Various causes - difficult diagnosis
The cause of back pain is often difficult to determine. Typically, in adults, age- and stress-related (degenerative) mechanical wear and tear of certain anatomical structures of the spine is responsible for the plaguing symptoms. Despite careful anamnesis and examination, it is often difficult to clearly identify the cause of the pain. Even the most modern radiological procedures such as MRI do not always help. The reason for this is that various anatomical structures of the spine can be responsible for the pain. Degenerative changes in intervertebral joints (facet joints) and/or intervertebral discs (discus) are often the cause of the pain. There are also various other causes of pain, such as irritation of a nerve root (sciatica) or overloading of the back muscles.
Symptoms
Die Ursache von Rückenschmerzen ist oft schwer zu bestimmen. Typischerweise ist bei Erwachsenen eine alters- und belastungsbedingte (degenerative) mechanische Abnutzung bestimmter anatomischer Strukturen der Wirbelsäule für die quälenden Symptome verantwortlich. Trotz sorgfältiger Anamnese und Untersuchung ist es oft schwierig, die Ursache der Schmerzen eindeutig zu identifizieren. Auch modernste radiologische Verfahren wie die Kernspintomographie helfen nicht immer weiter. Der Grund dafür ist, dass verschiedene anatomische Strukturen der Wirbelsäule für die Schmerzen verantwortlich sein können. Häufig sind degenerative Veränderungen der Zwischenwirbelgelenke (Facettengelenke) und/oder der Bandscheiben (Diskus) die Ursache für die Schmerzen. Darüber hinaus gibt es verschiedene andere Schmerzursachen, wie die Reizung einer Nervenwurzel (Ischias) oder eine Überlastung der Rückenmuskulatur.
Diagnosis
A detailed medical history and a thorough physical examination are crucial for a precise diagnosis. Imaging procedures such as MRI, CT or X-ray may be used in certain cases, but are not always necessary.
Targeted test injections under ultrasound or X-ray control play an important role in back diagnostics. For example, local anesthetics can be injected specifically into a suspected facet joint to check whether the pain improves temporarily. If there is significant pain relief, the cause of the pain can probably be traced back to this structure.
Targeted test injections can help further
Therapeutic options for chronic back pain
The treatment of chronic back pain requires individually tailored planning in order to combine various measures in a targeted and effective manner. Here are the central therapeutic approaches:
Physiotherapy, manual medicine and chiropractic care
Physiotherapy, manual therapy and chiropractic treatments play a key role in back pain therapy. They aim to promote mobility, strengthen the back muscles and correct poor posture in order to relieve the spine and reduce pain.
Medication
Various medications are available for pain treatment:
- Basic analgesics: Basic analgesics are usually used first to relieve pain.
- NSAIDs (non-steroidal anti-inflammatory drugs): These anti-inflammatory painkillers are often effective for back pain.
- Paracetamol and metamizole: Studies have shown that these drugs do not provide any significant benefit for chronic back pain and are therefore rarely recommended.
Interventional treatments
Targeted injections under X-ray or ultrasound guidance provide effective pain treatment:
- Radiofrequency treatment of the medial branches of the facet joints: this minimally invasive technique obliterates small nerve fibers to interrupt pain conduction.
- Steroid injections: Local injections of cortisone can provide targeted pain relief and reduce inflammation. Injections can be made around the facet joints, directly into the facet joints or at the nerve root.
- Pulsed radiofrequency treatment of the DRG (dorsal root ganglion): The targeted application of radiofrequency pulses reduces pain conduction at the nerve roots.
Neuromodulation
Neuromodulation can be helpful for chronic back pain that is refractory to therapy. This involves applying electrical impulses to the spinal cord in order to influence the pain signals and reduce the sensation of pain.
Surgical measures
Surgery may be considered for certain causes of back pain or after conservative and interventional measures have been exhausted. Careful consideration is required here in order to achieve the best possible improvement in quality of life.
