Back pain is severe

Back pain, neck pain and lower back pain

Every tenth visit to the family doctor's practice and every second visit to an orthopedic surgeon is due to back problems. Since it is often accompanied by pain, those affected generally speak of Back pain, which is even more detailed in Neck- or Lower back pain let subdivide. The causes are manifold and often combined, they range from degenerative spinal diseases to poor posture and tension to psychological stress.

If back pain lasts for more than six weeks, it becomes too chronic back pain. They lead to severe restrictions in everyday life and often require long-term sick leave. As the pain persists, those affected feel worn down and psychologically stressed.

Depending on the cause, back pain is treated with medication, physiotherapy, physical measures, and surgical procedures. The central pillar is regular physiotherapy with strengthening the core muscles, supported by a back-friendly lifestyle.

Leading complaints

  • Pain in the back, especially in the neck or lower back, when moving or at rest
  • Pain can be radiated into neighboring areas of the body, e.g. B. from the cervical spine in the head, shoulders and arms, from the thoracic spine to the chest and from the lumbar spine in the abdomen, hips and legs
  • Sometimes accompanying sensory disturbances or muscle weaknesses or even symptoms of paralysis.

The illness

The frequency of back problems is not surprising in view of the fact that every spine shows significant signs of wear and tear from the age of six at the latest. You express yourself z. B. in damage to intervertebral discs and vertebral body bones, arthrosis of the intervertebral joints and in bone attachments on the vertebral body edges (spondylophytes). On the one hand, considerable damage is often associated with surprisingly little discomfort, on the other hand, even minor changes can sometimes lead to severe pain.

For the doctor, it is difficult to find out the actual cause of back pain in individual cases. Highly tense parts of the back muscles that support or move the spine are possible triggers as well as constrictions or irritations of parts of the spinal cord or of nerves that leave the spinal cord in the spine. The same applies to many accompanying structures such as intervertebral discs, bones, joints and even pelvic organs.

Typical causes of back and lower back pain are e.g. B. the following diseases, which can occur alone or in combination:

Despite thorough examinations, the doctor often cannot find a clear cause for the symptoms. Because that is complicated System spine reacts quite similarly to very different disturbances. If the painful area is in the lumbar spine, it is therefore also referred to as a lumbar spine syndrome, pain in the throat and neck, and the cervical spine syndrome.

Vicious circle caused by muscle tension

Whoever or whatever triggered the pain, the pain stimulus always leads to reflex muscle tension. If the stimulus continues, the muscles cramp, creating tension. It ensures that the neighboring sections of the spine are also included in the pain process. In this way, a vicious circle arises that is strengthened and entertained independently of the triggering stimulus. Similar vicious circles are also triggered in the spinal cord and brain, where back pain is processed.

These mechanisms build up in such a way that the pain eventually becomes independent. Regardless of the original trigger, the pain is then in the foreground. In this case, the treatment of such chronic back pain problems belongs in the hands of specially trained pain therapists. These complement the treatment with relaxation techniques, e.g. B. Autogenic training or progressive muscle relaxation according to Jacobson as well as psychotherapeutic methods.

Diagnostic assurance

Because of the frequency of back pain in everyday practice, the doctor often initially refrains from determining the exact cause of the back pain. Rather, it is first clarified whether a dangerous or non-dangerous situation is present. Dangerous are v. a. Impending nerve damage or paralysis due to narrowing of the spinal canal and the nerve exit holes. Such emergency situations can usually already be recognized by the physical examination and confirmed by X-rays, CT or magnetic resonance imaging, in case of doubt also by special examinations such as measuring the nerve conduction velocity.

If dangerous causes are excluded, further examinations of the spine are not necessary because X-ray, CT and magnetic resonance findings often do not match the symptoms.

However, if there is no improvement within a few weeks despite treatment with medication and / or the best-known therapy methods, research into the cause is necessary. Now technical investigation procedures are used, e.g. B.

Note: Even if the doctor succeeds in uncovering the cause of back pain in this way, this knowledge rarely changes anything in the treatment.

Differential diagnoses. Occasionally, back pain can also be the cause of serious diseases of internal organs, such as heart attack, pleurisy, cracks and bulges in the main artery, pancreatitis or kidney stones. In women, low back pain can also be caused by gynecological diseases.

Note: The psyche is always involved in the extent of chronic back pain, either as a dampener, as an amplifier or even as a trigger. Back problems are among the most common somatoform disorders.

treatment

In the case of acute back pain, the pain must first be relieved:

  • Painkillers, massage, heat or cold (depending on individual needs) and various electrical currents have direct pain relieving effects. Complementary medical measures such as acupuncture and manual therapy also have their place here.
  • Even if many of those affected spontaneously prefer to lie quietly on the sofa, current treatment guidelines recommend that you go about your everyday life and move around a lot. This is the only way to prevent the muscles from tensing up again and the vicious circle from starting all over again. The German Society for the Study of Pain (DGSS) also found out in a study that bed rest promotes the chronicity of pain.

