Protrusions, tears, osteochondrosis - when diagnosed, patients immediately rush to the surgeon, ignoring conservative treatment methods, 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.As a result, their damage is often accompanied by pain that can occur after bending or turning the head and body and is relieved by rest.Anatomically, the spine is represented by alternate vertebrae and intervertebral discs.The latter undergo degeneration over time, which leads to the formation of protrusions and tears.These structures can cause pain by themselves, or they can cause pain by compressing neighboring structures - nerve roots and spinal ligaments.In some cases, it 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, which are a more rigid structure than the intervertebral disc.Their damage causes back pain in 15-65% of cases.Up to 30% of low back pain is caused by damage to the sacroiliac joint, a paired structure that connects the sacrum and pelvis.Finally, any irritation increases the tone of the surrounding muscles, which over time leads to a separate myofascial syndrome.
As a rule, physical activity causes back pain, especially in cases where it is pronounced or intense, or when it is performed in an unnatural position or when you are exposed to a forced position for a long time, for example, while driving a car or at a desk.A person's body weight and physical fitness are of great importance, because the intensity of the load is always relative.
What are the reasons for its development?
The reasons for the development of osteochondrosis cannot be named precisely, but a number of factors that cause this disease can be identified: poor physical development, metabolic disorders in the body, genetic predisposition, incorrect posture, staying in one position for a long time (for example, in front of a computer monitor, while driving), physical inactivity, too soft bed.As a rule, these reasons are combined with poor nutrition.
What to do if you have back pain?
The most important rule is not to self-medicate!
First, you need to 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 x-rays of the spine and tomography (magnetic resonance or computer tomography). The appointment of a certain study should be carried out only by the attending physician based on a specific clinical picture.
Drug treatment of spinal osteochondrosis includes not only pain relief, but also, if possible, elimination of the root causes.The doctor prescribes complex therapy (drug treatment, physiotherapy, acupuncture, balneotherapy).
Complex therapeutic care for osteochondrosis includes correction of nutrition and lifestyle (healthy and active lifestyle, optimal amount of physical training), in some cases, prescribing drugs from the group of chondroprotectors, which improve the condition of cartilage tissue.
The main indication of the surgical treatment of degenerative-dystrophic diseases of the spine is the ineffectiveness of conservative drug treatment for 4-6 weeks, an insurmountable pain syndrome, as well as increased weakness in the legs, which may be accompanied by urinary incontinence in some cases.In such cases, untimely and improper treatment can lead to a number of undesirable consequences and complications, including disability.
Back pain is known as the most common pain.Experts explain this with the peculiarities of human anatomy.The fact is that the spine is subjected to stress throughout a person's life: from the moment he stands up in childhood to his death.The spine wears out and sooner or later almost everyone experiences problems with it.While the most common diagnoses for back pain are "osteochondrosis" and "sciatica", patients self-diagnose and prescribe treatment without consulting doctors.But behind these diagnoses, which everyone seems to have heard, there are often reasons that only an experienced specialist can determine.
What hurts there?
The vast majority of pain (about 95%) is associated with muscles, ligaments and joints.This is popularly called back tension.These pains are unpleasant, but not dangerous, and in most cases they pass by themselves 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.When the swelling caused by the compression goes away, the pain disappears.
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, the pain syndrome can spread to the back.This is the most dangerous type of back pain.Be sure to consult a doctor to rule out such pathologies.
You cannot hesitate
The main indicator that you need medical help is the regularity of the pain.If you get stuck from time to time, it's probably nothing to worry about.If low or moderate pain is relentlessly haunting you, you can not hesitate.If during the treatment the pain is accompanied by a rise in temperature or an increase in the pain syndrome, it is necessary to consult a doctor urgently.
Types of pain
Doctors identify 3 types of pain most often felt in the back.The doctor's task is to determine exactly what kind of pain is bothering the patient who comes in contact with him, because each of them will be treated only in his own way.
Nociceptive painor, to put it simply, pain in the receptors - skin, muscles, ligaments, joints - is considered the most common.The causes of this are usually not visible on X-rays or CT scans.In this case, the specialist makes a diagnosis based on the symptoms described by the patient.The causes of muscle spasms can be physical exertion, for example, when a person lifts something heavy, bends sharply, or changes 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 is no other treatment.When the pain syndrome disappears, we recommend the patient to strengthen the muscles with physical exercises.This is both treatment and prevention of the disease in the future.
