Dorsalgia: types, causes, symptoms, treatment. Dorsalgia of the thoracic spine - symptoms, diagnosis, treatment Facet joint syndrome

Science, including orthopedics, is moving forward, which leads to changes in many scientific concepts. One of them concerned back pain. More and more often, instead of this familiar concept, we hear the term “dorsalgia”. Patients think that this is a previously unknown, discovered new disease, but this is not so.

Dorsalgia - what is it?

Dorsalgia literally translates as “back pain” (dorsum - ridge, back). But can all pain be considered dorsalgia?

(The back is not the area between the base of the neck (the seventh vertebra C7) and the coccyx, as one may be surprised to read in some medical articles. The back is all five sections of the spinal skeleton (cervical, thoracic, lumbar, sacral, coccygeal) with adjacent muscles. )

What back pain is classified as dorsalgia?

The reasons are a limitless field. What can not cause them:

degenerative processes;
scoliotic deformities;
injuries, sometimes hidden from a person, for example, compression fracture of the vertebrae;
dangerous chronic infectious processes (bone tuberculosis, osteomyelitis);
tumors (osteosarcoma, chondroma);
organ diseases (heart attack, appendicitis, pancreatitis, cyst torsion and many, many others).

The tasks of vertebrologists were to identify separately isolated back pain and secondary radiculopathy, not of a specific nature, but associated with dystrophic degenerative processes in it and dysfunctions that can still be cured and reversed. This pain is called dorsalgia.

According to the definition of ICD - 10, dorsalgia is an independent, nonspecific, that is, benign and reversible disease of the musculoskeletal structure of the back. She is treated primarily on an outpatient basis.

Main signs of dorsalgia

Dorsalgia occurs as a result of:

Destructive damage to muscles, fascia, ligaments, tendons, synovium, bones and periosteum.
Muscle spasm, myofascial syndrome.
Dysfunction of skeletal muscles and fascia, locking, reversible dislocations and subluxations of joints.

And although dorsalgia is presented today as a “new orthopedic disease”, it is a pain syndrome, the etiology of which is narrowed to mild reversible diseases related to degenerative-dystrophic and deforming diseases of the spine. Therefore, not every disease can cause a patient to be diagnosed with “dorsalgia.” Unfortunately, in medicine today they put it right and left, meaning dorsalgia for every pain. The separation of pain syndrome into a separate disease, dorsalgia, led to the fact that many doctors took it literally as an opportunity to treat simply back pain, without identifying destructive and dysfunctional changes in the musculoskeletal structures that were the source of pain. Prescriptions for the “most effective” medications are immediately written, and the patient is referred for expensive procedures. Such treatment is profanation, since it is unsafe and misleading to the patient, and doctors of this kind are more likely to be businessmen rather than doctors.

Definition of dorsalgia in ICD-10

Dorsalgia is classified in the international classification ICD-10 in the section “Other dorsopathies”. In domestic medicine, this formulation was first introduced by Doctor of Medical Sciences. Bogacheva.

Dorsalgia does not include:

injuries;
oncological pathologies;
infectious and inflammatory processes (including infectious and rheumatoid arthritis, ankylosing spondylitis, infectious myositis, bone tuberculosis);
purulent-necrotic processes (aseptic necrosis, osteomyelitis);
diseases of internal organs;
psychogenic pain;
neural amyotrophies and myopathies.

Based on this definition, we can conclude that a disease such as dorsalgia is not a critically dangerous disease.

But that would be if doctors everywhere had the same approach.

Contradictions in views on the nature of dorsalgia

In the domestic medical environment there is still no single priority opinion, and dorsalgia in articles on medical topics includes all existing diseases in the world.

Orthopedists also have different understandings of primary and secondary diseases, vertebrogenic and non-vertebrogenic dorsalgia, specific and nonspecific pain.

All the definitions below are consistent with the BME and ICD-10:

Primary diseases are all nonspecific diseases, that is, and benign processes.
Secondary diseases - trauma, tumors, inflammation.
Vertebrogenic dorsalgia is associated with. Nonvertebrogenic - with muscle, psychogenic, somatic pain.
Nonspecific pain is caused by neurological diseases.

But here are the correct modern ideas, in accordance with the BME and ICD-10:

According to BME, diseases caused by pathogenesis (cause, structure, mechanism of development) are primary.
Secondary are processes that occur during the development of structural and functional disorders. Based on this definition, all specific and nonspecific pain pathologies of the back can be either primary or secondary.
Muscle spasms and dorsalgia accompany all degenerative processes in the spine that affect the musculoskeletal system, so they cannot be considered non-vertebral. The division of dorsalgia into vertebral and non-vertebral is incorrect.
Pain due to internal organs, as well as psychogenic ones, do not relate to dorsalgia at all. In Russian science, they, together with dorsalgia, are included in the general section “Back pain”.
Nonspecific pain is not neurological (see Definition of dorsalgia).

Osteochondrosis according to ICD-10 includes only Calve's disease (aseptic necrosis of the lower thoracic and upper lumbar vertebrae) and Scheuermann-Mau disease in children and adults. Scheuermann-Mau osteochondrosis does not usually cause dorsal pain, and avascular necrosis is not included in the list of dorsalgia.

International classification of dorsalgia

The following types of dorsalgia are classified according to the international system ICD-10 (we summarize all the data in Table 1):

Type of dorsalgia	International cipher	Localization and area of distribution of nonspecific musculoskeletal pain
Panniculitis of the cervical and spine	M54.0	Muscle and joint pain in the neck or spine, combined with dermatosis
Unspecified radiculopathy * (neuritis, radiculitis) in the areas: chest; lumbar; lumbosacral; brachial	M54.1	Pain in the thoracic, lumbar, lumbosacral, shoulder areas, radiating: between the shoulder blades and ribs; in the groin and buttock areas; perineum and thigh surface; collarbone
Cervicalgia *	M 54.2	Posterior neck area
Thoracalgia *	M 54.6	Posterior chest
Lumbodynia*	M 54.5	Lumbar spine area
Lumbosacralgia*	M 54.4	Lower lumbar region, area of the lumbosacral spine. Irradiation to the gluteal region, groin, lateral thighs.
Sciatica**	M 54.3	Sacral region. Irradiation to the buttocks, groin, leg.

