lower back pain
Introduction
Introduction to lower back pain Lower back pain refers to the pain felt in the lower lumbar spine, lumbosacral region or temporal region. Often accompanied by sciatica, the pain is radiated to the sciatic nerve distribution area on one or both sides of the hip or lower extremity. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: lumbar disc herniation sciatica
Cause
Cause of lower back pain
The causes of lower back pain may be related to acute ligament injury or muscle strain, and have a tendency to self-limiting; or related to chronic osteoarthritis or lumbosacral ankylosing spondylitis, the incidence rate increases with age, in Up to 50% of people over the age of 60.
Back pain can be affected by long-term lack of sleep, fatigue, physical weakness, psychosocial problems and emotions. These factors can often change the patient's perception and description of physical pain, and can also affect patient dysfunction and loss of labor capacity. Degree and therapeutic effect.
Prevention
Lower back pain prevention
The main prevention of this disease is to identify the cause, treat and care patients for the cause, such as obesity to lose weight, improve muscle tone and muscle strength, improve posture, etc., for patients with arthritis of intervertebral joints, Specialized carapace and strengthening abdominal muscles have good curative effect, and lumbosacral flexion can also improve muscle tension and prevent recurrence.
Complication
Complications of lower back pain Complications Lumbar disc herniation sciatica
Lower back pain refers more to a symptom. The cause of complications needs to be considered. Because of the many causes of lower back pain, the possible complications are various, and the most common is chronic Ligament or muscle damage, if the old disease does not heal, can also cause disc disease and spinal cord stenosis.
Symptom
Lower back pain symptoms Common symptoms Myalgia Muscle tenderness Anxiety Stressful severe pain Back pain Osteoporosis Sprain Neuralgia involvement pain
The conditions that cause lower back pain are various and are described as follows:
(1) Patients with acute, self-limiting lower back pain have no chronic discomfort. The typical onset is often related to overwork, sprain, trauma or stress reaction. The detailed history and experience are sufficient for diagnosis.
(2) The differential diagnosis of chronic low back pain is difficult, and the onset can be carefully determined. The characteristics of the pain and the precise positioning start. The pain may be local (feeling and tender points in the lesion), such as fibromuscular muscle. Pain; or diffuse, such as primary fibromyalgia, pain can also be caused by deep tissue, such as lumbar pain in chronic osteoarthritis of the lumbar spine; radioactive, such as sciatica; or involvement (caused by visceral or spinal cord disease) , the organ and the painful part are innervated by the same spinal segment of the spinal cord), such as serositis, pyelonephritis, osteoporosis, compression fracture or osteomyelitis, caused by pain, muscle tension and tenderness of the paraspinal muscles Restricted back activity is a common feature of all diseases affecting the musculoskeletal and nervous system (mechanical pain), pain is aggravated at rest, relieved with stretching movement or activity, which is characteristic of fiber muscle origin, but internal organs This is not the case with pain (non-mechanical pain). The typical visceral pain is not aggravated by activity, nor is it relieved by rest, usually sustained and added at night. , The Valsalva test (hard, coughing, sneezing) increased pain, leg raising limited, reflexes and sensory changes in spinal nerve roots and sciatic nerve involvement features.
(3) sciatica, pain is radiated along the sciatic nerve, most of which radiates to the back of the buttocks and lower limbs, with or without lower back pain. The most common cause is disc herniation or intratumoral tumor compression of peripheral nerve roots; Implantation, tumor or bone abnormalities in the spinal canal or intervertebral foramen (such as osteoarthritis, spondylitis); or nerves outside the spinal cord, pelvis or buttocks, poisoning or metabolism (such as alcoholism, Diabetic neuritis is rare, and such lesions are confirmed by clinical or electrical diagnosis due to sensory or motor impairment.
