Back pain

from Wikipedia, the free encyclopedia
Classification according to ICD-10
M54 Back pain
M54.0 Panniculitis in the neck and back region
M54.1 Radiculopathy
M54.2 Cervical neuralgia
M54.3 Sciatica
M54.4 Lumboischialgia
M54.5 Low back pain
M54.6 Thoracic spine pain
M54.8 Other back pain
M54.9 Back pain, unspecified
ICD-10 online (WHO version 2019)

When back pain all more or less strong are pain in the area of the spine called, regardless of its cause. In technical terms, pain in the are lumbar spine often as low back pain ( lumbago / lumbago ) or lumbar spine syndrome referred to as the thoracic either non-specific back pain or in the narrow sense pain in the thoracic spine called (there synonymously: BWS syndrome ). Cervical spine pain is often called neck pain, cervicalgiaor cervical spine syndrome . In the case of radiating pain in the extremities, one speaks of sciatica or lumbar sciatica in the area of ​​the lumbar spine, and of brachialgia or cervicobrachialgia in the cervical spine .

definition

According to duration:

  • Acute back pain : less than 6 weeks
  • Subacute back pain : 6 to 12 weeks
  • Chronic back pain : more than 12 weeks

Other definition by duration:

  • Acute back pain. occur either for the first time or within one day after at least six months of symptom freedom and last for a maximum of three months.
  • Temporary back pain. last for a maximum of three months and do not return within a year.
  • Recurring back pain. are present with more than one episode on less than half the days of a year.
  • Chronic back pain. are usually present with more than one episode on more than half of the days of the year.

The ancient names lumbago , Alpschoss , leg shot , bullet , witch sting , loin pain , shot or spear point to pre-scientific explanations.

As lumbago is popularly referred to a sudden, sharp pain in the back, by irritating the sensitive innervation spine is triggered d. H. of the nerves that supply the spine itself - not by compressing the spinal nerves emerging from the spine and supplying the rest of the body. It is a frequently acute onset, initially segmental, mostly stabbing low back pain, which is often associated with a feeling of paralysis, constrained posture, restricted movement, hard tension, pain in the spinous process, etc. After a pain-free interval, the transition to a chronic form may be possible. The demarcation to the nerve root irritations such. B. sciatica is not always easily possible. The doctor occasionally speaks of “ pseudoradicular symptoms ” when the area of ​​pain radiates but does not match the dermatome of a spinal nerve.

Epidemiology

Statistically speaking, 27–40% of people in Germany currently have back pain. About 70% have the pain at least once a year and about 80% complain of back pain at least once in their life. This means that Germans fall ill more often in an international comparison. However, comparisons are problematic. Of the sections of the spine , the thoracic spine ( thoracic spine ) is the least affected in terms of percentage of back pain and the lumbar spine (lumbar spine) is most frequently affected.

Back pain is by the infection of the respiratory tract , the second leading cause of doctor visits.

Back pain is most common in the 50 to 70 age group, but children are not excluded.

Back pain is the cause of 15% of all sick days. The economic importance of the various diseases of the spine is enormous. For most early retirement (18%), spinal complaints are more or less the direct reason for retirement. As part of the risk assessment , the key indicator method is intended to measure and ensure the health protection for workers when lifting, holding, carrying, pulling and pushing loads manually. In 2010, the economic damage due to chronic back pain amounted to around 17.5 billion euros.

causes

Recognizable causes of back pain, which are assigned to the combined specialist area of trauma surgery / orthopedics in a broader sense , range from vertebral fractures to herniated discs , spinal stenoses and gliding vertebrae to degenerative spinal diseases such as osteochondrosis . Inflammatory causes such as Scheuermann 's disease or Bechterew's disease and tumorous causes of the vertebrae can also lead to back pain.

After introducing manual medicine / osteopathy , nonspecific back pain can regularly be blocked , especially in the lumbar spine and sacroiliac joints . These can be primary or secondary.

(→ A comprehensive list of possible causes can be found under List of diseases of the musculoskeletal system and connective tissue according to ICD-10 )

In the case of pain in the back, the presence of internal diseases must always be considered ( Head's zones ). Breath-related pain can be caused by pleurisy , exercise-related pain can be caused by coronary artery disease, and diet-related pain can be caused by duodenal ulcer . Biliary colic often radiates to the right shoulder and occasionally to the back, and pancreatitis pain can also be projected into the back. Acute severe pain between the shoulder blades is the main symptom of aortic dissection , heart attacks and pulmonary embolisms can also present themselves in the form of sudden back pain. If you have pain in the lumbar spine, you should also consider kidney inflammation and kidney or ureteral stones . Also, shingles can cause unclear pain before the appearance of typical skin sores. In addition, gynecological diseases can also cause complaints in the lumbar spine region. Acute Lyme disease can also trigger wandering back pain.