Note:

* Except for discogenic radiculopathies.

**Sciatic nerve neuralgia is excluded.

What type of dorsalgia occurs most often?

The greatest prevalence of musculoskeletal pain was found in the lumbosacral region - 42%. Lumbosacralgia is especially common in the C5 - C6 vertebrae and in the transition segment C6 - S1.
The second place is occupied by dorsalgia of the cervical spine - 30%. Here, the transitional upper (C1 - C2) and transitional lower (C6 - C7, C7 - T1) are also more likely to suffer.
The least common is thoracalgia (dorsalgia of the thoracic region) - 15%.

What diseases lead to dorsalgia

Dorsalgia occurs:

with destructive structural changes and microtraumas of the musculoskeletal system;
myofascial syndrome;
decompensatory spondyloarthrosis;
decompensatory coxarthrosis;
joint blocking;
dysfunctional subluxations of the joints of the spine and hip joint;
myogelosis (muscle pain and stiffness due to a sedentary lifestyle);
radiculopathies (non-discogenic).

Memo for the doctor: Dorsalgia does not include the following vertebral pathologies:

lesions of the intervertebral discs (herniation, protrusion);
any discogenic radiculopathy;
sciatic nerve neuralgia;
all types of arthritis;
Bekhterev's disease;
spondylolisthesis and spondylolysis.

Priority classification of dorsalgia in domestic medicine

Bogacheva, in her works on orthopedics, prioritized the Russian classification of dorsalgia and abolished a number of traditional previous divisions of this disease into primary/secondary, vertebrogenic/non-vertebrogenic.

Types of pain with dorsalgia

Dorsalgia is a nonspecific musculoskeletal pain (NSPS), which is divided into three types:

acute isolated;
chronic isolated;
secondary radiculopathy.

Acute isolated pain is burning, intensifies with the slightest movement and palpation, does not extend beyond the sore area of the back and can last up to three months.

Chronic dorsalgia may be less pronounced in color than acute - aching, pulling. Lasts over three months.

Secondary radiculopathy is what we used to call radicular syndrome. It is secondary because it joins the already ongoing DDZP. The pain goes beyond the pathology, has a ribbon character - it follows along the nerve and spreads to other areas of the back and limbs.

How to make a diagnosis based on the type of pain

To differentiate pain, its nature is examined.

The type of pain can be:

localized (somatic);
reflected (visceral);
projection (neuropathic)

Type of pain	Nature of pain	Movement disorders and symptoms	Pain on palpation
Localized (somatic)	The painful area is accurately identified	The range of motion of the back and limbs is limited. Pain worsens with movement	When pressing on painful areas, the pain intensifies
Reflected (visceral)	Vaguely felt, directed from the inside to the surface	There is no restriction of movement and no dependence of pain on movement	Painful areas are not detected during palpation
Projective (neuropathic)	Directed along the nerve, can be encircling	There are movement restrictions in the back, but there are no restrictions in the limbs, with the exception of lumbosacral radiculopathy. With increased movement, the pain intensifies, acquiring the character of a lumbago. Lasegue and Wasserman symptoms are observed	In the initial stages, painful areas are detected only in the back, in the final stages - in the limbs

Localized pain in the spine is caused by musculoskeletal pathologies and destructive changes.
Referred pain reflects diseases of the internal organs.
Projection neuropathic pain occurs due to irritation or inflammation of the spinal nerve.

How to treat dorsalgia

It is considered a medical crime to treat back pain without a diagnosis when the doctor immediately prescribes NSAIDs without excluding up to thirty other dangerous diseases that may also cause acute or chronic pain.

Such differentiation, in order to exclude the most dangerous diseases first, should be a priority in treatment.

Thus, dorsalgia of the thoracic spine can be reclassified as a life-threatening disease:

heart and aorta - angina pectoris, myocardial infarction, pericarditis;
RRD (respiratory diseases) - pleuropneumonia, pneumothorax, pleurisy;
Gastrointestinal tract (diseases of the gastrointestinal tract) - penetrating ulcer, acute cholecystitis or pancreatitis.

The doctor must be especially careful when differentiating thoracalgia from organ diseases, since chest pain is often associated specifically with the organs, and not with destructive functional disorders.

Dorsalgia of the lumbosacral spine during examination may turn out to be:

renal colic;
renal artery thrombosis;
ovarian cyst;
inflammation of the appendages.

But here the picture is the opposite: more often it is lumbodynia that is diagnosed in the lumbar region than visceral pain.

A New Approach to Pain Treatment

Linking pain syndromes to destructive and functional musculoskeletal disorders has overturned all past ideas about pain and changed old treatment regimens. Osteochondrosis is no longer considered the cause of dorsalgia, and this is fair, since pain here can only arise as a result of radiculopathy - a painful reaction of the nerve root, and such a situation with disc DDZ occurs only with an exacerbation of the hernia.

The doctor's task:

Differentiate dorsalgia from other diseases based on symptoms, that is, first of all, exclude injuries, organ disease, tumors, infectious processes, etc.
Establish a diagnosis of the disease based on the differential diagnosis. (There is no diagnosis of “dorsalgia”! This is part of the anamnesis, describing in detail where and how it hurts, using a clear dislocation and existing terminology: for example, acute cervical dorsalgia).
Treat the disease itself. Treatment of pain syndrome is carried out by the doctor intelligently and does not imply prescribing the patient only non-steroidal/steroidal drugs and antispasmodics (in this case it will only be symptomatic).