Pharmacotherapy

Painkiller.If back pain is so severe and persistent that it disrupts the daily routine, we recommend taking painkillers such as diclofenac (e.g. Voltaren® or Diclac®), ibuprofen (e.g. Ibu® or Brufen®), or regularly over several days Etoricoxib (e.g. Arcoxia®). Because of the numerous side effects, the pain relievers should not be taken for more than three days without a doctor's prescription and control.

If this is not enough, the doctor often prescribes a combination with stronger painkillers. Here comes z. B. Metamizol (e.g. Novalgin®), but also weak opioids such as Tilidine (e.g. Valoron®) or strong opioids such as Fentanyl (e.g. Durogesic®). In the case of chronic back pain, antidepressants, e.g. B. amitriptyline or anti-epileptics, e.g. B. Prescribed gabapentin.

If the back pain is associated with severe muscle tension, muscle relaxants can help, z. B. Tolperisone (e.g. Mydocalm®). Most of the drugs in this group of drugs make you tired as a side effect and thereby impair your ability to drive. When taken in the evening, this side effect can be used as a sleep aid.

Syringes or tablets? It is widely believed that drugs work better when injected. However, this assessment is wrong - injected drugs only work faster than tablets or suppositories. Local anesthetics are an exception, that can only be injected, and certain cortisone preparations that v. a. act at the injection site without causing severe side effects throughout the body. All other (pain) medications are just as effective as tablets or suppositories, as are injections into the spine or buttocks. In addition, complications occasionally occur with syringes when the injection needle has important structures, e.g. B. nerves and blood vessels, or brings in bacteria that cause infection.

Orthopedic injection treatment. In most cases, local anesthetics and cortisone preparations are used, which the doctor injects either superficially as neural therapy wheals or deeply into the tissue. With ultrasound, X-ray or CT control, injections can also be placed directly on the nerve roots next to the spine (periradicular therapy). A more complex treatment is the injection of local anesthetics, cortisone preparations and other substances into the space between the spine and the spinal cord (peridural infiltration), as precisely as possible to the painful area. It takes place via a thin tube (catheter) that the doctor inserts under X-ray control and leaves there for several days for repeated injections. The long-term effects of the latter methods are controversial.

Conservative treatment

Only a few back therapy procedures are based on scientifically substantiated proof of effectiveness; this also applies to some conventional medical therapies.

Note: In general, passive therapies, e.g. B. massages or mud packs, as a rule, do not have a long-term effect, even if they relieve the pain in the short term. They are active therapies such as B. inferior to physiotherapy, which builds up the muscular system and thereby supports the skeleton. With these, success is associated with effort and active cooperation and occurs more slowly.

Frequently prescribed therapies are:

Physiotherapy. Targeted exercises help build supportive muscle groups that stabilize the spine. They stretch tense and shortened muscles and thus improve back mobility. They also train coordination and body awareness, which in the long term leads to more back-friendly and healthier movement patterns.

Note: The effectiveness of physiotherapy has been scientifically proven for back pain, but only if the exercises are continued consistently (daily) at home.

Physiotherapy on machines (Exercise therapy). Targeted muscle building is supported by training on fitness equipment. With competent guidance from a specialist, it is an important treatment method with lasting effects for back pain.

Physical procedures.Physical procedures such as warmth (red light, fango, hot roller), cold (ice, alternating showers) and electricity (direct current, various alternating currents, TENS therapy) alleviate back pain, improve blood circulation, relax or activate the muscles. The effects can be measured in the short term; however, there is no long-term effectiveness.

Gentle exercise therapies.Yoga, Tai Chi and Qigong, Feldenkrais or progressive muscle relaxation according to Jacobson train body awareness with different focuses, change movement patterns and improve the coordination of movements. Although not originally developed as back therapy, these mind-body procedures have proven themselves in practice for the treatment of chronic and sometimes acute back pain. Scientific proof of effectiveness is also available, especially for yoga.

Back school. In addition to gymnastic exercises to strengthen the muscles and flexibility, the instructions for self-help also convey knowledge about behavior that is easy on the back. Health insurance companies, physiotherapists and rehabilitation clinics offer courses on this, the costs of which are often covered by the health insurance company. The back school is helpful for chronic back problems if the person concerned uses the techniques they have learned on their own in their everyday lives.

Physical therapy. Very effective, especially in combination with manual therapy. A muscle is first tensed against resistance, then you let it loose and the therapist can then stretch the muscle painlessly.

