Sprains, hernias, osteochondrosis - when they are diagnosed, patients immediately rush to the surgeon, regardless of conservative methods of treatment, but this is wrong.
According to statistics, 84% of people have back pain at least once in their life.The spine and surrounding muscles are part of the musculoskeletal system.Consequently, their damage is often accompanied by pain, which can occur after bending or turning the head and body and is relieved by rest.Anatomically, the spine is represented by alternating vertebrae and intervertebral discs.The latter undergo degeneration over time, which leads to the formation of protrusions and hernias.These structures themselves can cause pain, or they can cause pain through compression of neighboring structures - nerve roots and spinal ligaments.In some cases, they can cause stenosis (narrowing) of the spinal canal (the space in which the spinal cord is located).
Among other things, the vertebrae are connected by paired facet joints, a stiffer structure than the intervertebral disc.Their damage in 15-65% of cases causes back pain.Up to 30% of back pain is caused by damage to the sacroiliac joint, a paired structure that connects the sacrum and pelvic bones.After all, any irritation increases the tone of the muscles around it, which over time causes a special myofascial syndrome.
As a rule, physical activity leads to back pain, especially when it is pronounced or intense, or when it is performed in an unnatural position, or when it involves prolonged exposure to a forced position, for example, while driving a car or at a desk.A person's body weight and physical ability are of great importance, since the severity of the load is always relative.
What are the reasons for its development?
It is impossible to clearly name the reasons for the development of osteochondrosis, but a number of factors can be identified that contribute to the appearance of this disease: poor physical development, metabolic disorders in the body, genetic predisposition, incorrect posture, prolonged standing in one position (for example, in front of a computer monitor, while driving), physical inactivity, excessively soft bed.As a rule, these reasons are combined with poor nutrition.
What should you do if you have back pain?
The most important rule is not to self-medicate!
First, you should make an appointment with a neurologist or neurosurgeon.In order to make an accurate diagnosis, a comprehensive examination of the patient is necessary, which necessarily includes radiography of the spine and tomography (magnetic resonance or computer tomography. The appointment of a special study should be done only by the attending physician based on the specific clinical picture.
Drug treatment for osteochondrosis of the spine includes not only pain relief, but also, if possible, elimination of the root causes.The doctor prescribes complex therapy (drug therapy, physiotherapy, acupuncture, balneotherapy)
Comprehensive therapeutic care for osteochondrosis includes correction of nutrition and lifestyle (healthy and active lifestyle, optimal amount of physical education), prescribing, in some cases, drugs from the group of chondroprotectors that improve the condition of cartilage tissue.
The main indication for surgical treatment of degenerative-dystrophic diseases of the spine is the ineffectiveness of conservative drug therapy for 4-6 weeks, intractable pain syndrome, as well as increasing weakness in the legs, which in some cases may be accompanied by urinary incontinence.Premature and incorrect treatment in such situations can lead to a number of unwanted consequences and complications, including disability.
Back pain is known to be the most common.Experts explain this with the peculiarities of human anatomy.The thing is that the spine is subjected to stress throughout a person's life: from the moment he stands up in childhood until his death.The spine gets tired and sooner or later almost everyone has problems with it.The most frequent diagnoses made for back pain are "osteochondrosis" and "sciatic nerve pain", while patients often make them themselves and prescribe treatment on their own, without seeking advice from doctors.However, even behind these diagnoses, which seem to be heard by everyone, there are often hidden reasons that only an experienced specialist can determine.
What hurts there?
The vast majority (about 95%) of pain is associated with muscles, ligaments and joints.This is commonly called a back strain.These pains are unpleasant, but not dangerous, and in most cases they pass on their own within 2-3 days.
3-4% of pain is associated with radiculopathy (radiculitis) - damage to the spinal root.It is usually damaged by a hernia.The pain disappears when the swelling caused by the compression goes away.