It is important to establish the true causes that caused structural changes in the musculoskeletal system and eliminate them.

Dorsalgia is a combined concept, literally translated from Latin as back pain. Includes all diseases of the spinal column, the main symptom of which is pain in any part of the back and spine. This condition is found everywhere and affects people of any age group.

Causes

There are a number of predisposing factors that increase the risk and lead to the development of dorsalgia:

Spinal diseases characterized by dorsalgia:

Malignant tumors of the spine;
Tuberculosis, bone form;
Vertebral osteomyelitis;
Congenital developmental anomalies;

Classification

By location of pain There are 4 types of dorsalgia:

Cervicalgia – back pain at the level of the cervical spine;
Thoracalgia (intercostal neuralgia) - back pain at the level of the thoracic spine;
Lumbodynia - back pain at the level of the lumbar spine;
Combined dorsalgia is back pain at the level of two or three parts of the spine.

By origin There are two types of dorsalgia:

Vertebrogenic dorsalgia - back pain caused by diseases of the spine. Some experts distinguish subspecies:

traumatic – caused by spinal injuries;
inflammatory – caused by inflammatory processes in the spine;
degenerative – caused by degenerative processes in the spine;
neoplastic – caused by tumor growth in the spine and its structures.

Nonvertebrogenic dorsalgia is back pain not associated with spinal pathology. Its subspecies:

myofascial – caused by changes in the muscular framework of the back (sprains, bruises, inflammation, etc.);
psychogenic – without physical reasons, caused by mental and psychological factors;
other reasons.

Symptoms of dorsalgia

The symptoms of dorsalgia are quite varied:

Pain in the back, in the spine. Localization - cervical, thoracic or lumbosacral spine, from localized to widespread. Intensity – from mild to intense, disrupting performance. Character – aching, sharp, pulsating, constant or periodic, pulling, occurs at rest or after exercise, shooting, blocking, etc.;
Gait disturbance;
Numbness of the skin of the back;
Discomfort in the legs;
Weakness in the body;
Increased body temperature.

Diagnostics

For a complete examination and diagnosis of dorsalgia, an integrated approach is applied to each patient:

Survey (collection of complaints and anamnesis of life and illness). Helps to establish complaints at the time of contacting a doctor, the chronology of their occurrence, the mechanism of development of the underlying disease and its complications, causes;
Inspection. Allows you to identify forced body positions, visible deformations of the spine, violations of active and passive movements in the affected part of the spine, etc.;
Palpation. Feeling the spine reveals tension in the muscular frame of the back, pain in the spine, any deformation, etc.;
Neurological examination. Checking for sensitivity of the skin and muscle fibers (pain, temperature, tactile sensations), preservation of physiological reflexes, paresis or paralysis, the presence of pathological reflexes;
X-ray of the spine in two projections (antero-posterior and lateral). Allows you to detect deformations of the spinal column, the condition of the spinal canal, fractures, dislocations and other changes in bone tissue;
CT (computed tomography). Layer-by-layer X-ray images make it possible to determine the pathological area with great accuracy, detecting a violation of the integrity of not only the spine, but also the spinal cord, etc.;
MRI (magnetic resonance imaging). The most accurate visual method. Determines any violations of the structure of the spine, spinal cord, soft tissues, blood vessels and nerves;
Spinal tap. Allows you to detect hemorrhage in the spinal cord, the presence of tumor cells in the cerebrospinal fluid, purulent and inflammatory processes, etc.;
Myelography. A contrast X-ray determines the condition of the spinal cord.

Treatment of dorsalgia

Treatment of dorsalgia of any location and origin can be divided into conservative and surgical.

In case of exacerbation of dorsalgia, in the case of severe pain, bed rest is recommended. To speed up the healing process and its maximum effect, the bed should have an orthopedic mattress and pillow, the patient should be comfortable and comfortable. It is necessary to receive complex of medicines:

NSAIDs. They are basic in the treatment of dorsalgia. They are prescribed both in the form of tablets or capsules (for mild to moderate pain) and by injection (for intense pain). It is recommended to combine with local products from the same group (cream, gel, ointment). Representatives: Diclofenac, Nimid, Analgin, Indomethacin, Baralgin, Pentalgin, etc. The frequency of oral administration is 1-4 times a day, injections are 1-2 times a day.
Muscle relaxants. Relaxes the back muscles and smooth muscle fibers in the walls of blood vessels, reduces pain, restores posture and mobility of the spinal column. Representatives: Mydocalm, Tizalud, Tizanil, Baclofen, etc. The frequency of administration is 1-2 times a day.
Chondroprotectors. Accelerate the restoration of affected cartilage tissue and prevent further development of the disease. The course of treatment with these drugs is long, at least several months. Representatives: Mucosat, Chondroitin sulfate, Artron Complex, Artra, etc.
Angioprotectors. They restore patency in blood vessels, normalize and accelerate gas exchange and metabolism between blood and tissues, improve the condition of the vascular walls, and reduce tissue swelling. Representatives: Pentoxifylline, Detralex, Troxevasin, Ascorutin, etc.
Biological stimulants. Stimulate and accelerate metabolic processes and natural mechanisms of fighting the disease, increase the rate of tissue restoration, restore blood flow and conduction of nerve impulses. Representatives: Aloe, Plazmol, FiBS, etc.
Vitamins. They accelerate metabolism, blood supply to tissues, nerve conduction, improve tissue restoration processes, and reduce the development of the disease. Representatives: Milgamma, B vitamins (B1, B2, B6 and B12).
Metabolic agents. They accelerate metabolic processes, restore blood flow and gas exchange in tissues, and activate natural mechanisms to combat the disease. Representatives: Mildronate, Trimetazidine, etc.

