οι αιτίες της κάτω κοιλιακής μυαλγής είναι ποικίλες, οι κλινικές εκφράσεις διαφέρουν ανάλογα με τις διαφορετικές περιπτώσεις, θα αναφερθούμε παρακάτω:
1οι ασθενείς με επιληπτικές χαρακτηριστικές κάτω κοιλιακές μυαλγές δεν έχουν προηγούμενη χρόνιοι δυσφορίες, η τυπική έναρξη συνδέεται συχνά με υπερφόρτωση, τραυματισμό, τραύμα ή στρες, μια λεπτομερής ιστορία και εμπειρία είναι αρκετή για τη διάγνωση.
2、The differential diagnosis of chronic lumbar and back pain is difficult. It can start with careful determination of the onset, characteristics of the pain, and precise localization. The pain may be localized (with tenderness at the site of the lesion, such as fibromyalgia), or diffuse, such as primary fibromyalgia. The pain can also be caused by deep tissue, such as lower back pain due to chronic osteoarthritis of the lumbar spine. The pain can also be radiative, such as sciatica, or referred, such as peritonitis, pyelonephritis, osteoporosis, compressive fracture, or osteomyelitis. Back movement is limited due to pain, muscle tension, and paravertebral muscle tenderness, which is a common feature of all diseases affecting the musculoskeletal and nervous systems (mechanical pain). Pain worsens at rest and is relieved by stretching or activity, which is a feature of fibromuscular origin, but visceral referred pain (non-mechanical pain) does not have this feature. Typical visceral referred pain does not worsen with activity or relieve with rest, and is usually persistent and worsens at night. The Valsalva maneuver (forceful coughing, sneezing) increases pain, limited straight leg raising, disappearance of reflexes, and changes in sensation are characteristic of involvement of the spinal nerve roots and sciatic nerve.
3、Sciatica, the pain radiates along the sciatic nerve, most often radiating to the posterior side of the buttocks and lower limb, with or without lower back pain. The most common cause is intervertebral disc herniation or compression of the surrounding nerve roots by a spinal cord tumor. It can also be caused by spondylolisthesis, tumor, or abnormal bone in the spinal canal or intervertebral foramen (such as osteoarthritis, spondylitis). It can also be caused by compression of the nerve outside the spinal cord, pelvis, or buttocks. Lesions caused by toxic or metabolic reasons (such as alcoholism, diabetic neuropathy) are rare. Such lesions can be confirmed by clinical or electrodiagnostic findings due to sensory or motor disturbances.
4、Spinal stenosis is an uncommon form of sciatica caused by narrowing of the lumbar spinal canal, compressing the nerve roots before they exit the intervertebral foramen (or compressing the spinal cord, but less common), and is suspected of being a vascular disease due to similar intermittent claudication. Spinal stenosis is more common in middle-aged or elderly people and can be caused by osteoarthritis, Paget's disease, spondylolisthesis, or sciatica, and is manifested as pain in the buttocks, thigh, or lower leg during walking, running, and climbing stairs. Standing still does not relieve the pain, but bending over and sitting can (although paresthesia may persist). It is easier to walk uphill than downhill because the bending posture, rest, and back flexion can reduce the pain.
5、Certain patients with physiological or psychological disorders often have a history of minor trauma, causing disproportionate severe pain after injury, leading to loss of mobility, but no injury or primary disease can be found. In addition, there are usually factors such as anxiety and depression, but these persistent symptoms cannot be fully explained by lower back pain. Carefully obtaining the patient's description of pain and examination findings is often non-specific, or inconsistent with any known neuroanatomical pathways or disease processes. After excluding injuries or organic diseases, symptoms and functional disorders continue to exist and even worsen, and many such manifestations progress to more typical fibromyalgia.