1-2% of back pain is caused by injuries or inflammatory diseases of the spine, oncological processes, diseases of the cardiovascular system or gastrointestinal tract, in which the pain syndrome can spread to the back.This is the most dangerous type of back pain.To rule out such pathologies, be sure to consult a doctor.
You can't hesitate
The main indicator that you need medical attention is the regularity of the pain.If you occasionally feel tight, it's probably nothing to worry about.If pains of low or moderate intensity follow you without rest, you cannot hesitate.It is necessary to urgently consult a doctor if the pain is accompanied by an increase in temperature or the pain syndrome increases during treatment.
Types of pain
Doctors identify 3 types of pain, which are most often felt in the back area.The doctor's task is to determine exactly what kind of pain bothers the patient who contacts him, because each of them will be treated exclusively in his own way.
Nociceptive painor, simply put, pain in the receptors - in the skin, muscles, ligaments, joints - is considered more common.The causes that cause it are usually not visible on X-rays or computed tomography.In this case, the specialist makes a diagnosis based on the symptoms described by the patient.The causes of muscle spasms can be, for example, physical exertion, when a person lifted something heavy, bent hard or a change in temperature (a common example is air conditioning).This type of pain is treated with two types of medication.
Acute pain is treated with pain relievers, anti-inflammatory drugs and muscle relaxants.In this case there can be no other therapy.When the pain syndrome is relieved, we recommend the patient to strengthen the muscles through physical exercises.This is a treatment and prevention of the disease in the future.
Exercise not only helps strengthen muscles, but also helps produce endorphins in the body, as well as serotonin and norepinephrine.These substances increase a person's pain threshold and relieve depression.
Neuropathic painor nerve pain, this disease is popularly known as sciatica.This type of pain in a person occurs, in particular, when a vertebral hernia becomes large and squeezes the nerve endings.At the same time, experts warn patients and the entire professional community against misdiagnosis in cases where X-rays or MRIs reveal that there is a hernia or some other type of wear and tear on the spine, but it is not significant enough to affect the nerve.It is necessary to carefully understand the real cause of the pain.It is possible that muscle spasm is to blame, and this is a completely different type of pain, and the treatment for it will also be different.What is considered osteochondrosis not only does not appear as pain, but is also the norm.
Osteochondrosis is a sign of aging of the body.But "osteochondrosis" and "pain" are not the same thing.Since there are practically no nerve endings in the bone tissue, protrusions (the initial stage of an intervertebral disc herniation. - Author) or hernias cannot damage themselves.Studies were even conducted: groups of people of different ages were given MRIs - they chose, mainly those who had never consulted a doctor with complaints of back pain, but were found to have hernias and osteochondrosis.
In addition, the doctor gives examples when patients received treatment - and their pain went away, despite the fact that osteochondrosis remained in the picture.Osteochondrosis today is a concept that is used locally.
There are places where the word "osteochondrosis" is not used at all.Last year they officially said that this diagnosis was made by neurologists of the previous generation.Abroad, when a patient comes to an appointment and says that his back hurts, he is diagnosed with non-specific back pain, but it is understood that the person has put stress on the muscles.
Experts most often confirm that the pain is caused by radiculitis and not a spasm from a symptom in the form of pain in the back, radiating along the nerve to the leg.
Nerve pain can also be caused by complications caused by diabetes and herpes.With diabetes, patients often complain of pain, as this disease damages the nervous system.Postherpetic neuralgia is characterized by red lines along the damaged nerve and, accordingly, pain.There are special medications for the treatment of nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.The name of drugs of this type, it must be said, often scares patients, so it is important to explain to them that it is antidepressants that increase the pain threshold.These are the standards for pain management.
Psychogenic painor chronic.This type of pain is not caused by physical changes in the human body, but by a change in his mental state.In this case, the symptoms torment the patient for a long time.In this case, as a rule, it is not only the back that hurts.