Patients often hear from an orthopedist-traumatologist the diagnosis of “dorsalgia.” What is this? What danger does this unknown phenomenon pose to the body? Dorsalgia is a pain syndrome in the back. Negative sensations vary in degree of intensity, localization, and the reasons against which the discomfort developed.

The Latin root "algia" means pain in the words lumbodynia, thoracalgia, cervicalgia, sacralgia. Why does pain occur? Is it possible to quickly get rid of painful manifestations? The answers are in the article.

Reasons for the development of pathologists

According to the observations of doctors, most often pain in the back area appears against the background. With a severe degree of pathology, noticeable destruction of the vertebrae, the patient feels discomfort even at rest.

The vertebral bones are separated by a nucleus pulposus filled with fluid. With age-related changes, under high loads, cracks appear in the shell, some of the liquid leaks out, and the “lining” that prevents abrasion of the bone tissue decreases. With osteochondrosis, protrusions of the affected nucleus (hernia) are often noted, a nerve is often pinched, and painful sensations occur.

Other causes of pain:

severe;
microtraumas, cracks, fractures of vertebral bodies;
tuberculosis, tumors in various parts of the spinal column, provoking the formation of bone growths - thorns, causing pain.

Destruction of bone tissue, decreased elasticity of cartilage pads, lack of nutrients, poor blood circulation in the problem area are a consequence of negative factors.

Often, patients do not attach importance to mild pain, their lifestyle remains the same, and there is no talk of changing their occupation. After a certain time, problems in various areas of the back become more pronounced.

It is important to know what factors accelerate damage to the vertebral bodies and intervertebral discs. It's time to listen to negative feelings in the following cases:

presence of extra pounds;
high physical activity;
heavy work associated with lifting and moving heavy objects;
pathologies of internal organs;
uncomfortable posture during the working day, causing excessive stress on the back muscles and spinal column;
depression, psycho-emotional overload for a long period;
drafts, frequent hypothermia;
hormonal imbalances during pregnancy and menopause;
lack of sufficient range of motion, working at a computer;
injuries;
harmful production factors;
lack of microelements, especially calcium, in foods that appear on the table every day.

Characteristic symptoms

Localization of pain syndrome:

sacralgia – coccyx area;
– lumbar region;
Thoracalgia – pain in the thoracic region;
Cervicalgia – discomfort in the neck area.

Negative signs depend on the nature of the pain. The classification is based on the causes of the development of pain.

Doctors distinguish two types of back pain:

reflex. The main reason is degenerative processes in the intervertebral disc. The destruction of the shell of an important element is provoked by chemical processes to protect other tissues of the spinal column. Against the background of certain reactions, muscle tissue becomes tense and a dull, aching pain appears. The muscles are dense, spasmodic, the pain syndrome does not depend on the nature of the movements;
compression Negative symptoms occur when nerves and blood vessels are compressed. Often the pain radiates to the leg or arm; on the compression side, the limb gradually becomes thinner due to loss of muscle mass. Characteristic symptoms of compression of sensitive tissues: a feeling of “pins and needles” in the arm or leg, tingling, numbness of the limbs, limited mobility of the arm or leg on the affected side.

Important! Vertebrogenic pain is associated with pathological changes in the spine. Dorsalgia of a nonvertebrogenic nature develops against the background of the action of psychogenic factors, with somatic diseases, fibromyalgia.

Symptoms of dorsalgia in the cervical region

It’s time to contact a traumatologist-orthopedic surgeon if the following signs appear:

pain occurs when the body is in an uncomfortable position, discomfort spreads along the back of the neck;
discomfort disappears when changing position or stopping activities that caused pain;
unpleasant sensations have a short duration;
Often the “shots” radiate to the neck or arms, the problem areas are heavy and “cotton-like”.

Pain syndrome in the thoracic region

Characteristic signs will help to suspect damage to cartilage and bone tissue in the spinal column:

with ossification of the joints between the vertebrae, the elasticity of the spinal column decreases, movements are more limited;
in the thoracic region, the ribs connect to the vertebrae; as bone formations grow, the affected areas thicken. Any careless movement or higher load provokes pain;
discomfort often occurs during sleep when a person stretches;
a characteristic sign of dorsalgia in the thoracic region is that the strength of the pain changes with movement;
the pain syndrome manifests itself more clearly with a deep breath;
with intercostal neuralgia, lumbago on the side of the ribs is very painful, after the painful sensations subside, an unpleasant feeling of burning tissue in the lumbago area remains;
When the shoulder blades are brought together, a crunching sound is often heard, and a feeling of heaviness remains for a long time;
Dorsalgia of the thoracic region is often confused with an attack of angina.

Signs of tissue damage in the lumbosacral region

Peculiarities:

The risk group is men aged 40 years and older, engaged in hard work (age-related changes in the vertebrae and cartilage tissue are affected). Pain syndrome often occurs at an earlier age with high loads on the limbs and spine;
At the peak of the load, a characteristic sign was noted - lumbar lumbago. Painful symptoms limit the patient’s mobility: the person is afraid to move so as not to provoke a new attack of pain;
discomfort often manifests itself on one side: aching pain occurs when a nerve root is pinched;
When a shooting occurs, the body tries to ease the acute symptoms, and the lower back muscles automatically relax. For this reason, the patient is in a half-bent position;
pain often spreads to the groin, buttocks, and lower extremities. With dorsalgia of the lumbosacral region, slight lameness develops.

General rules and effective treatment methods

It is possible to eliminate pain, prevent relapses, and reduce the negative impact on the body only after establishing the exact cause of the pain and the factors that increase the risk of developing dorsalgia. During diagnosis, the patient is examined by an orthopedic traumatologist, has an X-ray of the spine, MRI and CT scan. The help of a neurologist, therapist, or endocrinologist is often required. Depending on the identified diseases, the patient often visits two or three specialists during the treatment period.

