Back pain

“St. Naum” University Hospital for Active Treatment in Neurology and Psychiatry, Sofia, Bulgaria
Correspondence: Prof. Ivan Milanov, MD, PhD, DSc, “St. Naum” University Hospital for Active Treatment in Neurology and Psychiatry, 1 Louben Roussev str., Sofia 1113, Bulgaria,
tel.: +35 9888707880, e-mail:

Pediatr Med Rodz Vol 10 Numer 3, p. 253–264
DOI: 10.15557/PiMR.2014.0028

Back pain is a symptom of a number of underlying diseases. The pain syndrome may be due to disorders of bone structures, apophyseal joints, ligaments, fascia, muscles or intervertebral discs, subsequently affecting or not the spinal cord and peripheral nerves. According to the pathophysiological mechanisms precipitating the pain, it can be classified as nociceptive or neuropathic pain. Nociceptive pain is precipitated by the mechanical irritation of nociceptors in ligamentous and muscular structures. Neuropathic pain is caused mostly by the compression of nerve roots. When acute nociceptive pain is not treated in a timely manner, it may develop into chronic neuropathic pain due to functional changes occurring in the central nervous system. Treatment of back pain involves a combination of myorelaxants, analgesics and non-steroidal anti-inflammatory drugs. It starts, as a first choice, with paracetamol because of a small number of its adverse effects. The combined administration of non-steroidal anti-inflammatory drugs and analgesics is preferable as it enhances the analgesic effect without increasing the toxicity. A similar combination is that of paracetamol with a mild opioid (tramadol). Neuropathic pain is influenced by several main groups of medications: antidepressants, anticonvulsants, membrane-stabilizing drugs, and GABA-B agonists. Early treatment of back pain is necessary in order to prevent pain chronification. Because of the different treatments of nociceptive and neuropathic pains, it is of particular importance to differentiate between them early.

Keywords: back pain, nociceptive, neuropathic pain