It happens that people come and say: "Everything hurts - my head, my back - constantly. You ask: did they lift something heavy? No! And there is no clear localization. In this case, we can conclude that the patient has a lowered pain threshold, and the pain analyzer, which is located in the brain, is constantly felt. Anything can provoke pain on the fear, feeling of such a patient.
Painkillers will not help in this case.For patients with chronic pain, specialists usually prescribe antidepressants and physical exercises, but sometimes it is enough to find the cause with the help of a psychologist or psychiatrist.
A young woman who complained of back pain for six months says she suffered.I recommended that he go to a psychologist and go to physical education.A few days later she returned to full health without taking any medication.The psychologist helped him understand that the cause of the pain was stress: there were family problems, and physical education helped him calm down.
At homeThe most effective drug is an oral anti-inflammatory drug.Just don't overdo it - they are only safe the first time.When taken for a long time, such drugs can cause ulcers and bleeding in the stomach lining.Traditional home treatment - non-steroidal ointments - can only be used as an additional measure.They are harmless but ineffective.Wearing a corset also provides relief - the fixation eases the spine, relieves spasms and limits sudden movements.Only the corset should be ordinary - elastic, and not heating.
If the treatment has no effect within three days, you should consult a doctor who will administer a blockade with anti-inflammatory injections.By relieving the spasms and relaxing the muscles, the pain goes away immediately and often permanently.
Forbidden!
Baths and massages are strictly prohibited.They increase swelling and pain.
Contact chiropractors through newspaper ads.Manual therapy is a field where for every specialist there are three hundred charlatans.If you really want to find a good doctor, you should contact certified clinics where certified specialists work.
It is important to immediately determine the appropriate treatment tactics.This should be done by a neurologist or neurosurgeon.Treating the back alone is dangerous.30% of patients in the neurosurgery department tried home treatment methods and ended up in a hospital bed.
When pills don't help
If the drug treatment prescribed by a therapist or neurologist does not give results within 3-6 months and the pain continues to torment the patient, the doctor is obliged to transfer the patient to another specialist.In some situations, physical therapy can be of significant help.It is suitable for the first two types of pain: in receptors and nerves.Physiotherapy is also prescribed to those patients who have allergies to medications or stomach problems.
Because of this, the treatment is carried out, but there is no effect;patients often come to us in severe cases, with depression, so we approach their treatment with a multidisciplinary approach, which includes various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
Among the techniques used by local physiotherapists, borrowed from Russian colleaguesinterstitial electrical stimulation.Its principle is to apply current through a special disposable electrode-needle, bypassing the skin barrier, directly to the source of pain.Diagnoses for which this procedure is prescribed, including protrusion and hernia.The procedure, according to experts, is comfortable and does not require pain relief.The effect is usually felt after the first procedure.In total, they are assigned from 3 to 6.
In addition, it is usedlaser therapy.This technique is also convenient because it can be prescribed to patients with various pacemakers, including cardio, and there is no concern that a malfunction will occur.The laser is used not only to treat diseases related to spinal problems, but also as a treatment for the complications of diabetes and herpes, which have already been discussed.
The laser promotes good healing.In addition, the device improves microcirculation in the spine itself, and because of this, the nutrition of the discs improves.As a result, swelling and inflammation are relieved, and pain, accordingly, goes away.
Blockade
The concept of "blockage" in medicine is not new.For severe pain, since Soviet times, patients have been prescribed injections in the area where the pain is located directly.Little has changed in local clinics since then.Meanwhile, in accordance with international recommendations, these procedures must be carried out exclusively under control, using special equipment that allows you to monitor the process in real time.The consequences of an unsuccessful injection can be very different: in the best case, a medicine administered in the wrong place will not give the desired effect;at worst, it is fraught with serious complications.
The medicine must be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, because the medicine is administered specifically in the area where the source of pain is.If the doctor goes to the wrong place, this is fraught with respiratory arrest in the patient and total spinal anesthesia.