Therapy goals:

determine the cause of pain and negative factors;
stop the destruction of cartilage tissue and vertebral bodies;
reduce pain syndrome;
eliminate compression of nerves and blood vessels, reduce the risk of necrosis of the affected areas;
remove or reduce the strength of neurological symptoms (“goosebumps”, decreased sensitivity, numbness of the arms and legs);
restore the speed of metabolic processes, normalize the supply of oxygen and nutrients to the affected intervertebral discs;
restore functionality to problem areas of the spinal column. Compliance with this point restores the patients’ ability to work.

application of European standards for the treatment of nonspecific pain in the back;
short courses of group drugs. In severe stages, the duration of use of NSAIDs reaches three months. Diclofenac, Ortofen, Indomethacin, Nise, Ibuprofen, Voltaren Emulgel, Ketoprofen;
medications that reduce muscle spasms. Central muscle relaxants are effective: Mydocalm, Sirdalud;
injections of B vitamins. The combination of vitamins B12 and B1 improves neurohumoral regulation, prevents seizures, which often accompany the use of potent drugs;
painkillers. The most commonly used drugs are paracetamol-based. For acute pain, to relieve attacks (painful shooting), paravertebral blockades with hormonal agents and anesthetics, the drug Ketanov (up to five days), are allowed.

Helpful Tips:

During the treatment of dorsalgia, it is important to maintain physical activity: bed rest is not the best way to eliminate pain;
only in severe cases, during an attack it would not hurt to reduce the load on the back and limbs;
You cannot lie in bed for a long time: muscles weaken, blood circulation worsens, the risk of thrombosis increases, there is insufficient nutrition and oxygen supply to tissues;
Lack of reasonable exercise slows down metabolism, and the healing process is delayed.

To eliminate problems in the thoracic, cervical and lumbosacral spine, other methods of therapy are used: in this article.

optimal loads on the spine and limbs: the health of bone and cartilage tissue is at risk, both with hard work and with low mobility;
You cannot stand in one place for a long time; it is harmful to sit for several hours without a break;
you need to eat right, focus on foods that support the quality of the tissues of the musculoskeletal system;
morning exercises are the easiest way to keep your muscles toned. Flexibility of the spine, good health, prevention of joint diseases and vertebrogenic pathologies, improved metabolism are not all the “advantages” of regular exercise;

The term dorsalgia (nonspecific back pain) has recently begun to be used to refer to benign nonspecific back pain. Usually the term dorsalgia used to refer to back pain syndromes of unknown origin (except when there are red flag symptoms, fibromyalgia or psychogenic pain). But basically the term dorsalgia refers to pain syndromes in the back, caused by dysfunctional degenerative-dystrophic changes in the musculoskeletal system; pain syndromes can be accompanied by irradiation of pain in the limbs.

Dorsalgia (nonspecific back pain) is very common. Only a few can state the absence of episodes of back pain in their lives; Most people experience back pain occasionally, and for some, back pain is chronic. Chronic nonspecific back pain ( chronic dorsalgia) is most often localized in the lumbosacral region and in the back of the neck. In industrialized countries, low back pain is the most common cause of disability in people under 45 years of age. If the pain syndrome lasts up to 6 weeks, then we are talking about acute dorsalgia. If the pain syndrome lasts more than 12 weeks, then the term chronic dorsalgia is used. And if acute dorsalgia, as a rule, has a good prognosis, then in the case of chronic dorsalgia, disability can be quite significant. For example, in the United States, approximately 80% of people will experience episodes of low back pain during their lifetime. Approximately 20% experienced prolonged pain, and in 2-8% of cases the pain became chronic. Every year, about 3-4% of people were temporarily disabled, and in 1% of cases there was permanent disability in patients of working age.

Dorsalgia is divided into acute and chronic dorsalgia and by localization (thoracalgia, cervicalgia, lumbodynia).

According to the genesis of development, they distinguish: spondylogenic dorsalgia, associated with degenerative changes in the spine, spinal injuries, infectious or oncological lesions of the spine, and non-vertebrogenic dorsalgia, which is caused by changes in muscles, ligaments or somatic diseases, since the pain syndrome can be of a reflected nature or of a psychogenic nature.

Vertebrogenic (spondylogenic) dorsalgia in most cases is caused by degenerative changes in the spine and a group of syndromes can be observed:

Reflex syndromes (lumbar ischialgia, cervicalgia, cervicobrachialgia)
Muscular-tonic syndromes
Compression syndromes (radiculopathies)
Spinal cord compression syndrome (myelopathy)

Causes of dorsalgia

The center of gravity of the human body is located in the lumbar spine and this section bears the greatest load. The lumbar spine, due to its slight forward bending, can withstand heavy loads. But unlike the thoracic spine, the lumbar spine does not have lateral support. The shock-absorbing (support) function in the spine is performed by intervertebral discs, which provide 70% support for the spine under load. The intervertebral disc consists of 90% water, but as the body ages, especially after 45-50 years, the water content in the disc decreases significantly, which leads to disruption of both the supporting and shock-absorbing functions of the intervertebral disc. Due to the disturbance in the distribution of loads, there is an increase in loads on the facet joints, which in turn leads to damage to the facet joints and compensatory growth of bone tissue (osteophytes). Such changes in the facet joints are a normal compensatory reaction of the body to degenerative changes in the intervertebral discs and clinical manifestations of this process appear only in case of an excessive reaction of the body and when osteophytes begin to affect nearby nerve structures.

Discogenic pain

Research has shown that the intervertebral disc and other structures of the motion segments can cause pain. At the same time, it is not clear why mechanically caused back pain tends to become chronic, since in theory the duration of the pain syndrome should fit within the period required for regeneration, as usually happens when soft tissues or joints are damaged.

Inflammatory factors may play a role in some cases of discogenic pain, and then the effectiveness of epidural steroids may be quite high. Corticosteroids inhibit the production of arachidonic acid and its metabolites (prostaglandins and leukotrienes) and inhibit phospholipase activity. A 2. Studies have shown high levels of phospholipase A2 in herniated discs (removed during surgical treatment).

