constant stress), the results of physical and paraclinical examinations, and an assessment of the psychological state play an essential role in establishing the correct diagnosis.

Relief of acute non-specific back pain

Timely and effective relief of an acute episode of back pain is an extremely important stage in the management of this category of patients, since it allows increasing the volume of rehabilitation measures, adequately expanding the motor regimen and reducing the period of disability.
It has been shown that restrictive behavior (both intuitively chosen by the patient himself and recommended by the doctor), as well as adherence to prolonged bed rest (more than 7 days), is associated with a high risk of an increase in the duration of exacerbation, transformation of acute pain into chronic pain and a high probability of the formation of depressive disorders [15 ]. On the other hand, there is an obvious relationship between the effectiveness of pain therapy and the duration of recovery of an adequate motor regimen [16].In this regard, it is necessary to orient the patient to the earliest possible inclusion in the program of rehabilitation and rehabilitation measures, to recommend the patient active behavior as part of the course of rehabilitation treatment, to form positive motivation that provides the mood for achieving convalescence and compensation for the existing neurological and orthopedic defect [16, 17].
For the purpose of relief of BS, drugs from the NSAID group are most widely used. NSAIDs are a pathogenetic agent for the treatment of pain associated with pathological conditions caused by local and generalized inflammatory reactions, which determines the main indications for the appointment of this group of drugs in various fields of medicine – inflammatory processes of various origins, pain and fever [13].
The emergence and introduction of drugs used today from the NSAID group has its own history. More than 5 thousand years ago, willow bark was used as an anesthetic for diseases of the musculoskeletal system [18], from which salicillin was isolated in 1828 [19]. Paracetamol was synthesized by H. Morse in 1877, 10 years later it was applied in practice by D. Mehring, but it became widespread only in the middle of the 20th century. due to the erroneous concept of its toxicity [20].The prototype of modern NSAIDs was acetylsalicylic acid, synthesized by F. Hoffman at the end of the 19th century. The toxicity of high doses of the drug was a powerful incentive for the development of new, “nonsalicylate” NSAIDs, in particular diclofenac sodium, in the research laboratory of the Geigi company (1966) [20]. Over the next 10 years, the indomethacin, ibuprofen and naproxen used today were developed and used [19].
Currently, NSAIDs are a very numerous and heterogeneous group of drugs, the basis of the anti-inflammatory and analgesic action of which is the suppression of the activity of the enzyme cyclooxygenase (COX) and the biosynthesis of prostaglandins.The clinical efficacy of NSAIDs, as well as the nature of the side effects accompanying their use, are largely determined by the main points of application – the ability to inhibit the activity of COX type 1 or 2 [16]. The peculiarities of the chemical structure of drugs, their metabolic pathways in the body, and the ability to interact with other chemical compounds entering the body are also of some importance.
The two isoforms of COX differ in expression characteristics depending on the state of the human body.Under normal conditions, COX-1 is produced in most tissues and takes part in a wide variety of adaptive reactions [16]. The anti-inflammatory effect of NSAIDs is due to the ability to inhibit the processes of COX-2 synthesis, since the increased expression of this particular isoform is observed during the development of the inflammatory process. The development of drugs with selective selectivity for COX-2 is due to the development of side reactions due to the suppression of the physiological enzyme – COX-1, while non-selective NSAIDs inhibit both isoforms of COX.
