Back Pain

Chronic back pain is the pathological condition encountered in industrialized countries and the most common cause of activity limitation in people younger than 45 years. It is defined as pain that persists beyond 12 weeks and is often attributed to degenerative or traumatic conditions of the spine. Fibrosis, spondiloartropatia inflammatory and metabolic bone disease are also causes of back pain.Lumbar back pain is defined as chronic after 3 months of evolution because most connective tissues heal in 6-12 weeks if instability persists patoanatomica. Traumatic or degenerative conditions of the spine are the most common causes of back pain. Although disc protrusion and herniation are publicized causes of back pain and sciatica, disc hernia are asymptomatic joint.
If diagnostic studies showed no structural cause to wonder if the pain is not a predominant factor is psychological. Physical factors and the influence psifologici transition from acute pain to chronic back. Identify all contributing factors is essential for successful therapy.
Lumbar back pain is more prevalent in industrialized countries.Genetic factors that predispose people to specific ethnicity or race in this condition have not been clearly identified. Men and women are equally affected, but over 60 women reported symptoms more often than men. The incidence of back pain are highest in middle and decreases with age with age when prevalence of spinal degenerative changes. Sciatica occurs in patients in the fourth, fifth decade of life, and the average age of occurrence is 42 years.
Therapy of choice is conservative and includes bed rest, administration of anti-inflammatory and muscle relaxants. The surgery of pain syndromes is needed in radiculopatiie discogenica or myelopathy with persistent radicular pain, motor weakness, progressive neurological deficits or spinal cord compression without response to conservative therapy.
Most of the etiologies of back pain are not life threatening, still have significant morbidity associated with syndromes of chronic back pain. A significant number of patients can not return to normal life and work. Most cases of back pain are not medical emergencies except ponytail syndrome that requires immediate decompression to prevent permanent neurological sequelae.
Pathogenesis and causes of back pain arePain localization in the spine may have cervical region, lumbar or coccyx.
Types of back pain:It is divided into discogenica pain, acute-traumatic pain, skeletal pain and radicular miofasciala.Cervical and lumbar pain:Pain discogenica:It is caused by degenerative changes of the spine. They are judged by the loss of intervertebral disc height and osteophytes develop, leading to loss of ability to absorb shock forces transmitted abnormal and abnormal loading of the intervertebral joints. The combination of reducing vertebral disc and joint degeneration with hypertrophy girls cause collapse of the intervertebral foramen and its association with symptoms of nerve root compression. Next intervertebral disc becomes infiltrated with abnormal collagen and fibrotic.
Classical radicular syndrome:It is characterized by painful nerve root by the incarceration of herniated discs. A similar syndrome can be produced by inflammation and irritation. The pain is sharp, well-located and associated with paresthesia, while durarea the irritation is mild, poorly located and without paresthesias. Incarceration is associated with nerve pain down his leg while raising no irritation.Neurological deficits and pain radiation below the knee are often seen only in joint irritation in jail. Other causes of spinal stenosis and are solitary nerve syndrome ponytail.Spinal stenosis occurs when the lower disc space and intervertebral disc loses volume with age. even a minor trauma causes inflammation in these cases or incarceration classic sciatic nerve.Ponytail syndrome is caused by massive externalization disc nucleus or the appearance of a tumor that presses on the spinal caudal sac. Classic presentation is bilateral sciatica, bowel or bladder dysfunction. Urinary retention is first observed and followed by incontinence. Perineal or perianal anesthesia is present in 80% of cases.
Discogenica predisposing factors for pain include:Prolonged post-enactment of a defective spine regardless of the region-Bouncing, local trauma, frequent flexion.
Pain miofasciala:Miofasciala pain is attributed to muscle pain and adjacent fascia spine. Diagnosis of this syndrome is clinically without laboratory tests to confirm it. This pain is localized by palpation miofasciala painful trigger points located in skeletal muscle. A trigger point is defined as an area located hiperiritabila palpable muscle band intro.Miofasciala pain is considered to be caused by trauma suprauzajul or shoulders and neck muscles that support for the cervical spine and pelvis for lumbar spine and thorax. Other less common causes are nutritional deficiencies, chronic infections, endocrine dysfunction, poor posture taken by the patient and psychological stress.
Skeletal pain:Other causes include disorders of the back duerrii osteomyelitis, and malignancy sacroileita.Osteomyelitis occurs through the development of inflammatory processes involving the bones of the spine, while sacroileita inflammatory changes result from the sacroiliac joint. Pain in the sacroiliac joints and radiates in aneterioare and posterior thighs.Pain is worse at night and it exacerbates the bipedal position or prolonged sitting.Malignant tumors of the spine may be primary or metastatic. Most primary tumors are discovered in patients under 30 years and involved the posterior vertebral elements. Metastatic tumors are found especially in patients over 50 years and tend to occur in the vertebral body.Pain or coccidodinia Cocis:Different etiologies have been described for coccidodinie. The most common damage occurs by direct sacrococcigiene sincondrozei. Another common etiology is a vaginal delivery. At the end of the third quarter some hormonal changes increase joint mobility coccyx. A third of coccyx injury is idiopathic. Other causes are rare pear pain, nerve damage pudentali to cyclists, pilonidal cyst formation, obesity and bursitis in patients lose lean gluteal.
Neurological diseases associated with spinal pain:-Myelopathy, plexopatia diabetic neuropathy inflammatory-Mononeuropatia, myopathy (myositis), dystonia.
Systemic diseases associated with spinal pain:-Primary or metastatic neoplasm-Infection, inflammatory spondiloartropatia, Metabolic bone disease, osteoporosis, Atherosclerosis, vasculitis.
Spinal pain by irradiation at a distance:, Gastrointestinal, genitourinary: nephrolithiasis, prostatitis, pyelonephritis-Ectopic pregnancy, pelvic inflammatory disease, hip pathology.