Operative treatment

Operations on the spine. Stubborn and chronic back pain alone is not a reason for surgery. Disregarding this fact has led to so many failures of operations in the past that a medical term has even become established for it: the Failed Back Surgery, the failed back surgery.

Operations are only necessary and promising if severe symptoms do not respond adequately to non-operative treatments and the symptoms can be traced back to clearly identifiable causes which can be surgically corrected.

Investigating the cause usually requires a great deal of diagnostic effort. The findings from imaging procedures, e.g. B. X-rays, CT and magnetic resonance are only meaningful if they match the symptoms and the results of the physical examination. Fortunately, doctors and patients are rarely under time pressure when deciding on surgical therapy; An exception are the few situations in which an impending nerve damage, e.g. B. forcing an immediate operation in the event of a herniated disc.

Relief operations. The aim is to relieve constricted nerves, e.g. B. with narrowing of the spinal canal (spinal stenosis). For this purpose, the surgeon * removes parts of ligaments and vertebral arches, possibly also pathological bone attachments (spondylophytes). The operation affects the stability of the spine only to a small extent; the overall structure is retained.

Stiffening operations (Spondylodesis). They are mostly used to stabilize an unstable section of the spine, e.g. B. in spondylolisthesis, vertebral sliding, vertebral fractures or bone metastases. Another area of ​​application for Stiffening operations is the correction of spinal curvatures, e.g. B. in scoliosis or severe Scheuermann's disease. The surgeon inserts screws into the vertebral bodies of the affected region and connects them with one another in the longitudinal and possibly transverse directions using rods. Often several intervertebral discs are also replaced by bone blocks or titanium implants. The actual stiffening is the task of the body and takes place in the following months, as the stabilized spine sections grow together. Since the stiffened segments no longer move against each other, the neighboring segments are exposed to increased stress; therefore, these often wear out prematurely and then cause pain in turn.

Scheuermann's disease is rarely so pronounced that an operation is necessary. In the example, the left x-ray shows a strong hump formation (kyphosis) in the thoracic spine area, which was corrected by an erectile stiffening operation (right). The screws in the vertebral bodies and the rods that connect them are recognizable.
Georg Thieme Verlag, Stuttgart

Vertebroplasty and kyphoplasty. These techniques are used to treat vertebral fractures caused by osteoporosis; But they are also used for severe pain caused by spinal metastases. In the Vertebroplastic (Vertebroplasty) the doctor injects bone cement into the vertebra and tries to stabilize the bone substance and prevent further deformation. The Kyphoplasty (Kyphoplasty) includes the same surgical steps, but the surgeon inflates the vertebra to its original height with a balloon before injecting the cement.

Further therapy methods

Laser acupuncture. Treatment with soft or low-level lasers is said to provide pain relief compared to classic needle acupuncture and have only minor side effects.

Denervation. In the case of painful wear and tear of the intervertebral joints (facet syndrome), the procedure of Denervation at. Targeted electrical impulses switch off those nerve fibers that transmit pain stimuli from the diseased joints. A thermal probe is used for this, which is brought to the nerves via a needle under local or brief anesthesia. The procedure eliminates the pain, but not its cause. In addition, it is difficult and time-consuming to correctly identify all of the painful intervertebral joints.

Your pharmacy recommends

What you can do yourself

Acute pain relief.

Without relieving the acute pain, those affected will hardly be able to get moving again at all. The following self-help options are available here:

  • Do not hesitate to take pain relievers for acute back pain.If you are otherwise healthy, there is nothing to prevent you from using non-prescription pain relievers such as diclofenac (e.g. Voltaren® or Diclac®), ibuprofen (e.g. Ibu® or Brufen®) or paracetamol (e.g. . ben-u-ron®). They help break the vicious circle of pain and tension.
  • Find a posture that will minimize your pain. Experience has shown that lying and walking are perceived as more pleasant than standing and sitting.
  • Many therapists recommend lying on your back with the hip and knee joints bent by 90 ° (stepped position, stepped bed position). For some people suffering from pain, lying on the prone with an elevated upper body or lying on the side with legs drawn up can also relieve pain.
  • When you have found a posture with little pain, try to consciously relax: breathe consciously and deeply, listen to music intensely, read an interesting book.
  • Go for a walk as soon as the pain allows. Walking slowly moves the back muscles gently and relaxes them at the same time.

Self-help with back pain

It is based on three principles: movement, movement and movement - as long as it doesn't hurt. The commitment of those affected in the context of self-help plays just as important a role as the treatment by the doctor. In addition to the treatment of back pain, this applies all the more to its prevention: Even after the most effective treatment, back pain returns if the person concerned does not continue to pay attention to their back in everyday life. However, in the long term, most people only do those types of exercise that they either enjoy or that can be easily integrated into their everyday lives.