Although at the population level all drugs from the NSAID group in equivalent doses have similar efficacy and toxicity, clinical experience indicates significant differences in the response to drugs in this group in individual patients [21]. For some of them, one drug is significantly more effective in suppressing pain and inflammation, or, conversely, more often causes toxic reactions than the other. The reasons for this phenomenon are not completely clear. The importance of individual characteristics of absorption, distribution and metabolism of drugs, the relative prevalence of mechanisms of action dependent and not dependent on COX blockade are discussed [21].
One of the selective COX-2 inhibitors is nimesulide (Nise®), which is a sulfonamide derivative. Nimesulide is a highly effective and well-studied drug in the course of numerous experimental and clinical studies, which has a wide range of various effects. In particular, it was shown that under the action of nimesulide, the production of short-lived prostaglandin H2 decreases, followed by a significant decrease in the blood concentration of its metabolic product, prostaglandin E2, which is one of the key inflammatory mediators [16].This effect leads to a decrease in the activation of EP-type prostanoid receptors, which results in the onset of analgesic and anti-inflammatory effects, since prostaglandins, using various mechanisms, increase the sensitivity of primary sensory neurons to pain. Nimesulide, like a number of other selective COX-2 inhibitors, has an effect on various body systems involved in the initiation and / or maintenance of inflammation processes, primarily the prevention of fibroblast activation.
It should be noted that nimesulide (Nise®) has a number of pharmacological effects independent of the class-specific effect on COX-2. In particular, it suppresses the overproduction of the main proinflammatory cytokines (interleukin 6, tumor necrosis factor alpha), reduces the activity of metalloproteinases, which are responsible for the destruction of the glycoprotein complex of cartilage tissue in osteoarthritis, and has an antihistamine effect [21]. The absence of a damaging effect of nimesulide on proteoglycans and collagen in cartilage tissue favorably distinguishes this drug from a significant number of NSAIDs and, probably, explains the preservation of cartilage tissue even with prolonged use of nimesulide [16].
Among the non-COX-2-associated effects of nimesulide, the ability to suppress the enzyme phosphodiesterase 4 and thereby reduce the activity of macrophages and neutrophils, which play an important role in the pathogenesis of an acute inflammatory reaction, should be especially noted [21]. It has been shown that nimesulide has the ability not only to inhibit the production of inflammatory mediators directly in the lesion focus, but also to reversibly inhibit the formation of prostaglandin E2 in the ascending pathways that conduct pain signals, in particular in the spinal cord.Due to its pharmacological effects, nimesulide inhibits the formation and conduction of pain impulses at different levels of the nociceptive system, thereby not only stopping acute pain, but also preventing the formation of chronic BS [21], which is important for patients with nonspecific back pain.
It has been shown that non-selective representatives of NSAIDs have greater gastro- and hepatotoxicity, and highly selective COX-2 inhibitors (primarily coxibs) more often promote thrombus formation, which can lead to cardiovascular diseases, such as strokes and heart attacks [22].Over the past years, considerable experience has been accumulated not only in the effective use of nimesulide (Nise®) for the treatment of various BSs, but also in its high safety and good patient tolerance even with prolonged use.
Thus, carried out by A.E. Karateev in 2009, a study devoted to a retrospective analysis of the development of side effects and complications from the gastrointestinal tract, the cardiovascular system and liver function with prolonged use of nimesulide (at least 1 year) in 322 patients with rheumatic diseases, did not show a clinically expressed pathology of the studied systems according to data additional laboratory and instrumental examinations [23].Nimesulide (Nise®) can be used in a fairly wide range of patients, differing from many other NSAIDs in the low risk of complications from the gastrointestinal tract and the cardiovascular system [17, 22, 23]. The obvious and significant advantages of nimesulide (Nise®) include a combination of a quick analgesic effect (15–20 minutes after oral administration of the drug), anti-inflammatory action, safety of use, good tolerance and affordable price [17].