Exercise not only helps strengthen muscles, but also helps the body produce endorphins, as well as serotonin and norepinephrine.These substances increase a person's pain threshold and relieve depression.
Neuropathic painor nerve pain, popularly known as sciatica.Such pain occurs in a person, especially when the vertebral hernia grows and compresses the nerve endings.At the same time, experts warn patients and the entire professional community of a misdiagnosis when an X-ray or MRI shows a herniated disc or other type of erosion in the spine, but 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 its treatment will also be different.What is considered osteochondrosis is not only not manifested as pain, but 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 intervertebral disc herniation. - The author) or herniations cannot cause damage by themselves.There were even studies: MRIs were given to different age groups - they mainly chose those who never went to the doctor with complaints of back pain, but hernia and osteochondrosis were found in them.
In addition, the doctor gives examples when patients received treatment - and the pain went away, despite the fact that osteochondrosis remained.Today, osteochondrosis is a concept that is used locally.
There are countries 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 the reception and says that his back hurts, he is diagnosed with non-specific back pain, but it is understood that the person is straining the muscles.
Experts often confirm that the pain is caused by radiculitis and is not a spasm with a symptom in the form of back pain radiating along the nerve to the leg.
Nerve pain can also be caused by complications caused by diabetes and herpes.Patients with diabetes often complain of pain, because this disease damages the nervous system.Postherpetic neuralgia is characterized by strips of rash along the damaged nerve and corresponding pain.There are specific medications to treat nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.The name of this type of drugs, it must be said, often scares patients, so it is important to explain to them that they are 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 changes in its 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, it can be concluded that the patient's pain threshold is low, and the pain analyzer located in the brain constantly makes itself felt. Everything can cause pain in the patient: such stress, work, fear.
In this case, painkillers will not help.For patients with chronic pain, specialists usually prescribe antidepressants and exercise, but sometimes it is enough to find the cause with the help of a psychologist or psychiatrist.
A young woman who has been complaining of back pain for six months says that she is suffering.I advised him to go to a psychologist, go to physical education.After a few days, he came back completely healthy without taking any medicine.The psychologist helped him understand that the cause of the pain was stress: he had family problems, and physical education helped him relax.
At homeThe most effective means are oral anti-inflammatory drugs.Just don't overdo it - they are only safe the first time.When such drugs are taken for a long time, they can cause ulcers and bleeding in the gastric mucosa.Traditional home remedies - non-steroidal ointments - can be used only as an additional measure.They are harmless but ineffective.Wearing a corset also provides relief - the fixation relaxes the spine, eliminates spasm and limits sudden movements.Only the corset should be ordinary - elastic and not heated.
If the treatment does not work within three days, you should see a doctor who will manage the blockage with an anti-inflammatory injection.By relieving the spasms and relaxing the muscles, the pain disappears immediately and often forever.
It is forbidden!
Baths and massages are strictly prohibited.They increase swelling and pain.
Contact doctors through newspaper ads.Manual therapy is a field with three hundred quacks for every specialist.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 correct treatment tactics.This should be done by a neurologist or neurosurgeon.Treating your back alone is dangerous.In the neurosurgery department, 30% of patients tried home remedies and ended up in a hospital bed.
When pills don't help
If the drug treatment prescribed by the therapist or neuropathologist 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 cases, physical therapy can help significantly.The first two types are suitable for pain: in receptors and nerves.Physiotherapy is also prescribed for patients with drug allergies or stomach problems.
Therefore, the treatment takes place, but there is no effect;patients often come to us in severe cases, with depression, so we approach their treatment with a multidisciplinary approach involving various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
Among the methods used by local physiotherapists borrowed from their Russian counterpartsinterstitial electrical stimulation.Its principle is to directly apply the current to the source of pain by passing the skin barrier through a disposable special needle-electrode.Diagnoses for which this procedure is prescribed, including protrusion and hernia.The procedure, according to experts, is comfortable and does not require painkillers.The effect is usually felt after the first procedure.It is set from 3 to 6 in total.
