Low back pain is pain on one or both sides of the lower back, lumbosacral, with or without radiating pain in the lower extremities. It is a symptom and can be described as a syndrome rather than the name of a disease. It is mostly referred to as low back pain (LBP) abroad, which is translated as lower back pain or lower back pain by domestic scholars.
Since humans have evolved into upright walking animals, they have been standing or sitting in an upright position for most of their lives, and with the physiological anterior convexity of the lumbar segment of the spine and the posterior convexity of the sacral segment, various load stresses are concentrated in the lumbosacral segment when moving in an upright position, especially at the junction of the two opposite curves, so acute and chronic injuries and degenerative changes are likely to occur there. In addition, a more complicated situation is that in addition to localized spinal lesions that can cause lumbago, many adjacent organs or systemic diseases can also affect the lumbar region and cause lumbago, so lumbago is very common, and about 60% to 80% of adults have a history of the disease.
In addition, some complex low back pain is not cured for a long time if the cause is unknown to the doctor and the treatment is not right.
Is low back pain really so difficult to treat? The old ancestors have a very reasonable saying: It is not that it is not treated, but that it has not got its art!
Here, the author will first talk about some cases of back pain that have not been cured for a long time.
According to media reports, a Ms. Fan, who suffered from low back pain, was checked out to have a herniated lumbar disc. However, Ms. Fan and her doctor were baffled by the fact that despite various treatments, her “stubborn” back pain was not relieved at all.
Subsequently, Ms. Fan went to the hospital for irregular menstruation and was diagnosed with pelvic inflammatory disease after a pelvic ultrasound examination. The specialist believed that her menstrual disorder was caused by pelvic inflammatory disease, and the lumbago was probably not caused by a herniated lumbar disc, but by chronic pelvic inflammatory disease. After three courses of rehabilitation treatment, Ms. Fan’s pelvic inflammatory disease was controlled and her lumbago symptoms basically disappeared.
After telling this story, you may have understood why some stubborn back pain is such a headache for some doctors, right?
I remember that in the past, when talking about low back pain, if there was no traumatic fracture, everyone including many doctors would immediately think of lumbar muscle strain and lumbar spine osteophytes, and now there is a new word for lumbar disc herniation.
But is low back pain really that simple? Absolutely not!
In the clinical diagnosis and treatment guidelines for low back pain prepared by the Chinese Medical Association in 2009, we can see that at least 18 diseases involving internal medicine, surgery, orthopedics, gynecology, dermatology, and male medicine can cause low back pain (according to the author, it is now known that there are still some diseases that cause low back pain that are not covered in the guidelines).
The number of patients seen for low back pain is increasing day by day, and some physicians, when seeing these patients, tend to be preoccupied with the diagnosis of localized diseases of the spine and ignore other diseases that can cause low back pain. This is an important reason why patients have back pain and doctors have headaches? s important reason.
Once the cause is found, the solution to the problem will be ready: we must know what diseases can cause low back pain and use the appropriate treatment!
Next, we will briefly explain what diseases can cause low back pain in the context of the clinical guidelines for the treatment of low back pain prepared by the Chinese Medical Association in 2009.
1. Spinal fracture: there is a clear history of trauma (a few elderly patients with osteoporosis may have no clear trauma), percussion pain at the fracture site, posterior concave or lateral convex deformity of the spine, and impaired movement.
2. Lumbar disc prolapse/protrusion : The occurrence of this disease is closely related to trauma and strain, therefore, lumbar pain and sciatica on one side suddenly appear after weight-bearing sprain, and the two coexist or occur separately. CT or MRI is a reliable method to diagnose this disease.
3. spinal tumor, metastatic cancer of the spine : For older patients with sciatica, think of malignant metastases of the spine or multiple myeloma, etc. The most common one is prostate cancer, followed by thyroid cancer, breast cancer, kidney cancer, lung cancer and so on. The clinical manifestations are intractable back and back pain and radiating radicular pain. It is characterized by severe and persistent pain that cannot be relieved by rest, medication or physical therapy. The diagnosis of this disease needs to be combined with imaging and pathological examination, etc.
4. Lumbar muscle strain: chronic, intermittent or persistent pain around the lumbar muscles, which worsens with exertion and improves with rest. The site of pressure pain is mainly in the medial aspect of the posterior superior iliac spine, next to the 4th and 5th lumbar vertebrae, with muscle spasm and sometimes radiating leg pain. It can be a sequelae of incomplete treatment after acute sprain, or due to muscle ligament tear and strain caused by continuous bending labor.