Non-drug treatments for acute nonspecific back pain

Non-drug methods of treating acute back pain include manual therapy, physiotherapy exercises, acupuncture, physiotherapy, methods of social support [3], special devices for the musculoskeletal system or musculoskeletal system [11] – orthoses; you should remember about the need for comfortable furniture, the correct posture for seated work, etc.d.
Orthoses or corsets are external devices designed to affect the structural and functional characteristics of the musculoskeletal and musculoskeletal system: unloading, fixing, activating and correcting the functions of the damaged joint or limb. Since muscular-tonic BS of lumbosacral localization are common causes for the development of dorsopathy, the analgesic effect from the use of lumbosacral orthoses (LBO) is quite expected. SALW are one of the most used types of medical corsets and are used in the complex treatment of pain in the lower back or for orthopedic purposes – for posture correction [24].Therapy using orthoses is not only effective, but also more cost-effective than standard methods of exposure [25]. In particular, a large meta-analysis of 2008 demonstrated a greater effect of the treatment of nonspecific back pain with the help of SALW than the purely drug treatment [26]. When contacting medical institutions in other countries for pain mainly in the lumbar spine, wearing SALW is recommended in most cases (73%), and this appointment is carried out by primary care physicians [27].At the same time, the use of a brace helps to reduce the severity of pain, but does not affect the likelihood of recurrence of such an episode in the future [11].
Despite the obvious clinical effect of using braces in the form of a decrease in the severity of BS, there is a well-established idea of ​​the danger of developing muscle weakness and atrophy during long-term use [28, 29]. The direct mechanical effect of the orthosis on the adjacent muscles is considered as possible reasons [30].However, a large meta-analysis (36 literature sources), where this issue was studied, did not find such a relationship [31], as well as another meta-analysis that studied the possibility of a negative effect of prolonged wearing of SALW (up to six months) on the extensor muscles of the back using instrumental examination methods ( Ultrasound and MRI) [30].
In recent years, in the event of an acute episode of back pain, the method of kinesio taping has been widely used, which makes it possible to eliminate local pain and muscle tension to varying degrees [4, 7].Also, for acute nonspecific back pain, therapeutic transcranial magnetic stimulation is increasingly used; in this case, high-frequency protocols are mainly used [13].
Despite the complete and timely relief of acute BS, the further prognosis of the course of nonspecific back pain is not always unambiguous, since even with complete regression of pain in more than 50% of cases, patients have recurrences [9]. That is why adherence to behavioral guidelines and necessary lifestyle changes in patients with back pain is of particular importance in preventing recurrent pain episodes.At the same time, in the event of repeated relapses of nonspecific back pain, the timely use of an effective, safe and well-tolerated anesthetic and anti-inflammatory drug nimesulide (Nise®) to relieve acute pain and prevent further chronicity of the pathological process is pathogenetically justified.


Why back pain is dangerous and why it cannot be ignored

Back pain is a common occurrence even among the younger generation.Tingling, bruising, fatigue, discomfort – discomfort brings any discomfort at the end of the working day or after physical exertion. And sometimes the back can ache after sleep, after a sudden sneeze or cough, with an unsuccessful tilt, jump, too soft sofa …

If you begin to notice painful sensations in the back, you need to eliminate the cause of the ailment and start treatment.

Statistics are unforgiving: only 5% of people over 18 years old do not have pronounced problems with the spine.The most common symptoms are a pulling lower back, numbness in the arms and legs, sharp or dull pain. In America, researchers have come to the conclusion that pain in the back is the most common reason for going to the doctor and absenteeism at work for health reasons.

Many are very negligent about the unpleasant sensations, tingling sensations that have appeared – attributing to a sudden and unreasonable appearance, in the expectation that “it will pass by itself.” But too often, the cause turns out to be extremely serious, and a neglected disease can turn into disability after a few years.

In case of acute back pain that does not go away for more than 3 days, and with frequent pain symptoms, you should consult a doctor!

In the absence of treatment, the disease of the spine will begin to progress, causing more and more inconvenience, pain and, ultimately, this will affect the appearance and capacity of a person. Don’t expect consequences:

  • The transition of the disease to a chronic form will affect more muscles and joints, and the amount for treatment will grow like a snowball;
  • In the early stages, spinal disease can be cured without surgery.If untreated, to avoid disability, surgery may be the only salvation;
  • Disability, recumbency and costly patient care;
  • Pathology in the spine is not just pain and curvature: the disease can affect the work of all internal organs and systems, including urinary incontinence, lack of erection and loss of limb sensitivity;

Do not wait until the disease progresses to a severe stage – rush to see a doctor as early as possible.

  • Tension and muscle spasms. At risk are people with routine sedentary work, rarely playing sports. The pain appears after light exertion on the muscles or back. If untreated, it turns into a permanent spasm with myofascial pain syndrome.
  • Violation of the symmetry of the spine. Scoliosis, kyphosis – any curvature can cause discomfort, spoil the appearance, and in a neglected form, cause constant pain.
  • Hernias.When the intervertebral disc is deformed, pressure is exerted on the spinal cord and nerves are pinched. There are severe pains up to the inability to move, neurological disorders.
  • Osteochondrosis. Degenerative appearance of premature signs of aging and destruction of joints, intervertebral discs, bones.
  • Osteoarthritis of the intervertebral joints. The destruction of the cartilage of the joints and nearby bone tissue is observed in 4/5 of the world’s population over 55 years old.
  • Osteoporosis of the vertebrae.Slow but irreversible destruction of bone tissue. In an advanced form with such a disease, with a slight load on the back, a compression fracture of the spine can be obtained.
  • Ankylosing spondylitis. Curvature of the spinal column as a result of numerous destruction of the ligaments, articular elements of the spine, incessant pain and difficulty in movement.

