Protrusions, hernias, osteochondrosis - when they are diagnosed, the patient immediately rushes to the surgeon, without considering conservative treatment methods, but this is wrong.
According to statistics, 84% of people experience 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, 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 is subject to 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, it can cause stenosis (narrowing) of the spinal canal (the space where the spinal cord is located).
Among other things, the vertebrae are connected by paired facet joints, structures that are more rigid than the intervertebral discs.Their damage in 15-65% of cases causes back pain.Up to 30% of low back pain is caused by damage to the sacroiliac joint, a paired structure that connects the sacrum and pelvic bones.Finally, any irritation increases the tone of the surrounding muscles, which over time causes a separate myofascial syndrome.
As a rule, physical activity leads to back pain, especially in cases where it is pronounced or intense, or when it is performed in an inappropriate 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 fitness are very important, because 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 several factors that contribute to the occurrence of this disease can be identified: poor physical development, metabolic disorders in the body, genetic predisposition, incorrect posture, staying for a long time in one position (for example, in front of a computer monitor, while driving), physical inactivity, beds that are too soft, flat feet.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!
Initially, you need to come to an appointment with a neurologist or neurosurgeon.To establish an accurate diagnosis, a comprehensive examination of the patient is necessary, which necessarily includes x-rays of the spine and tomography (magnetic resonance or computed tomography. The appointment of a specific study should be made only by the attending physician based on a specific clinical picture.
Drug treatment for osteochondrosis of the spine includes not only pain relief, but also, if possible, the elimination of the root cause.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), prescription, in some cases, drugs from the group of chondroprotectors that improve the condition of cartilage tissue.
The main indications for surgical treatment for degenerative-dystrophic diseases of the spine are ineffectiveness of conservative drug therapy for 4-6 weeks, uncontrollable pain syndrome, as well as increasing weakness in the legs, which in some cases may be accompanied by urinary incontinence.Untimely and incorrect treatment in such situations can lead to a number of undesirable consequences and complications, including disability.
Back pain is recognized as the most common.Experts explain this with the characteristics of human anatomy.The problem 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 spinal column wears out, and sooner or later almost everyone has problems with it.The most common diagnoses made for back pain are "osteochondrosis" and "sciatica", while patients often make them themselves and prescribe treatment on their own, without consulting a doctor.However, even behind this diagnosis, which everyone seems to hear, there are often reasons that can only be determined by an experienced specialist.
What hurts there?
The majority (about 95%) of pain is associated with muscles, ligaments and joints.This is popularly called back stretch.This pain is unpleasant, but not dangerous and in most cases disappears by itself within 2-3 days.
3-4% of pain is associated with radiculopathy (radiculitis) - damage to the spinal roots.It is usually damaged by a hernia.The pain goes away 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, where the pain syndrome can spread to the back.This is the most dangerous type of back pain.To exclude such pathology, 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 experience congestion from time to time, it's most likely nothing to worry about.If pain of low or moderate intensity haunts you without stopping, you should not hesitate.It is necessary to immediately see 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 most often make themselves felt in the back.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 the most common.The cause is usually not visible on an x-ray or computed tomography.In this case, the specialist makes a diagnosis based on the symptoms described by the patient.The cause of muscle spasms can be, for example, physical exercise, when a person lifts something heavy, bends suddenly, or changes in temperature (a common example is air conditioning).This type of pain is treated with two types of medicine.
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 has been relieved, we recommend that the patient strengthen the muscles through physical exercise.This is the treatment and prevention of future diseases.
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, popularly this disease is better known as sciatica.This type of pain in a person occurs, in particular, when the vertebral hernia becomes large and pinches the nerve endings.At the same time, experts warn patients and the entire professional community against misdiagnosis in cases where an X-ray or MRI reveals that there is a hernia or some other type of wear on the spine, but it is not significant enough to affect the nerves.It is necessary to thoroughly understand the true cause of the pain.It is possible that muscle spasms are to blame, and this is a completely different type of pain, and the treatment for it is also different.What is considered osteochondrosis not only does not manifest itself as pain, but is also the norm.
Osteochondrosis is a sign of aging.But "osteochondrosis" and "pain" are not the same thing.Since there are almost no nerve endings in the bone tissue, the protrusion (early stage of herniated intervertebral disc. - Author) or hernia cannot be painful by itself.Even a study was carried out: groups of people of different ages were given an MRI - they chose, especially those who had never consulted a doctor with complaints of back pain, but they were found to have hernias and osteochondrosis.