5. Fibrous histitis (myofibrillar histitis): mainly fibrous histopathy within the muscle membrane, tendons, ligaments and adipose tissue. The main manifestation is diffuse dull pain in the low back, especially more pronounced over the lumbar muscles and iliac crest on both sides. There is pain, chilliness, numbness of the skin, muscle spasm and movement disorders in the low back. The pain starts in the morning, is light in the daytime, and reoccurs in the evening. The pain can be triggered by prolonged inactivity or excessive activity, and has a long duration, and attacks due to exertion and climatic changes. On examination, there are obvious limited pressure points on the affected area, and touching this point can cause pain and radiation. The pain disappears after injection of procaine into the painful spot. X-ray examination is not abnormal. Laboratory tests were normal or slightly elevated for anti-“O” or blood sedimentation. Magnetic resonance MR examination, lumbar dorsal subcutaneous visible strips of long T1 long T2 signal, the boundary is relatively clear, as the signal of exuded fluid.
6. Spinal cord compression: characterized by nerve root provocation signs and slow sensory and motor conduction. It manifests as neck and back pain or low back pain radiating along the area of distribution of one or more posterior spinal nerve roots. Root pain produces constant and severe intolerable pain, which may be felt as a fasciculation.
7. Acute myelitis: Early on, low back pain may occur, and the painful area corresponds to the surface of the lesion. Complete or incomplete paraplegia and urinary and fecal disorders may occur rapidly within 1 to 2 days.
8. Spinal radiculitis: characterized by irritating radiating pain along the distribution area of the nerve roots, with pressure pain in the corresponding spinal spinous process or paraspinal process, and pain that increases with a change in position.
9. Herpes zoster: It is a viral infection. It often starts suddenly, and there is severe neuralgia at the site of the nerve pathway where the herpes occurs before the herpes appears, commonly intercostal herpes zoster, sometimes spreading to the abdomen and low back with pain.
10. Kidney disease: common are pyelonephritis, kidney stones, renal tuberculosis, nephritis, hydronephrosis, pus accumulation in the kidney, etc., mainly in addition to lumbar pain accompanied by abnormalities such as urination.
11. Pancreatic disease: acute abdominal pain of acute pancreatitis often radiates to the lower back, often accompanied by fever, blood and urine amylase measurement has important diagnostic significance.
12. Ulcer disease: penetrating ulcers often have obvious back pain, but some retroduodenal bulb ulcers, although not penetrating, can also present with back radiating pain.
13. Retroperitoneal tumor: malignant lymphoma is the most common, and the main symptom is low back pain, or abdominal pain and fever.
14. Gynecological diseases: Common causes include severe retroversion and retroflexion of the uterus, chronic adnexitis, dysmenorrhea, cervical cancer and uterine cancer. In addition to lumbosacral pain, it is characterized by gynecological manifestations such as heavy sensation and pressure pain in the lower abdomen.
15. Chronic prostatitis: back pain with perineal discomfort, burning sensation in the urethra, urinary frequency and symptoms of neurological disorders. Routine examination of prostate massage fluid (EPS) is diagnostic when leukocytes >10/HP and lecithin vesicles are reduced in number.
16. Prostate cancer: back pain with difficulty in urination, urinary frequency and urinary retention, etc. Imaging data can provide diagnostic reference.
17. Respiratory diseases: common ones are pleurisy, pleural thickening or adhesions, tuberculosis and lung cancer. Characteristically, back pain is accompanied by respiratory signs and symptoms.
18. Cardiovascular diseases: Angina pectoris pain is mostly found in the upper and middle sternum, occasionally radiating backward to the lower back. EBT (electron beam computed tomography) is the most direct means to confirm the diagnosis of aneurysm, and enhanced CT examination requires contrast injection to enhance the visualization, but sometimes it is not easy to MRI does not require contrast, but its accuracy may be affected by the lack of hemodynamic stability in the acute phase.
In fact, many factors can cause low back pain, and in most cases it is a combination of multiple factors. The task of the clinician is to grasp the balance between the factors and the dominant role of each factor in different patients, and to choose the appropriate treatment according to the results of the analysis.