(4) Spinal stenosis is an uncommon form of sciatica, which is caused by the narrowing of the lumbar spinal canal, which presses the nerve root before the intervertebral foramen (or oppresses the spinal cord, but is rare), due to similar intermittent claudication. Suspected vascular disease, spinal stenosis is more common in middle-aged or elderly, can be caused by osteoarthritis, Paget disease or spinal forward and cauda equine edema, manifested as walking, running and lagging, buttocks, thighs or calves pain, standing not The movement does not relieve the pain, but bending and sitting can alleviate the pain (although the feeling is abnormal), walking up the mountain is easier than going down the mountain, because bending down during the uphill position, rest and back flexion can alleviate the pain.
(5) Some patients with physical or mental disorders often have a history of minor trauma, causing disproportionately severe pain after injury, resulting in loss of mobility, but no injury or other primary disease can be found. In addition, there is usually anxiety. And factors such as depression, but these persistent symptoms cannot be fully explained by lower back pain. Careful acquisition of the patient's description of the pain and examination are often non-specific or inconsistent with any known neuroanatomical pathway or disease process. Symptoms and dysfunction continue to persist or worsen after the exclusion of injury or organic disease, and many of these manifestations progress to more typical fibromyalgia.
Examine
Examination of lower back pain
Because the causes of lower back pain are various, clinical diagnosis of the cause of this disease also requires a lot of auxiliary examination methods, such as X-ray examination, CT scan, bone scan, MRI examination, especially MRI examination can provide valuable value. The image of the longitudinal axis cavity deformation provides a more powerful basis for diagnosis. In addition, ESR and EMG are also necessary for specific differential diagnosis. It is necessary to select an appropriate examination method according to clinical manifestations.
Diagnosis
Diagnosis of lower back pain
Differential diagnosis
The differential diagnosis of chronic low back pain is difficult, and the onset can be carefully determined. The characteristics of the pain and the precise positioning start. The pain may be local (feeling and tender points in the lesion), such as fibromyalgia; Or diffuse, such as primary fibromyalgia, pain can also be caused by deep tissue, such as lumbar pain in chronic osteoarthritis of the lumbar spine; radioactive, such as sciatica; or involvement (caused by visceral or spinal cord disease, the dirty The device and the part that feels pain are innervated by the nerves of the same spinal cord segment, such as serositis, pyelonephritis, osteoporosis, compression fracture or osteomyelitis.
Clinically, it is necessary to differentiate the cause of the disease:
(1) Congenital bone defects, degenerative diseases or bone deformities can be examined by X-ray, such as the oblique slice showing the intervertebral facet joint.
(2) intervertebral disc rupture, ligament sprain and muscle tear are sudden onset, symptoms often start within 24 hours after weight lifting, local tenderness and muscle spasm in specific parts are meaningful, suggesting that the lesion itself is not in the pelvis or Retroperitoneal disease, CT scan or MRI can provide valuable images of longitudinal axis cavity deformation.
(3) Fracture and fracture dislocation can be ruled out by medical history, nature of trauma, X-ray examination, CT scan, bone scan (such as 99m pyrophosphate label).
(4) Chronic arthritis of the posterior facet joint of the vertebral body is usually associated with degenerative disc disease. The former has special clinical manifestations and X-ray signs of osteoarthritis, and the latter has symptoms of nerve root irritation. Excessive stretching usually aggravates the affected vertebral body. Pain in the posterior facet joints.
(5) The gradual lower back pain in younger adults suggests potential bone abnormalities such as anterior spine or spondyloarthropathy (such as ankylosing spondylitis or sacroiliitis); puberty is highly suggestive of spondyloarthropathy, pelvic and pelvic Retroperitoneal disease has corresponding symptoms and no local signs of the waist.
(6) Tumors and infections are more difficult to diagnose. They can be similar to ruptured intervertebral discs. Space-occupying tumors are often diagnosed by CT, MRI or myelography. Cerebrospinal fluid examination may not be able to identify tumor and intervertebral disc rupture. Both cerebrospinal fluid protein contents can rise. High, but this check is necessary in the diagnosis of meningitis and other infections.
(7) Fibromyalgia can cause chronic lower back pain and stiffness, as part of its localized (myofascial) or diffuse (fibromyalgia) symptoms.
