Lumbar spine pain: diagnosis and medical treatment

2021-07-19 11:48 PM

Low back pain is the cause of reduced working capacity at the age of under 45 and the cost of self, as well as social costs in treatment, is very expensive

Low back pain is very common. Clinically, nearly 80% of people have experienced this condition in their lives. The age of the disease is usually between 30 and 50 and the ratio between men and women is similar. Low back pain is the cause of reduced working capacity at the age of under 45 and the cost of self, as well as social costs in treatment, is very expensive. Signs of pain: acute-chronic, dull, intense, spreading, accompanying signs.

Definite diagnosis

Based on clinical manifestations

Low back pain is acute (lasting 3-6 weeks) or chronic (lasting more than 3 months).

Accompanying symptoms

Manifestations of root irritation such as weakness, paresthesia, numbness.

There may be symptoms of round muscle disorders (intestines, bladder), horsetail syndrome. These are signs that urgently need to diagnose the cause and treat it promptly.

Diagnose the cause

Based on clinical and subclinical symptoms. To diagnose the cause, it is necessary to take a thorough history such as: history of trauma, age factors (risk of osteoarthritis and osteoporosis, ...) factors of work, family, spirit, and circumstances. economic, cultural level; factors for chronic diseases (bone metastatic cancer, multiple myeloma, ankylosing spondylitis, paraspinal abscess, ...) and careful examination to detect accompanying signs, especially neurological manifestations: sciatica; signs of root compression, spinal cord compression, signs of paralysis, ...

Pain due to mechanical causes

Majority: muscle strain (including working posture), tendon injury (70%), disc degeneration, joint facet, disc herniation, spinal stenosis, vertebral collapse due to osteoporosis, disease spondylolisthesis, traumatic fractures, congenital diseases (humpback, scoliosis, ...), spondylolisthesis, disc degeneration, vertebral disc herniation.

Pain not due to a mechanical cause

Cancer, metastatic cancer (breast, lung, prostate, colon...): multiple myeloma (Kahler); metastatic bone cancer, retroperitoneal tumor, lymphoma, leukemia, spinal neuroma, primary vertebral tumor.

Infections: vertebral discitis due to infection, paraspinal abscess, equine abscess.

Arthritis: ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome, ...

Scheuermann osteochondrosis (osteochondrosis).

Paget disease

Some other diseases such as kidney disease (kidney stones, pyelonephritis, ...); duodenal ulcer, pelvic disease...

Other causes

Stress, mental disorders.

Tests to diagnose the cause

Peripheral blood cells, erythrocyte sedimentation rate, reactive protein (CRP), total urine, urea, creatinine, liver enzymes... Although not specific, they are valuable for initial differential diagnosis between inflammation, cancer, and some other reasons. (For example, in the presence of anemia, with elevated erythrocyte sedimentation rate, and urine with thermolytic protein are often suggestive of multiple myeloma.

Biochemical tests: calcium, phosphorus, alkaline phosphatase, ... may change if due to bone metabolic diseases such as osteoporosis or bone cancer, ...

Diagnostic imaging techniques

Routine X-ray: evaluate the morphology of the spine and vertebrae, allowing diagnostic orientation such as spondylarthritis (infection, tuberculosis, ...) vertebral lesions due to metastatic cancer,  .. Routine X-rays can also identify images of vertebrae that are collapsed due to osteoporosis, ...

Contrast-enhanced disc imaging to detect disc damage.

Nerve root capsule: when there are signs of compression, nerve roots.

Computed tomography (CT scan) of the spine when there is suspicion of damage to bone structures, spinal canal...

Magnetic resonance imaging (MRI): can evaluate soft tissue structures such as discs or muscles, paraspinal ligaments, and bones, detect tumors. Allows early and sensitive diagnosis, can detect 30% of lesions without clinical symptoms.

Other exploration methods

Electromyography: to detect damage of nerve origin, locate the damaged nerve.

Scintigraphy: to detect metastatic cancer or discitis - vertebrae, inflammatory bone marrow.

Biopsy, cytological diagnosis, histopathology, ...

Treat the cause

Depends on the cause.

Treatment of nonspecific low back pain

Non-drug treatments

Stay in place (acute pain): 3-5 days.

Physiotherapy: acupressure, acupuncture, infrared, ...

Methods of drug treatment

Analgesics: choose one of the drugs according to the World Health Organization analgesic ladder (paracetamol, Efferalgan), Efferalgan codeine, morphine. For example, use paracetamol 0.5g tablets with a dose of 1-3g/day.

Depending on the pain, adjust the dose accordingly.

Non-steroidal anti-inflammatory drugs: choose one of the following drugs (note absolutely do not combine drugs in the group because they do not increase the therapeutic effect but have many side effects):

Diclofenac (Voltaren) 50mg x 2 tablets/day divided into 2 or 75mg x 1 tablet/day after a full meal. 75mg/day intramuscular injection can be used for the first 2-4 days when the patient is in severe pain, then switch to oral.

Meloxicam (Mobic) 7.5mg x 2 tablets/day after meals or intramuscular injection 15mg/day x 2-4 days if the patient has a lot of pain, then switch to the oral route.

Piroxicam (Felden) 20mg tablets or ampoules, take 1 tablet per day orally after meals or intramuscularly 1 ampoule in the first 2-4 days when the patient has a lot of pain, then switch to oral.

Celecoxib (Celebrex) 200mg tablets, dose 1 to 2 tablets / day after a full meal. Should not be used in patients with a history of cardiovascular disease and with greater caution in the elderly.

Muscle relaxants: choose one of the following:

Mydocalm: 150mg x 3 tablets/day (if muscle contractions are high) or mydocalm 50mg 4 tablets/day.

Myonal 50mg x 3 tablets/day.

Physiotherapy such as hot compresses, running rays, acupuncture, acupressure, ...

Combination of sedatives, antidepressants when necessary: ‚Äč‚Äčamitriptyline 25mg x 1-2 tablets/day (should be taken in the evening).

Prevention

Exercise regularly, work with correct posture, do not smoke, avoid being overweight.