  • If possible, go on foot or use the bike. Prefer the stairs to the elevator or escalator.
  • Do you do sports. Sports that are easy on the back and train the core muscles are swimming, aqua jogging, cycling, Nordic walking and cross-country skiing. Make sure you have good equipment (running shoes).
  • If this type of exercise suits you, start weight training at the gym. With competent supervision, you can specifically build up muscles that strengthen your back.
  • If you sit in the car a lot for work, buy a good car seat and use the breaks to walk around, stretch and stretch.
  • When you are in the office, do as much as possible while standing or walking. Such breaks in movement are particularly important in times of stress in order to prevent tension in the neck and back muscles. While sitting, change your position regularly, alternately leaning slightly forward, upright and leaning back.

Workplace ergonomics.

Work chairs with the "dynamic sitting" function make sense. They have a backrest that moves with you and supports your back at the same time. If you find it difficult to change your sitting posture frequently, choose a permanent sitting position that includes an angle of around 120 ° between your back and thighs. What used to be perceived as a sloppy posture has proven in more recent scientific studies to be significantly more back-friendly than a "straight" sitting posture with a right angle in the hip. The correct height of the table and chair is also important for workplace ergonomics. Ideally, the upper and lower arms as well as the upper and lower legs form at least a right angle. If the arms rest loosely on the armrests, this position relieves the shoulder area. Palm rests in front of the keyboard also relax the shoulders while typing, but are also good for the neck.

Work that is easy on your back.

If you do physical work, try to avoid activities that put strain on your back as much as possible. If this does not succeed, carry out the required work in a way that is easy on your back. Lift and carry objects with your back straight and evenly distributed on both arms. Carry heavy loads close to your body and absolutely avoid turning your upper body while standing. Better: crouch down instead of bending down as much as your knees allow.

Normalize weight.

Reduce excess weight. This not only relieves your back, but also increases the joy of movement and joie de vivre at the same time.

Complementary medicine

warmth

soothes and relaxes the muscles and thereby helps to relieve pain. Warm full baths (calming: lemon balm, lavender; stimulating and stimulating blood circulation: rosemary), warm wraps (hay flower, fango), hot water bottle or warming pillow in bed, blood circulation-promoting plasters (e.g. ABC warming plasters), rubs, for example, have proven to be useful. B. with horse ointment, warming underwear made of angora wool, woolen scarves or a visit to the sauna. Because of the circulatory stress, people with heart disease must first consult their doctor before treating themselves with full baths, diapers or visits to the sauna.

That is particularly effective hot role: Fold a kitchen towel and two terry towels lengthways. Wrap the kitchen towel width-wise into a tight roll. The other two towels are wrapped around them diagonally so that the whole thing looks like a funnel or like a candy that is only opened on one side. Now pour about three quarters of a liter of scalding water into the roll (be careful of burns!) And wrap the terry towels completely around the now wet inner roll. Check the heat. If the roll is too hot, wrap another terry towel around it. With this hot roller, roll, dab and massage over your back. When the roll gets cooler, take off a sheet of terrycloth. In acute irritation, cold sometimes works better than heat. Cool packs from the pharmacy or crushed ice cubes wrapped in a washcloth and placed on the painful area several times a day for 1–5 minutes have proven effective. To prevent frostbite, it is advisable to wrap the pads in a cloth and avoid direct contact with the skin.

Herbal medicine.

For severe acute back pain, standardized plant extracts are hardly an alternative to the generally effective, synthetically produced painkillers. Accordingly, pain relieving combination preparations such. B. ash bark in connection with quivering aspen (contained in Phytodolor® tincture, for example) is only recommended if the back pain is minor or subsiding.

If muscle tension is the cause of back pain, rubbing in with essential oils such as arnica oil, St. John's wort oil, rosemary oil or eucalyptus oil (e.g. contained in Dolocyl® muscle and joint oil) can alleviate the symptoms.

Homeopathy.

Homeopathy recommends an individually tailored constitutional remedy as an accompanying therapy, e.g. B. on physiotherapeutic measures. Here come, among other things. Aconitum, Bryonia, Nux Vomica, Rhus toxicodendron and Sulfur are possible.

Acupuncture.

The aim of inserting fine needles into standardized acupuncture points is to normalize a disturbed "energy flow". The effectiveness has been scientifically proven for chronic back pain. In the corresponding studies, therapy success was also seen when the needles were placed outside the intended points. Some critics therefore assume an unspecific effect.

Biofeedback.

The procedure, which is useful in chronic cases, visualizes states of tension and relaxation and enables back pain patients to deal better with situations that cause stress or pain.

Further information

Authors

Dr. med. Siegfried Locher in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:29


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.