As in all areas of the spine, psychosomatic difficulties can also play a role in the development of pain: The spine is an important "organ of success" for this. Formulations like: “Somebody has a hard time carrying something”, “That broke someone's back”, “Somebody has to crouch” are indications from everyday language that refer to this context. According to various studies, back pain has no organic cause in at least 40 percent of cases. They can therefore be traced back to psychological stress . Some psychosocial risk factors can be excessive demands, insults, inadequate job satisfaction, compulsive helper attitude, masochistic altruism, self-idealization. Pain states without an organic background can occur as a conversion of a depression.

Other causes can be, for example: tight muscles, poor posture, obesity, too little exercise, long periods of sitting, as well as everyday, emotional or professional stress.

Diagnosis

The anamnesis asks the pain characteristics, e.g. B. on what occasion the pain occurs and whether it is movement-dependent. The clinical examination should z. B. uncover anatomical differences in length of the legs and the resulting pathological changes as well as functional deficits (Schreiber in Hoffmann / Siegfried 2005). The clinical examination may also reveal swollen muscles and local tenderness. If a rib joint is involved, the associated rib stands out from the relief of the rib cage.

Apparatus diagnostics (conventional X-rays, computed tomography or magnetic resonance tomography ) are sometimes necessary, especially in the case of paralysis of the legs and disorders of the bladder and rectum function. However, the results of such imaging procedures for back pain should also be viewed critically. A randomized, controlled study from California by M. C. Jensen and others with MRI examinations of the lumbar spine of 98 symptom-free persons showed a protrusion of the intervertebral disc (s) in 52% of the examined, a herniated disc in 27% and a herniated disc with compression in 1% surrounding nerve tissue . 38% had abnormalities on more than one intervertebral disc (Schreiber in Hoffmann / Siegfried 2005).

Therapy and Prevention

As a preventive measure , "back-friendly" behavior in everyday life is essential, for example when lifting loads. Suitable gymnastic exercises and compensatory sport can have a supportive effect.

Treatment depends on the cause of the discomfort. The vast majority of episodes of pain are temporary and only require symptomatic therapy ( painkillers , physiotherapy , massage , fango, etc.). In the case of a benign course, rapid, targeted therapy can avoid the formation of pain memory . The guidelines of the orthopedic society and the Drugs Commission of the German Medical Association emphasize that only measures that involve the active cooperation of the patient are useful in the long term. Interventions with passivating therapies that are continued for months or years should be avoided because they promote the chronification of back pain.

A meta-analysis of studies on non-surgical treatment methods shows that non-steroidal anti-inflammatory drugs (NSAIDs) had significant effects on acute back pain . In the case of chronic pain, acupuncture and behavioral therapy measures helped in particular .

Osteopathy , manual medicine , relaxation exercises, autogenic training , massages, electro massage and stretching of shortened muscles are also used. Local infiltrations are supposed to loosen the muscles. Most patients experience physical therapy as beneficial, but insurers often describe the cost-benefit ratio as inadequate, and studies to support their benefits are scarce.

The effectiveness of acupuncture for treating back pain is not seen consistently in the literature. The large German GERAC study on acupuncture for chronic low back pain showed that the success of a 6-week acupuncture treatment is around 1.7 times as high as a six-month, guideline-oriented standard therapy with medication and physiotherapy. However, there was no significant difference between Chinese acupuncture points and false, non-Chinese acupuncture points. Nevertheless, acupuncture was recommended by some experts in 2006 and by the Federal Joint Committee in 2007 as an additional or sole therapy option for chronic back pain.

Relaxation techniques such as B. Progressive muscle relaxation according to Jacobson or yoga are repeatedly used for back pain. The Alexander Technique and the back school should work in back pain by learning how to move appropriately and using it in everyday life.

If conservative treatment options for chronic, neuropathic back or leg pain have not been successful in the long term, neuromodulation (Spinal Cord Stimulation, SCS) can be used. As part of the pain therapy arm in the S3 guideline 'Epidural spinal cord stimulation for the therapy of chronic pain', this method is classified with recommendation grade B.

Even placebos can be highly effective in back pain.