The essence of the blockade is that the drug administered for several months to six months prevents the propagation of the impulse along the nerve that is involved in the conduction of the nerve impulse.Although this procedure does not guarantee a permanent effect, it significantly improves the patient's quality of life: the person completely forgets about the pain for a while, can sleep peacefully or go about his business.
Surgery – pain relief
When medications do not help - neither pills nor injections, when physical treatment is ineffective, neurosurgeons come to the rescue.Modern technologies allow these specialists to bring back to life patients who have suffered for years without pain.There are many techniques: from manipulations with minimal intervention in the body to complex surgical operations with vertebral prostheses.
For hernias that press on a nerve, one of the most common and effective methods is the so-calledradiofrequency ablation.Basically, this is a kind of blockage, only instead of a drug that relieves the pain only temporarily, an electric current is used that can completely solve the problem.Ablation is often done after blockades, thanks to which doctors get a clear understanding of which nerve needs to be affected.The procedure is offered both for a fee and for a quote.
The procedure is performed within 20 minutes.It is called an operation, but in fact it is a surgical procedure that is performed with local anesthesia, always under the control of special devices.First the pain syndrome is reproduced and, if the patient confirms that this is exactly the pain he usually experiences, we apply a pulse flow - and the pain, so to speak, goes away.
In special cases, methods are usedneurostimulation, including the implantation of an electrode.The patient undergoes an operation: the surgeon places a small device at the site of pain that will suppress pain impulses in real time.Patients receive this procedure according to a quote.
There are cases when various types of surgical interventions have already been performed, but the pain syndrome has continued to one degree or another, then we install the stimulator - first in test mode, and if the desired effect is achieved, then we install it permanently.This is an operation that is performed through a small incision.The only thing is that the patient will have to come periodically for test control.
What do we risk?
The risk of surgery, due to which it is postponed or rejected altogether, is considered by many patients to be greatly exaggerated.In neurosurgery, there are technologies that make it possible to accurately calculate the effectiveness of the operation and which symptoms will disappear after it and which will remain.
The possibility of pain returning after surgery does not exceed 1-1.5%.Hernias in other places can indeed appear, but this is not a complication, but a spread of the disease, which is often found in young and undisciplined patients.As soon as the pain goes away, they return to their usual lifestyle: drive, resume training.But this is absolutely impossible to do.
Is osteochondrosis to blame for everything?
Osteochondrosis is a chronic degenerative-dystrophic change in the intervertebral space.All people over 25 years old have signs of osteochondrosis.It is impossible to avoid osteochondrosis, but you can protect yourself from its complications, which are the cause of back pain.
Why is this and not otherwise?
Is it necessary to spend time, effort and money on treatment: pills, injections, physiotherapy, if you can immediately undergo a small operation and get rid of the pain once and for all?– This is a question that patients ask more and more recently.The answer is usually clear: yes, it is necessary!The thing is that with the correct diagnosis and the right treatment, only a few reach the surgeries.The rest get rid of pain in the first stages of care - on average, 30% of patients are eliminated at each stage.
It is a mistake when people, seeing a protrusion or hernia in an image, immediately run to see a surgeon, bypassing specialists in the previous stages of care.In cases where the changes are small, surgery is not required.Moreover, with the right lifestyle - doing physical therapy, swimming, watching your body weight - a person with so-called osteochondrosis can feel healthy and not experience pain.
It is important that at every stage the patient is given an accurate diagnosis and the appropriate treatment is prescribed.This can only be achieved collectively.It is also proposed, using the example of foreign experience, to introduce a new specialization, such as an algologist - this is a type of therapist specializing in pain, a doctor with the knowledge of a neurologist and interventional anesthesiologist, capable of treating without taking the case to surgery, but, if surgical intervention is still unavoidable, will immediately transfer the patient to a neurosurgeon.