There are actually many more reasons. Self-diagnosis has remained in the last century – modern medicine allows you to accurately diagnose the disease and select an individual course of treatment for the spine.Only an experienced doctor can not only remove the symptoms of the disease, but also eliminate its causes in the early stages without leaving a trace.

A visit to the doctor is required when:

  • Acute pain does not subside after 2 days;
  • Pain is stable or increasing;
  • Soreness when moving interferes with your daily activities and work;
  • There is a shooting pain in the limbs;
  • After a bruise or injury, the back does not stop hurting;
  • After physical exertion or after sports, discomfort appears, tension in the muscles of the back;
  • There was a prolonged tingling numbness of the arms, legs, groin area;
  • You notice incontinence of urine, stool;
  • When soreness appeared, the body temperature became higher than normal;
  • Pain appears and does not go away at the moment of rest, when the weather changes;
  • Pain appears sporadically, but at the same time the weight began to go away.

You may be at risk!

  • Lead a sedentary lifestyle, move little. The muscle corset loses its tone, weakens. Because of this, the bone tissue of the vertebrae becomes fragile, and the discs and joints between the vertebrae age prematurely.
  • Overload the back. Despite the pain and discomfort, they continue training – damage is inflicted on the spinal column and its parts constantly, as a result of which destruction leads to pain and irreversible consequences.
  • Are overweight. The body is designed for certain loads, when the body weight is exceeded, the vertebral frame cannot cope and is destroyed ahead of time.
  • Work in a tense, uncomfortable and asymmetrical posture. Uneven load on the vertebrae and intervertebral discs leads to curvature.
  • Heavy objects are worn and lifted incorrectly. Incorrect tilt and bend of the lower back can lead to injury, even with light exertion.
  • Are often stressed.Anxiety, mood swings, and nervous disorders are the most subtle and destructive causes of diseases, including problems with the spine.

The complex program “Healthy back” of the specialists of our center will allow:

  • Correct posture, achieve symmetry;
  • Relieve tension and fatigue from the back muscles, relax the neck and lumbar region;
  • Improve mood and feel lightness in the body;
  • Strengthen the health of the body and restore the muscle corset.

For convenience, our center is built on the basis of a family club, the trainers of which are experienced rehabilitation doctors. The program of the complex includes consultations, individual preparation of a course for restoring back health, fitness and training, massages, baths and saunas, adjusting nutrition and home physical education. Suitable for all ages of patients.

  • Try not to skip morning exercises. Just 10-15 minutes of physical exercise daily will keep the back muscle in good condition for many years.
  • Workers in offices and long sedentary jobs are encouraged to take frequent but short breaks. Every hour you need to be distracted from the work process for 5 minutes, walk around the office, stretch, stretch. This will not only relieve tension from the lower back, but also improve performance.
  • Purchase an orthopedic bed kit. Consult your doctor after diagnosis and determine the required type of mattress filler and its thickness. In a dream, we spend a third of our lives, and you can significantly increase comfort while maintaining health and correct spine curvature.
  • Watch out for excess weight. 5-10 extra kilograms can be to the face, but exceeding the norm several times is fraught with complications of movements and the appearance of other diseases.
  • Add sports and exercise in your spare time – get a membership to the fitness room, pool or dance.
  • Do not overdo it with physical activity. It is important to know when to stop, and consultation with a specialist will help you choose an individual course of exercises with the possibility of adjustment.In the presence of diseases of the spine, the main loads during physiotherapy exercises should occur under the supervision of a trainer.
  • Watch your food. Get rid of the diet of unhealthy, excessively fatty and high-calorie foods. Supplement your diet with natural vitamins and natural sources of calcium.

Pain in the lower abdomen – Clinic Health 365, Yekaterinburg

Pain in the lower abdomen arising under the navel or in the pelvic region can be triggered by diseases and malfunction of some body systems and are only part of a number of symptoms that, as it may seem at first, are not related to each other.In addition, they can radiate to the thigh and lower back.

