There are many patients with low back pain in the outpatient clinic who do not know which department to see when they visit the clinic. In fact, low back pain is really complicated for doctors, and can involve a variety of diseases causing low back pain in orthopedics, neurology, neurosurgery, oncology, respiratory medicine, cardiovascular medicine, gynecology, dermatology, male medicine and other departments. The authors combined with the clinical treatment guidelines for low back pain prepared by the Chinese Medical Association in 2009 to say what diseases can cause low back pain.
1. Spinal fracture.
There is mostly a clear history of trauma, percussion pain at the fracture site, the spine may have posterior concave or lateral convexity deformity, painful activity disorder, and X-ray examination is the main method to diagnose this disease.
2, lumbar disc herniation.
The occurrence of this disease is closely related to trauma and strain, and lumbar pain and sciatica on one side appear, and the two coexist or occur separately. The signs are lumbar scoliosis, flat back or posterior convexity, limitation of spinal motion, paraspinal pressure pain, radiating pain, positive straight leg raising test and other specialized signs.
3. spinal tumors, metastatic carcinoma of the spine.
For older patients with sciatica, think of malignant tumor metastasis of the spine or multiple myeloma, etc. The most common one is prostate cancer, followed by thyroid cancer, breast cancer, kidney cancer, lung cancer, etc. 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. Diagnosis of the disease should be combined with imaging and pathological examination, etc.
4. Lumbar muscle strain.
It is characterized by chronic, intermittent or persistent pain around the lumbar muscles, which worsens with exertion and improves with rest. The site of pressure pain is mainly on the medial side of the posterior superior iliac spine, next to the 4th and 5th lumbar vertebrae, with muscle spasm and sometimes radiating leg pain. It is caused by incomplete treatment after acute sprain or continuous bending labor causing muscle ligament tear and strain.
5. Fibrous tissue inflammation (myofibrillar tissue inflammation).
Mainly fibrous tissue lesions within the muscle membrane, tendons, ligaments and adipose tissue. Low back pain, chills, skin numbness, muscle spasm and movement disorders. The pain is painful in the morning, light during the day and reoccurs in the evening, and can be triggered by prolonged inactivity or overactivity, exertion, and climate change. There are obvious restricted pressure points on the affected area during physical examination.
6. Spinal cord compression.
Characterized by nerve root irritation sign, 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 roots of spinal nerves. Root pain produces constant and severe unbearable 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 infectious disease. Often sudden onset, herpes appears before the nerve pathway site where herpes occurs has severe neuralgia, common intercostal herpes zoster, sometimes spread to the abdomen, low back pain.
10. Kidney disease.
Common are pyelonephritis, kidney stones, renal tuberculosis, nephritis, hydronephrosis, pus in the kidney, etc., mainly in addition to back 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 non-penetrating, may also present with back radiating pain.
13, retroperitoneal tumors.
Malignant lymphoma is the most common, and the main symptom is low back pain, or accompanied by 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. Features in addition to lumbosacral pain at the same time with gynecological manifestations such as lower abdominal heaviness and pressure pain.
15. Chronic prostatitis.
Low back pain with perineal discomfort, burning sensation in the urethra, frequent urination and symptoms of neurological dysfunction.
16.Prostate cancer.
Low back pain with difficulty in urination, urinary frequency, urinary retention, etc. Imaging data can provide diagnostic reference.
17.Respiratory system diseases.
The common ones are pleurisy, pleural thickening or adhesions, tuberculosis and lung cancer. Characterized by back pain along with respiratory signs and symptoms.
18, cardiovascular diseases.
The painful site of angina is mostly seen in the upper and middle sternum, occasionally radiating backward to the lower back. Abdominal pain, shock, and low back pain are the most common manifestations of ruptured abdominal aortic aneurysm. ebt examination (electron beam computed tomography) is the most direct means to confirm the diagnosis of aneurysm, and enhanced CT and MRI examination have low accuracy.
In fact, there are more reasons for low back pain. As a smart patient, when visiting the clinic, you should first consult at the triage desk before registering for a department number, and in addition, you need to listen to the advice of the professional doctor of the department you are visiting (for example, the doctor considers the disease that is not your specialty by asking medical history and physical examination, and recommends transferring to other departments for consultation, etc.), so as to avoid detours and reduce the consultation time and unnecessary medical expenses.