It is hypothesized that phospholipase may have a dual function by initiating disc degeneration and sensitizing the nerve endings of the annulus fibrosus.

Radicular pain

The pathophysiology of such a well-known syndrome as radicular pain is still not clear.

Etiologically, the pain is thought to be due to nerve compression resulting from foraminal stenosis, ischemia, and inflammation. Radiculopathy often has a multifactorial origin and is more complex than just a reaction to mechanical compression. In clinical practice, structural nerve damage may play a role if inflammation is present. However, the administration of steroids epidurally or pararadicularly is practiced quite often, although the long-term effect of such manipulations is very controversial.

Facet joint syndrome

The superior and inferior articular processes of the vertebral plate form the facet joints. Together with the intervertebral discs, they withstand the effects of compression forces on the vertebrae. Following injury or inflammation of the facet joints, pain, joint stiffness, and degenerative changes may occur. Oddly enough, there is no clear correlation between the results of neuroimaging and pain, and therefore the diagnosis is sometimes made on the basis of clinical data (characteristic pain in the lower back with irradiation to the buttocks or anterior thigh, which intensifies with retroflexion of the back or rotation of the back). Unfortunately, both steroid injection and electrical ablation of the nerves innervating the facet joints do not provide lasting results.

Sacroiliac pain

The sacroiliac joints are innervated from a root that emerges at the level of the first sacral vertebra. Arthrography or injection of irritant solutions into the sacroiliac joint provokes the appearance of various local pain and reflected pain patterns in the buttock area, lumbar region, and lower extremities. Certain tests (such as the Patrick maneuver) may also cause typical pain. Local blockades and the use of physiotherapy and exercise therapy methods can sometimes achieve remission. If pain in the sacroiliac joints occurs in young men, then it is necessary to exclude ankylosing spondylitis.

Muscle pain

Muscle pain is the most common cause of back pain (including chronic pain). Pain receptors are very sensitive to various mechanical stimulation and biomechanical overloads. Anxiety and depressive states play an important role in the formation of chronic muscle pain due to the formation of cyclical persistence of muscle tension. Muscle pain is often referred to as myofascial pain syndrome if there are muscles in a state of spasm, increased muscle tone, stiffness and trigger points. In many patients, myofascial pain is the result of a combination of factors: individual hyperresponsiveness of muscle tissue, direct or indirect trauma, the accumulation of effects from repetitive muscle strain, postural dysfunction and deterioration of general physical condition. At the cellular level, this occurs due to abnormal and constantly increased release of acetylcholine at the neuromuscular junction, which leads to frequent muscle contraction and a pathological repeating cycle is formed. If muscle pain does not disappear within several weeks (up to 6 weeks), then we can talk about a complex chronic pain syndrome with physiological, psychological and psychosocial components. And therefore, in such cases, when local treatment is not able to provide a lasting effect, then the use of a complex of diagnostic and therapeutic measures (multimodal therapy) is required. If complete therapy is not prescribed in a timely manner, the effectiveness of even multimodal therapy may be low.

Symptoms

Back pain that lasts more than 3 weeks with the presence of functional impairment requires special attention, since it is necessary to identify serious causes of such pain, for example, malignant formations (metastases to bone tissue), inflammatory processes (for example, spondylodiscitis), instability of segments ( e.g. spondylolisthesis) or local compression (spinal or foraminal compression). Typically, serious causes of back pain occur in 5% of cases. The greatest alertness in case of pain for three weeks should be in relation to non-mechanical causes of pain - malignant diseases and infections. Typically, intense back pain at rest is most often a sign of a serious illness (cancer or infection). The presence of serious causes of pain (specific pain) in the back may include the following symptoms (red flags):

Paroxysmal pain or pain associated with visceral disorders.
A history of cancer, chronic fatigue, weight loss.
Fever or immunodeficiency.
Old age and the presence of osteoporosis.
Progressive neurological deficit or dysfunction of the pelvic organs.
Severe stiffness in the morning as the main complaint.
For nonspecific mechanical back pain, the following red flag symptoms are significant:
Dissociation between verbal and nonverbal expressions of pain
Affective description of pain.
Low pain modulation with prolonged intensity.
Presence of previous trauma.
Signs of depression (difficulty falling asleep, waking up earlier, decreased interest in life) and anxiety.
The need for the use of psychoactive substances
A history of unsuccessful surgical or conservative treatment.

Diagnostics

Intense pain at rest for 3 weeks and the presence of “red flag” symptoms usually suggest the presence of a serious illness (tumors or infections). In such cases, it is necessary to conduct instrumental research methods (visualization) using methods such as radiography, MRI, CT (MSCT). If there are signs of progressive neurological deficit, then imaging should be used as quickly as possible and the patient should be transported to a clinic where studies (MRI, CT, radiography) can be performed. X-rays can diagnose fractures, cancer, metabolic changes in bone tissue, infections and inflammatory changes in bone tissue. But it is often necessary to use more informative diagnostic methods, such as MRI or CT, especially when it is necessary to visualize in more detail changes in bone tissue and, especially, in soft tissue. In this regard, MRI is the most informative research method, allowing high-quality visualization of even minor morphological changes in both soft and bone tissues, this is especially necessary if it is necessary to diagnose damage to the nervous tissue of the muscles of the disc ligaments.

If it is necessary to identify focal changes in tissues, scintigraphy can be prescribed, which makes it possible to verify oncological or infectious diseases.

ENMG makes it possible to determine conduction disturbances in nerve fibers and is often used to monitor the dynamics of the disease and the effectiveness of treatment.

Laboratory research methods are used when it is necessary to verify inflammatory oncological and infectious processes.