Pain can occur due to disruption of the following systems and parts of the body:

– Lower intestine

– Reproductive system

– Urinary system

– Nervous system

– Musculoskeletal system

Depending on the source of occurrence, pain can be:

– Aching or sharp

– Mild, moderate or strong

– Sudden, continuous or gradually increasing

– Permanent or paroxysmal

Pain in the pelvic area may not always appear, for example, only during menstruation, during urination or during intercourse.

Causes of lower abdominal pain

Due to the structural features of the reproductive system and the presence of the menstrual cycle, pelvic pain occurs more often in women than in men. The causes of sudden and severe (acute) pain in the pelvic region in women can be summed up in the following conditions:

– Ectopic pregnancy

– Miscarriage

– Ovarian cyst

– Inflammatory diseases of the pelvic organs

– Premature birth

If the pain is persistent or paroxysmal for six months or more, then it is already considered chronic.For many women, pain in the lower abdomen occurs due to the menstrual cycle or due to disruption of the reproductive organs. Possible causes of chronic pelvic pain due to dysfunction of the reproductive organs in women can be:

– Adenomyosis

– Endometriosis

– Menstrual pain (dysmenorrhea)

– Ovulatory syndrome (painful ovulation)

– Ovarian cancer

– Fibroma of the uterus

Other causes of lower abdominal pain can be:

– Appendicitis

– Crohn’s disease

– Herniated disc

– Diverticulitis

– Constipation

– Interstitial cystitis

– Urinary tract infection

– Ulcerative colitis

– Inguinal hernia

– Consequences of physical or sexual violence

– Renal colic (urolithiasis)

– Colon cancer

– Irritable Bowel Syndrome (IBS)

– Spasms of the pelvic floor muscles

– Adhesions

– Fibromyalgia

The above diseases are most often the cause of this symptom.To find out the exact diagnosis, you should consult your doctor.

When to see a doctor?

If severe lower abdominal pain occurs, emergency medical attention may be required and a doctor should be consulted immediately. If pains in the lower abdomen or pelvic area have recently arisen, interfere with the normal course of life and intensify over time, we recommend that you consult with the doctors of the clinic “Health 365” in Yekaterinburg.

Related articles:

Menstrual pain

Signs of pregnancy




Ultrasound of the small pelvis

Ultrasound of mammary glands



Laparoscopy in gynecology

Uterine myoma


Ovarian cyst

Sexually transmitted diseases

Inflammatory diseases

Bacterial vaginosis

Human papillomavirus

Ovulatory syndrome, symptoms


Ectopic pregnancy


Menopause.Menopause syndrome

Urinary incontinence

Descent of internal organs

Premature birth

Removal of the uterus

Intimate plastic surgery

90,000 Pain in the region of the heart. Pay attention

Pain in the area of ​​the heart is one of the most common reasons people seek emergency help. So, every year, several million people seek emergency medical help with this symptom.

Heart pain is not always heart pain.It is often not associated with heart problems. However, if you are experiencing chest pain and do not know about the state of your cardiovascular system, the problem can be serious and it is worth taking the time to find out the cause of the pain.


Pain in the region of the heart can be very different. It cannot always be described. The pain can be felt as a slight burning sensation or as a violent blow. Since you cannot always determine the cause of the pain yourself, there is no need to waste time on self-medication, especially if you belong to the so-called “risk group” of heart disease.

Pain in the area of ​​the heart has many causes, including those requiring close attention. The causes of pain can be divided into 2 large categories – “cardiac” and “non-cardiac”.

“Heart” reasons

(Infarction, a blood clot that blocks the movement of blood in the arteries of the heart, can cause pressing, constricting chest pains lasting more than a few minutes. The pain can radiate (radiate) to the back, neck, lower jaw, shoulders and arms (especially the left).Other symptoms may include shortness of breath, cold sweats, and nausea.

(Angina pectoris Over the years, fatty plaques can form in the arteries of your heart, restricting blood flow to the heart muscle, especially during exercise. It is the restriction of blood flow to the heart arteries that causes attacks of chest pain – angina pectoris. Angina pectoris is often described by people as a feeling of pressure or constriction in the chest It usually occurs during exercise or stress.The pain usually lasts about a minute and stops at rest.