See also

literature

Web links

Commons : Back Pain  - Collection of pictures, videos and audio files
Wiktionary: back pain  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ IQWiG: Lower back pain: Can movement training prevent relapses? (341 KB; PDF) (No longer available online.) Gesundheitsinformation.de, August 5, 2010, p. 2 , archived from the original on September 28, 2010 ; accessed on September 30, 2010 (HONcode certified): "Depending on the duration of the complaints, a distinction is made between three types of back pain: less than 6 weeks, 6 to 12 weeks, more than 12 weeks" Info: The archive link was automatically inserted and not yet checked . Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.gesundheitsinformation.de
  2. ^ A b S. Schneider: Back pain: spread, causes and explanatory approaches. GRIN Verlag, 2007, ISBN 978-3-638-73218-5 , p. 9ff, (online)
  3. ↑ According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice . In: Z. Allg. Med. 83 (200), pp. 102-108. Quoted from: What family doctors mainly deal with. In: MMW update. Med. No. 16/2007 (149th year)
  4. ↑ Robert Koch Institute : Back Pain , Federal Health Reporting, December 2012, pp. 12-14, accessed on January 3, 2013.
  5. ↑ Economic damage caused by chronic illnesses of employees 2010 | Statistics. Retrieved May 22, 2017 .
  6. ↑ Reinhard Haller: The power of hurt. Ecowin, Salzburg 2015, ISBN 978-3-7110-0078-1 , pp. 141f.
  7. ↑ Volker Faust . With the collaboration of Walter Fröscher and Günter Hole and the Psychosocial Health Working Group. Liebenauer brochures mental health. Psychiatric and neurological information offered by the Liebenau Foundation. Liebenau Foundation. Special issue Volume 6: Back pain , Liebenau 2015, pp. 15–20, Psychosocial Risk Factors Today.
  8. ↑ Acute low back pain. In: patient information. Medical Center for Quality in Medicine (ezq), November 2017, accessed on November 7, 2019 . P. 1.
  9. ↑ National Health Care Guideline: Non-specific low back pain. Long version. In: 2nd edition, version 1, AWMF register no .: nvl-007. Sponsor: German Medical Association, National Association of Statutory Health Insurance Physicians, Working Group of Scientific Medical Societies, 2017, accessed on November 7, 2019 . P. 86.
  10. ↑ M. Kremer: Back school for primary, secondary and tertiary prevention - lifestyle change, physiotherapy / physiotherapy - in the age of integrated outpatient care. In: G. Hofmann, I. Siegfried: Widespread disease back pain: new perspectives (congress report). ( online , PDF, 1.37 MB).
  11. ^ Pinion in Hoffmann / Siegfried 2005.
  12. ↑ A. Keller u. a .: Effect sizes of non-surgical treatments of non-specific low-back pain. In: Eur. Spine J. 2007, doi : 10.1007 / s00586-007-0379-x (quoted modified after back pain: What really helps? In: MMW-Fortschr. Med. 150th Jg., No. 14, 2008, p . 20).
  13. ^ Dickreiter in Hoffmann / Siegfried 2005.
  14. ^ AD Furlan, MW van Tulder, DC Cherkin et al. a .: Acupuncture and dry-needling for low back pain . In: Cochrane Database Syst Rev . No. 1, 2005, p. CD001351. doi : 10.1002 / 14651858.CD001351.pub2 . PMID 15674876 .
  15. ↑ Hopton A, MacPherson H: Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyzes . In: Pain Pract . 10, No. 2, March 2010, pp. 94-102. doi : 10.1111 / j.1533-2500.2009.00337.x . PMID 20070551 .
  16. ↑ M. Haake, HH Müller, C. Schade-Brittinger a. a .: German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups . In: Arch. Intern. Med. . 167, No. 17, September 2007, pp. 1892-8. doi : 10.1001 / archinte.167.17.1892 . PMID 17893311 .
  17. ^ AF Molsberger, K. Streitberger, J. Kraemer u. a .: Designing an acupuncture study: II. The nationwide, randomized, controlled German acupuncture trials on low-back pain and gonarthrosis . In: J Altern Complement Med . 12, No. 8, October 2006, pp. 733-742. doi : 10.1089 / acm.2006.12.733 . PMID 17034279 .
  18. ↑ HG Endres u. a .: acupuncture for chronic knee and back pain. (397 kB) In: Dtsch Arztebl 2007; 104 (3). January 19, 2007, p. A123-A130 , accessed on October 3, 2010 : "10 to 15 acupuncture sessions, verum like sham, reduce the symptoms more than standard therapy carried out according to guidelines"
  19. ↑ Dieter Melchart, Andrea Streng, Andrea Hoppe, Susanne Juergens, Wolfgang Weidenhammer, Klaus Linde: Acupuncture for chronic pain: results from the model project of the substitute funds. In: Deutsches Ärzteblatt. 103, issue 4 of January 27, 2006, pp. A-187 / B-160 / C-159 (online) .
  20. ^ Claudia M. Witt, Benno Brinkhaus, Susanne Jena, Dagmar Selim, Christoph Straub, Stefan N. Willich: Effectiveness, safety and economic efficiency of acupuncture - a model project with the Techniker Krankenkasse. In: Deutsches Ärzteblatt. 103, edition 4 of January 27, 2006, pp. A-196 / B-169 / C-167 (online) .
  21. ^ Kremer in Hoffmann / Siegfried 2005.
  22. ↑ S3 guideline "Epidural spinal cord stimulation for the therapy of chronic pain". German Society for Neurosurgery eV et al., July 31, 2013, p. Register number 008-023 , accessed on May 15, 2017 .
  23. ↑ "How well a pain therapy works also depends on expectations", "Family doctor highlights from the German Pain Congress" in MMW-Fortschr.Med. No. 51-52 / 2007 (149th year), p. 6.