Lo que el dolor lumbar nos está diciendo

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Sabemos que el cuerpo humano, siempre nos envía mensajes para decirnos cómo se encuentra, a veces le hacemos caso, a veces ni caso le hacemos y es cuando vienen las crisis de todo tipo emocionales, físicas, mentales.

De todas las manifestaciones clínicas, la que más me toca atender son las lumbalgias, dolor lumbar, lumbago, dolor bajo de espalda, de acuerdo como lo queremos definir o como lo hemos aprendido.

Cuando aparece un dolor por primera vez, medio raro, sin haber realizado ninguna actividad fuera de lo normal.

¿En qué piensa primeramente?

¿Ver al médico y ver si necesita estudios?

¿Qué con algunos remedios caseros se va a sentir mejor?

Aplicarse calor, darse masaje y tomar algún medicamento tipo aine (ibuprofeno, diclofenaco o paracetamol, etc.)

Cuando aparece el dolor repentino, agudo, con una disminución de moderada intensidad pero que limita los movimientos: como al tender una cama, abrocharse los zapatos o simplemente agacharse.

¿En qué piensa primeramente?

Que no debió haber cargado, empujado, subido, jalado ese objeto ayer en casa u oficina.

En realidad. Los músculos abdominales y espinales que no los ejercitamos adecuadamente están contracturados y están sufriendo. Podría tratarse de una pequeña protrusión discal que empezó a manifestarse, tenemos 45 años y la verdad no hacemos ejercicio y el abdomen está más grande cada día.

¿Qué podría hacer?

Aplicarse calor local, masaje profundo, estar en reposo (si puede), utilizar una faja, y tratar de no hacer esfuerzo extra. Tomar un analgésico.

O, empezar a moverse, de acuerdo a sus posibilidades, tratar de relajar músculos, no acostarse salvo que sea imposible mantenerse de pie. Pero si es necesario, no permanecer acostado más de 48 horas y buscar ayuda médica.

¿Ver la posibilidad de que lo vea el médico?

Cuando aparece el dolor repentino, agudo por las mañanas, al despertar y que casi no lo dejó dormir.

Piensa que se acomodó mal al momento de dormir o que el colchón está vencido y que esto le causó el dolor.

Primero hay que considerar que los músculos de la columna, tienden a doler más sobre todo después de una actividad física, no después del descanso nocturno.

¿Qué debo hacer?

Pensar que alguna de la enfermedades reumáticas (cerca de 225 que existen) pueden empezar a causar inflamación en articulaciones, o tejidos blandos durante la noche y causar el dolor por las mañanas.

¿El médico lo tiene que valorar?

Definitivamente que sí, pero ahora el dolor que aparece es tan intenso que le impide moverse ¡de verdad es terrible.!

Primer pensamiento: cree que ahora si es serio.

Pero pensar qué edad tiene:

30 años: el dolor puede ser por: una actividad física o deportiva que causo contractura muscular. Un esguince lumbar.

40 años: el dolor puede ser por: el mismo esguince lumbar con ruptura de algunas fibras musculares, pero habrá que pensar en una protrusión discal (hernia de disco)

50 años: el dolor puede ser por: sobrepeso, la misma protrusión discal, lesión previa, esfuerzo extra.

60 años: el dolor puede ser por: proceso degenerativo (artrosis) o metabólico (osteoporosis). Además de problemas gastrointestinales, ginecológicos, renales o tumorales agregados.

70 años: el dolor puede ser por: un canal lumbar estrecho que está causando compresión de médula o de raíces lumbares.

80 años en adelante: todas las anteriores.

¿Qué debo hacer?

Acudir con el médico de preferencia un ortopedista y explicarle cada uno de los síntomas, pérdida de fuerza de movilidad, presencia de calambres, pérdida de masa muscular, antecedentes familiares, etc.

Todos los antecedentes son importantes:

Sufrió caídas, accidentes de auto, lesiones óseas, movilidad de ambas extremidades tanto (torácicas) brazos, antebrazos, muñecas, manos. O pélvicas, como caderas, rodillas, tobillos o pies.

Pérdida de control de esfínteres, pérdida de sensibilidad en ciertas áreas, fiebre, deformidad de algún hueso o de la propia columna dorsal o lumbar, debilidad, fatiga severa, etc.

La mayoría de nosotros, tenemos en caso varios medicamentos analgésicos o antiinflamatorios, que en otras ocasiones hemos utilizado por otros problemas osteoarticulares, de acuerdo, podríamos utilizarlos, a la dosis máxima que sugiere la etiqueta, pero si en lugar de mejorar, el dolor persiste; el paracetamol funciona, pero, no es antiinflamatorio. Recordar que no a todos los pacientes les funciona el mismo medicamento que a la vecina; pudieran inclusive ser alérgicos a ellos.

Lo mejor es acudir con el médico y no auto medicarse por varios días. Si el dolor o molestia no cede en 72 horas, el problema es mayor de lo que pensaba.

¿Tiene dolor de columna lumbar?

José Luis Sánchez Mejía
Ortopedia y Traumatología

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