Other cardiac causes. Other causes that can present with chest pain include inflammation of the heart girdle (pericarditis), most often due to a viral infection. Pericarditis pain is most often acute, stabbing. Fever and malaise may also occur. Less commonly, the cause of pain may be a dissection of the aorta, the main artery in your body. The inner layer of this artery can be detached under the pressure of the blood and the result is sharp, sudden and severe chest pain.Aortic dissection can result from chest trauma or a complication of uncontrolled hypertension.

“Non-heart” reasons

Heartburn. Acidic stomach acid from the stomach into the esophagus (the tube that connects the mouth to the stomach) can cause heartburn, an excruciating burning sensation in the chest. It is often combined with a sour taste and belching. Chest pain with heartburn is usually food-related and can last for hours.This symptom most often occurs when bending over or lying down. Eases heartburn by taking antacids.

Panic attacks. If you are experiencing bouts of unreasonable fear, combined with chest pain, rapid heartbeat, hyperventilation (rapid breathing) and profuse sweating, you may suffer from “panic attacks” – a kind of dysfunction of the autonomic nervous system. Pleurisy. Acute, limited chest pain that worsens with inhalation or coughing may be a sign of pleurisy.The pain is caused by inflammation of the membrane that lines the inside of the chest cavity and covers the lungs. Pleurisy can occur with various diseases, but most often with pneumonia.

Tietze’s syndrome. Under certain conditions, the cartilaginous parts of the ribs, especially the cartilage that attach to the sternum, can become inflamed. The pain in this disease can occur suddenly and be quite intense, mimicking an attack of angina pectoris. However, the location of pain may vary. In Tietze syndrome, pain may worsen when pressing on the sternum or ribs near the sternum.Pain in angina pectoris and myocardial infarction does not depend on this.

Osteochondrosis of the cervical and thoracic spine leads to the so-called vertebral cardialgia, which resembles angina pectoris. In this condition, there is intense and prolonged pain behind the sternum, in the left half of the chest. Irradiation to the arms, interscapular region may be noted. The pain increases or decreases with changes in body position, head turns, arm movements. The diagnosis can be confirmed with an MRI scan of the spine.

Pulmonary embolism. This type of embolism develops when a blood clot enters the pulmonary artery, blocking blood flow to the heart. Symptoms of this life-threatening condition may include sudden, sharp chest pain that occurs or worsens with deep breathing or coughing. Other symptoms are shortness of breath, palpitations, anxiety, loss of consciousness.

Other lung diseases. Pneumothorax (collapsed lung), high pressure in the vessels supplying the lungs (pulmonary hypertension), and severe bronchial asthma can also present with chest pain.Muscle diseases. Pain caused by muscle diseases, as a rule, begins to bother when turning the body or raising the arms. Chronic pain syndrome such as fibromyalgia. May cause persistent chest pain.

Rib injury and nerve entrapment. Bruises and fractures of the ribs, as well as entrapment of the nerve roots, can cause pain, sometimes very severe. With intercostal neuralgia, pain is localized along the intercostal spaces and increases with palpation.

Diseases of the esophagus. Some diseases of the esophagus can cause swallowing problems and therefore chest discomfort. Esophageal spasm can cause chest pain. In patients with this disorder, the muscles that normally propel food through the esophagus do not work in a coordinated manner. Because esophageal spasm can resolve after taking nitroglycerin – just like angina – diagnostic errors are common. Another swallowing disorder known as achalasia can also cause chest pain.In this case, the valve in the lower third of the esophagus does not open properly and does not allow food to enter the stomach. It remains in the esophagus, causing discomfort, pain, and heartburn.

Shingles. This infection, caused by the herpes virus and affecting the nerve endings, can cause severe chest pain. Pain can be localized in the left side of the chest or be shingles in nature. This disease can leave behind a complication – postherpetic neuralgia – the cause of prolonged pain and increased skin sensitivity.

Diseases of the gallbladder and pancreas. Gallstones or inflammation of the gallbladder (cholecystitis) and pancreas (pancreatitis) can cause pain in the upper abdomen that radiates to the heart. Since chest pain can result from many different causes, do not self-diagnose or self-medicate or ignore severe and prolonged pain. The cause of your pain may not be so serious – but in order to establish it, you need to contact a specialist.