Treatment

Bed rest is necessary only for acute radiating pain (for example, sciatica) and should not last more than 1-3 days, as this avoids the progression of a decrease in physical activity and the appearance of pathological behavioral dominants.
With all nonspecific myofascial pain, lack of physical activity will have a devastating physiological effect, leading to muscle and other soft tissue wasting, joint hypomobility, decreased muscle strength, and bone demineralization. Therefore, bed rest is generally not recommended. Patients are advised to maintain normal physical activity as much as possible. Bed rest leads to the patient developing a fear of movement and the formation of a pathological behavioral cycle.

Drug treatment often prescribed for dorsalgia and, moreover, long-term, unjustified prescription of NSAIDs is carried out, which not only do not have a pathogenetic effect, but also cause a lot of side effects. The use of NSAIDs is justified for acute pain and for a short period of time. For dorsalgia (nonspecific pain), central muscle relaxants are also prescribed to relieve muscle spasm. If we are talking about chronic pain syndrome, the prescription of antidepressants is justified, since in chronic pain syndrome the central link of pain sensations is in the foreground. Strong analgesics such as opioids are indicated for pain caused by spinal cancer or serious degenerative changes.

Blockades with the introduction of local anesthetics and steroids are quite effective if there are clear indications for their use (for example, blockades in the area of trigger points or paravertebral blockades).

For dorsalgia, non-drug treatment methods, such as physiotherapy, massage, manual therapy and exercise therapy, have become widely used. The use of a complex of these treatment methods often allows one to achieve good results (stable remission).

Spinal diseases, which are accompanied by pain, are a common phenomenon among modern people. Discomfort can occur due to a passive lifestyle, excessive physical activity, and sports injuries. Pain syndrome does not allow normal movement and reduces the quality of life.

Not all patients who suffer from recurring back pain know what is dorsalgia. This is not a pathology, but a clinical syndrome, which is manifested by painful sensations of varying intensity. This disorder can occur in patients of any age and gender. To get rid of unpleasant sensations, you need to identify the disease that provoked dorsalgia, and then begin to treat it. Dorsalgia is a symptom of various ailments, which are characterized by curvature of the spine, destruction of cartilage or bone tissue, mechanical injuries, etc.

Dorsalgia: Basics

Soreness occurs when nerve endings are pinched, inflammation develops, and physical damage to bones occurs. Moreover, the more intense the pain syndrome, the more damaged the nerve tissue is. If the nerves are located near the spinal column, then the likelihood of pinching the spinal cord increases, and this can lead to serious complications.

Reference. Dorsalgia of the thoracic spine is quite insidious, as it often has a gradual course. This is due to the fact that the thoracic segment is inactive, so the signs of the disorder are less pronounced. For this reason, patients seek medical help late, when the disease becomes chronic.

The main symptom of the syndrome is pain, other symptoms depend on the disease that provoked the disorder. To diagnose dorsalgia, it is necessary to conduct instrumental as well as laboratory tests. Treatment tactics are drawn up after determining the cause of the disorder. Most often, conservative therapy is performed. The code for dorsalgia in the international classification of diseases is M 54, and for a syndrome of unspecified origin is M 54.9.

Reference. Dorsopathy is a whole group of pathologies of the spinal column, surrounding muscles, ligaments and other soft tissues. Dorsalgia is one of the types of dorsopathies, which manifests itself as pain.

Causes

Back pain can appear for various reasons; for convenience, predisposing factors are divided into groups:

1. Pathologies of the spine:

osteomyelitis is a purulent-necrotic disease that affects bone, bone marrow, and surrounding tissues;
osteochondrosis, which is complicated by intervertebral hernia;
osteoporosis – decreased bone density, increased fragility;
spondylolisthesis – displacement of the vertebrae relative to each other.
curvature of the spinal column;
spondyloarthrosis is a pathology characterized by damage to all components of the bone joint, especially the cartilaginous lining;
tuberculosis of bone tissue - progressive destruction of bones;
protrusion – protrusion of the nucleus pulposus of the intervertebral disc without rupture of the outer shell;
spinal canal stenosis;
fractures and other bone injuries.

Reference. Spondylogenic dorsalgia is usually diagnosed with degenerative disorders of the spine.

2. Muscle disease:

fibromyalgia – musculoskeletal pain;
Crick;
inflammation of skeletal muscles;
involuntary muscle contraction.

3. Other reasons:

bleeding of the pelvic organs;
purulent hematomas in the retroperitoneal space;
diseases of the digestive organs, kidneys;
dissecting aortic aneurysm - rupture of the largest artery and its further dissection with escaping blood;
shingles;
rheumatological diseases.

Important. The likelihood of dorsalgia increases with massive injuries, lifting heavy objects, prolonged exposure to an uncomfortable position, and frequent hypothermia. In women, the disorder may appear during pregnancy or menstruation. Dorsalgia often occurs in patients with psychological disorders (frequent depression, anxiety).

Types of syndrome

Doctors distinguish several forms of dorsalgia syndrome:

1. At the location of pain:

cervicalgia – painful sensations appear in the cervical spine;
lumbodynia – discomfort is localized in the lumbar segment;
Thoracalgia – pain appears in the thoracic area.

Reference. Pain in the lumbosacral region is diagnosed more often than other forms of the syndrome.

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2. According to the duration of painful sensations:

acute – pain does not disappear within 6 weeks. This form of dorsalgia is easier to treat;
chronic – Discomfort does not disappear for 3 months or more. This form of disorder threatens with loss of ability to work and disability.

3. By etiology:

vertebrogenic – pain occurs due to injuries, as well as diseases of the spine;
nonvertebrogenic – pain syndrome is associated with somatic diseases or psychogenic disorders.

It is important to determine the form of dorsalgia in order to develop treatment tactics.

Symptoms

The main symptom of dorsalgia is back pain, which can be constant, paroxysmal, aching, or sharp. Regardless of the nature, pain discomfort increases with physical activity. As mentioned above, dorsalgia is provoked by various diseases, so its manifestations also differ in each individual case.