In addition, it is usedlaser therapy.This technique is also convenient because it can be prescribed to patients with a variety of stimulators, including cardio, and there is no concern about failure.The laser is used not only for the treatment of diseases related to spinal problems, but also for the treatment of 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 thanks to this, the nutrition of the discs improves.As a result, swelling and inflammation are eliminated, and pain, accordingly, disappears.
Blockade
The concept of "blockage" in medicine is not new.For severe pain, since Soviet times, patients have been prescribed injections directly to the site of pain.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 monitoring the process in real time.The consequences of an unsuccessful injection can be very different: in the best case, the drug administered in the wrong place will not give the desired effect;at worst, it is fraught with serious complications.
The drug should be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, because the drug is applied specifically to the area that is the source of pain.If the doctor gets to the wrong place, it is fraught with both respiratory arrest in the patient and general spinal anesthesia.
The essence of the blockade is that the drug used for several to six months prevents the propagation of the impulse along the nerve 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: a person completely forgets the pain for a while, can sleep comfortably or continue his work.
Surgery - pain relief
When drugs do not help - neither pills nor injections, when physical therapy is ineffective, neurosurgeons come to the rescue.Modern technologies allow these specialists to return patients who have suffered from it for years to a pain-free life.There are many techniques: from manipulations with minimal intervention on the body to complex surgical operations with vertebral prostheses.
One of the most common and effective methods for hernias that compress a nerve is the wordradiofrequency ablation.In fact, this is a kind of blockade, instead of a drug that only temporarily relieves pain, an electric current is used that can completely solve the problem.Ablation is often performed after blockades, thanks to which doctors clearly understand which nerve needs to be affected.The procedure is carried out both for a fee and on a quota basis.
The procedure takes 20 minutes.It is called an operation, but it is actually a surgical operation performed under local anesthesia, always under the control of special devices.First, the pain syndrome is repeated, and if the patient confirms that this is the pain he usually experiences, we apply pulse discharge - and the pain, so it goes away.
Methods are used in special casesneurostimulationincluding electrode implantation.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 on a quota basis.
There are cases where various types of surgical interventions have already been performed, but the pain syndrome persists to one degree or another, then we install the stimulator - first in test mode, if the desired effect is achieved, then we install it permanently.This is an operation performed through a small incision.The only thing is that the patient should come periodically for test control.
What are we risking?
The risk of postponing or completely rejecting surgery is considered highly exaggerated by many patients.In neurosurgery, there are technologies that allow you to accurately calculate the effectiveness of the operation and which symptoms will disappear after it and which will remain.
The probability of pain returning after surgery is no more than 1-1.5%.Elsewhere, hernias may indeed be seen, but this is not a complication, but rather an extension of the disease, often found in young, undisciplined patients.As soon as the pain passes, they return to their usual lifestyle: driving, continuing to exercise.But it is absolutely impossible to do this.
Is osteochondrosis to blame for everything?
Osteochondrosis is a chronic degenerative-dystrophic change in the intervertebral space.All people over the age of 25 have symptoms of osteochondrosis.It is impossible to avoid osteochondrosis, but you can protect yourself from its complications, which are the cause of back pain.
Why isn't it the other way around?
Is it necessary to spend time, effort and money on treatment: pills, injections, physiotherapy, if you can immediately get rid of the pain once and for all with a small operation?- This is a question that patients are asking more and more recently.The answer is usually clear: yes, you should!The problem is that with an accurate diagnosis and proper treatment, only a few reach surgery.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 for people who see a protrusion or hernia in the picture to bypass the specialists at the previous stages of care and immediately run to the surgeon.In cases where the changes are minor, surgery is not required.Moreover, with the right lifestyle - engaging in physical therapy, swimming, monitoring body weight - a person with osteochondrosis can feel healthy and not feel pain.
At each stage, it is important to accurately diagnose the patient and prescribe the correct treatment.This can only be achieved collectively.Using the example of foreign experience, it is proposed to introduce a new specialty, for example, an algologist - this is a kind of therapist specializing in pain, with the knowledge of a neurologist and an interventional anesthesiologist, who can treat the issue without leading to surgical intervention, but if surgical intervention is still unavoidable, he will urgently transfer the patient to neurosurgery.