When should you see a doctor?

If you experience acute, unexplained, and prolonged chest pain, possibly in combination with other symptoms (such as shortness of breath) or pain that radiates to one or both arms. Under the scapula, an urgent need to see a doctor. Perhaps it will save your life or calm you down if no serious health problems are found.


Pain in the region of the heart does not always signal heart disease.Methods that can help determine the cause of pain include: (Electrocardiography (ECG)) This method helps the doctor diagnose heart disease. It records the electrical activity of the heart through electrodes placed on the skin. Cardiac impulses are recorded as “teeth”. Since the damaged heart muscle cannot conduct electrical impulses normally, the ECG may indicate that the patient has heart disease.

Blood tests. Your doctor may order tests to check for elevated levels of certain enzymes.Damage to heart cells in myocardial infarction leads to the release of these enzymes and their entry into the bloodstream. Myocardial scintigraphy. This method helps doctors determine the “heart cause” of pain, for example. Narrowing of the coronary arteries. A small amount of a radioactive substance (such as thallium) is injected into the bloodstream. Special cameras capture the radioactive material and track its passage through the heart and lungs.

(Angiography) This test helps you see the arteries of the heart and the obstructions in them.Liquid contrast medium is injected into the arteries of the heart through a special catheter – a long, hollow tube that is passed to the heart through an artery (usually the femoral artery). With the help of X-rays, the arteries become visible. (Echocardiography (ECHO KG)) This method uses ultrasound waves to produce an image of a beating heart.

Electron beam tomography (CRT). This unique method allows detecting the early stages of coronary heart disease by detecting microcalcifications in the wall of the coronary arteries, even before the onset of symptoms.

Magnetic resonance imaging of the spine will help determine the cause of chest pain if it is caused by a pinched nerve root or herniated discs.

* Materials of the site were used www.corallcenter.ru

90 096 90 000 Chest pain. How to understand what hurts a child

For the parents of each child, there is nothing worse when their child is sick.Especially at an early age, when the baby still cannot tell, or even show at all what and where it hurts. Even if the child has shown or explained where he has unpleasant, painful sensations, you should not self-medicate, but you should immediately consult a doctor.

Pediatric cardiology in Saratov accepts children at different ages and allows early detection of possible disorders, and in addition to cope with the disease in the active phase.

How to understand what exactly hurts in the chest in a child

First of all, this is not just a whim, but crying, screaming and even hysterics.At this time, the child can clench his fists and pull them to the chest, or he can just beat himself in this area. Additional symptoms include:

  • shortness of breath;

  • heart palpitations;

  • difficulty breathing or swallowing;

  • , less often, increased temperature.

Since there are strong painful sensations in this area, the baby rarely turns over on his stomach, but will lie on his back or side, although before that he loved this position.

The key symptom of constricting pain is a sudden change in mood, and besides this, the child shrinks, assuming a fetal position, thus helping himself to instinctively cope with such severe pain. Sometimes sharp reddening of the whites of the eyes, red spots on the body in the chest region and face are noticeable.

Pressing pain can be felt on the increase. At one moment everything is good, at another moment it is difficult to breathe. In order to exclude all possible causes, and in the case of diagnosis and treatment, to return to its former healthy state, it is necessary to regularly visit a pediatric cardiologist in Saratov.The first reception is relevant at the age of 1-2 months, and then every six months, if there are no visible pain syndromes.

What diseases are indicated by pain in the region of the heart?

Pain in the region of the heart can be the cause of the following diseases:

To accurately determine the diagnosis, it is necessary to undergo a series of examinations, including:

Concerned parents are worried about what is the cause of the disease. If violations are observed from birth, this may be the result of intrauterine defects, and besides this, violations caused by birth trauma.

If pain in the region of the heart began to appear over time, it is necessary to trace at what moments it occurs:

If the heart is the cause of the pain symptom, then the baby may feel pain:

If the main cause is ischemic lesions of the heart muscle, then the key symptom will be that the pain is short, paroxysmal, often dull. As a rule, it manifests itself after active sports, an emotional outburst.