Symptoms of dorsalgia caused by rheumatological pathologies:

pain occurs in the lumbar region;
pain spreads to the buttocks, thighs;
when the body is at rest for a long time, the discomfort intensifies;
bilateral spinal column injury.

If the pain is caused by infections, then dorsalgia manifests itself with the following symptoms:

sharp pain along the entire length of the spine;
pain is localized in the lower back, buttocks, legs;
The skin on the affected area turns red and swells.

Clinical manifestations of the disorder arising from muscle diseases:

pain syndrome spreads along the left or right side of the torso;
discomfort becomes more pronounced with acclimatization or stress;
painful points appear in different parts of the body, which can be found by accidentally pressing them;
muscles weaken.

Symptoms of dorsalgia against the background of osteochondrosis and spondyloarthrosis:

pain increases when the patient turns or bends over;
unpleasant sensations appear when a person does not change position for a long time;
there is a feeling of numbness, tingling in the upper or lower extremities;
muscle tone decreases;
the patient suffers from frequent headaches and vertigo (dizzy);
hearing and vision disorders appear;
long-term and persistent muscle tension occurs, painful compactions (trigger points) form in them;
the mobility of the spine is impaired.

Reference. In case of kidney damage, dorsalgia is manifested by pain in the lower abdomen, frequent urination, in diseases of the digestive organs - girdle pain, in case of lung pathologies - pain in the chest and shoulder blades.

Most often, the discomfort goes away with treatment at home. The following symptoms indicate a serious medical problem:

the pain syndrome does not stop within 3 days;
the patient does not control urination and defecation;
the pain appeared after a fall from a height or a direct blow;
severe pain does not disappear even at night;
sensitivity in the lower extremities decreases;
discomfort is accompanied by rapid weight loss;
swelling appeared on the back.

You should urgently seek medical help if pain first occurred after age 50, you have previously been treated for cancer, taken steroids, or you have been diagnosed with osteoporosis.

Establishing diagnosis

If symptoms of dorsalgia appear, you should contact to a neurologist. First, the specialist analyzes the medical history to find out the cause of the pathology. Then a visual examination is carried out, the doctor palpates the spinal column to describe the status of the localis (the location and area of the lesion), and evaluates the amplitude of its movements. To do this, he conducts a test on the patient's ability to sit, stand, move, and raise his legs. A special hammer is used to test reflexes. Then he asks the patient about his sensations in order to identify the nature of the pain and other symptoms, as well as the degree of their severity.

To clarify the diagnosis, the neurologist prescribes hardware tests:

X-rays can detect pathological changes in the structural elements of the spine;
Electroneuromyography is used to assess muscle condition;
Ultrasound densitometry helps determine the degree of mineralization of bone tissue;
Computed tomography and magnetic resonance imaging allow a detailed examination of the spine. These techniques are used to evaluate bone tissue, intervertebral discs, muscles, ligaments, nerves, blood vessels;
Skeletal scintigraphy is performed using radiopharmaceuticals. This diagnostic method allows you to identify the location of the pathology (for example, lumbar dorsalgia).

If a neurologist suspects that the syndrome was provoked by some other disease that is not within his competence, then he refers the patient for a consultation with a vertebrologist, rheumatologist or orthopedist.

Treatment methods

To get rid of pain, you need to eliminate the underlying disease. Treatment of the spine should be comprehensive; for this, the following actions and techniques are used:

Complete peace. Immediately after discomfort occurs, the patient should remain in bed most of the time. It is advisable to follow this rule for 2 to 5 days.
To relieve the load on the spine, it is recommended to wear special corset.
Traction of the spine in a vertical position- This is an effective and gentle method of getting rid of many problems, for example, intervertebral hernia. With its help, it is possible to slow down further destruction of the discs and improve their trophism (nutrition).
Physiotherapy carried out only after the pain has subsided.
Massage normalizes muscle tone, improves local metabolic processes.
Effective alternative treatments for dorsalgia include leech treatment, reflexology.
Used to eliminate pain and inflammation NSAIDs in the form of tablets, injections, ointments. They will help to relax spasmodic muscles and eliminate acute pain. muscle relaxants.

Surgical treatment is performed extremely rarely. Doctors decide to perform surgery if the pain caused by cervical, thoracic or lumbar dorsalgia is not relieved by conservative methods for a long time. Warning signs include pain and numbness in the lower extremities, further weakening of the muscles, etc. However, doctors do not guarantee that the discomfort will go away after the operation. If an intervention is performed to remove a vertebral hernia, then patients need to know that there is a risk of its recurrence.

Reference. The need for surgical intervention appears in cases of bone tissue infections, cancer, and intervertebral hernias.

The operation must be performed for osteomyelitis; during the procedure, the surgeon opens the vertebral body to remove the abscess and dead tissue.

Preventive measures

To avoid such an unpleasant and dangerous disorder as dorsalgia, The following recommendations must be followed:

accustom yourself to sit with a straight back, if necessary, lean on the back of a chair, but do not hunch over;
treat diseases that can cause back pain in a timely manner;
for sedentary work, buy a chair with an orthopedic back;
purchase an orthopedic mattress, low pillows;
avoid excessive physical activity;
control your weight, try to keep it normal (you can’t quickly gain weight or lose weight);
undergo a medical examination at least once every six months.

The most important

Dorsalgia is not a deadly disease, but it requires competent comprehensive treatment. If pain, numbness, limited mobility or other suspicious symptoms occur, consult a doctor. To get rid of discomfort, you need to eliminate its main cause. Typically, conservative methods are used for treatment. The operation is prescribed only for severe pain that is not relieved by medications, or numbness of the limbs. To avoid dorsalgia, try to monitor your posture, use orthopedic furniture, bedding, control your weight, and promptly treat diseases that are accompanied by back pain. published .