Even though the child cannot always clearly explain exactly where and how it hurts, but makes you understand that the discomfort is in this area, complaints cannot be ignored and you need to urgently make an appointment with a doctor for consultation and receiving answers to many pressing questions.

Unfortunately, often the cause of pain is associated with rheumatism. If earlier many believed that this is a disease of people in old age, now it is more “rejuvenating”.The doctor can make or exclude this diagnosis based on the examination, as well as the results of the rheumatic test. Particular attention should be paid to the health of a child aged 5–8 years during the period of active growth, when the internal organs do not always keep up with the active growth of bone and muscle tissue.

The cause of pain may be neurosis or vegetative disorders. If the child is active, moves a lot and does not even consider your request or offer to rest, take a breath and experience pain after active play or sports, and they quickly pass, this indicates temporary manifestations of cardialgia.

Do infections and viruses cause pain symptoms?

Yes, first of all, it is a streptococcal infection, which gives a complication to the heart, and in addition, it can provoke the rapid development of rheumatism.

Viral myocarditis is provoked by disease-causing cells and can manifest itself as a consequence of the transferred flu, ARVI. If 2-3 weeks ago a child suffered from a sore throat or scarlet fever and then began to complain of chest pain in the front or back, it is urgently necessary to consult a specialist in order to exclude negative reactions.

If pain symptoms are actively manifested while running, then this may indicate excessive overexertion or dysfunction of the heart:

After resting after running, the child stopped experiencing pain? – All the same, you shouldn’t hesitate, and it needs to be shown to the cardiologist for consultation. To obtain an accurate diagnosis, blood tests, cardiogram, ultrasound of the heart are prescribed.

Main causes of pain associated with cardiac muscle dysfunction:

  • vessels do not have time to grow behind bone and cartilaginous tissues;

  • development of vegetative-vascular dystonia, which is especially important in adolescence;

  • violation of the functions of the musculoskeletal system.

When the child is too young and he has something in pain, the parents ask him to show with his finger exactly where. Sometimes babies can point to the left side of the chest area, but their stomach hurts. “Not real” pain in the heart area is caused by osteochondrosis, gastrointestinal disorders, and scoliosis.

Sometimes a child can simulate a painful reaction. You can understand this by his behavior, and besides this, if you switch attention to something else, the pain will pass, you can say that the baby is capricious and just requires attention.

If pain is observed during coughing or deep inhalation, but does not quickly go away when changing position or resting, this may indicate pleurisy or tachycardia. During the appointment, the cardiologist will listen to the heart, determine the heart rate and, if necessary, may prescribe other tests to get the most accurate result and prescribe treatment on time.

Observe the nature of the pain: pleural – during movement, deep breath, coughing. The second type is pressing pain in the chest.In any case, it is necessary to show the child to a specialist as quickly as possible.

When the baby is already able to speak to describe the nature of the pain, ask him to tell in detail exactly where he feels discomfort, what type of pain he feels, follow its intensity and, possibly, identify the accompanying factors:

  • active sports;

  • strong emotional reactions;

  • reactions to certain foods.

If the baby has undergone open heart surgery, then regular consultations with a pediatric cardiologist, adherence to the course of treatment and recommendations are mandatory.

Attentive parents not only pay attention to what may be troubling their child in time, but also constantly consult with professional medical personnel in order to exclude the aggravation of the disease and solve the problem at an early stage.

Your child’s health must be entrusted to professionals.If you experience the first symptoms, see your doctor! In the First Children’s Medical Center, experienced doctors quickly recognize the signs of the disease, conduct a full examination using modern medical equipment and provide qualified medical care. We work seven days a week and are waiting for you at any time from 8.00 to 20.00.

Make an appointment with a cardiologist

Congenital and acquired heart disease

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Should you be afraid of bradycardia in children?

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Holter ECG monitoring: what is it and how is it done

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Frequent pulse in children as a result of emotional and physical stress

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Common childhood diseases of the heart and blood vessels and how to prevent them

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When a child needs a routine examination by a pediatric cardiologist

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Ultrasound of the heart for a child is a quick and harmless diagnostic method

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The main reasons why physical education is better than professional sports

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Arrhythmia in children

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Arterial hypertension in children and adolescents

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