In addition, doctors give examples when patients receive treatment - and their pain disappears, despite the fact that osteochondrosis remains in the picture.Osteochondrosis today is a locally used concept.
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 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 pressure on the muscles.
Experts most often confirm that the pain is caused by radiculitis and not spasms by symptoms in the form of pain in the back, radiating along the nerves to the legs.
Nerve pain can also be caused by complications caused by diabetes and herpes.With diabetes, patients often complain of pain, because the disease damages the nervous system.Postherpetic neuralgia is characterized by a strip of rash along the damaged nerve and, thus, pain.There are special medications to treat nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.The name of this type of drug, it must be said, often scares patients, so it is important to explain to them that it is an antidepressant that increases the pain threshold.This is the standard for pain management.
Psychogenic painor chronic.This type of pain is not caused by physical changes in the human body, but by changes in his mental state.In this case, symptoms torment the patient for a long time.In this case, as a rule, not only the back hurts.
It happens that people come and say: "Everything hurts - my head, my back - always. 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 lower pain threshold and the pain analyzer, which is located in the brain, always feels itself. Anything can trigger excessive pain, stress in such a patient.
Painkillers will not help in this case.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 complained of back pain for six months said she was suffering.I recommend that he go to a psychologist and go to physical education.A few days later he was completely healthy again 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 drugs are oral anti-inflammatory drugs.Just don't overdo it - they're only safe the first time.When taken for a long time, the drug can cause ulcers and bleeding in the gastric mucosa.Traditional home treatment - non-steroid ointment - can only be used as an additional measure.They are harmless, but ineffective.Wearing a corset also provides relief - fixation relaxes the spine, relieves spasms and limits sudden movements.Only the corset should be normal - elastic, and not heating.
If the treatment does not have an effect within three days, you should see a doctor who will provide a restriction with an anti-inflammatory injection.By relieving the spasm and relaxing the muscles, the pain will disappear immediately and often permanently.
Forbidden!
Bathing and massage are strictly prohibited.They increase swelling and pain.
Contact a chiropractor through an ad in the newspaper.Manual therapy is an area where for every expert there are three hundred frauds.If you really want to find a good doctor, you should contact a certified clinic 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 own back is dangerous.30% of patients in the neurosurgical department try home treatment methods and end up in a hospital bed.
When pills don't help
If the drug treatment prescribed by the therapist or neurologist does not bear fruit within 3-6 months and the pain continues to torment the patient, the doctor must transfer the patient to another specialist.In some cases, physical therapy can help.It is suitable for the first two types of pain: on receptors and nerves.Physiotherapy is also prescribed for patients who have allergies to medicines or stomach problems.
Because of this, 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 techniques used by domestic physiotherapists, borrowed from Russian colleaguesinterstitial electrical stimulation.The principle is to use a current through a special disposable needle electrode, bypassing the skin barrier, directly to the source of pain.The diagnosis for which this procedure is prescribed, includes 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 stimulants, including cardio, and there is no concern that damage will occur.Lasers are used not only to treat diseases related to spinal problems, but also as a treatment for complications of diabetes and herpes, which have already been discussed.
Laser promotes good healing.In addition, the device improves microcirculation in the spine itself, and due to this, disc nutrition improves.As a result, the swelling and inflammation are relieved, and the pain, thus, disappears.
Restrictions
The concept of "restrictions" in medicine is not new.For severe pain, since Soviet times, patients have been prescribed injections to the area where the pain is located directly.Little has changed at the local clinic since then.Meanwhile, according to international recommendations, this procedure must be performed 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: at best, the medicine given in the wrong place will not give the desired effect;at worst, it is fraught with serious complications.
Medicines should be given under radiological control: fluoroscopy, CT, MRI, ultrasound, because the medicine is given specifically to the area where the source of pain is.If the doctor goes to the wrong place, this is fraught with both respiratory arrest in the patient and total spinal anesthesia.
The essence of the blockade is that the drug given from several months to six months prevents the propagation of impulses along the nerves involved in the conduction of nerve impulses.Although this procedure does not guarantee a permanent effect, it significantly improves the patient's quality of life: the person completely forgets the pain for a while, can sleep peacefully or go about his business.
Surgery - pain relief
When medicine does not help - pills or injections, when physical treatment does not work, neurosurgeons come to the rescue.Modern technology allows these specialists to return patients who have suffered from it for years in a row back to life without pain.There are many techniques: from manipulation with minimal intervention in the body to complex surgical operations with vertebral prosthetics.
For a hernia that pinches a nerve, one of the most common and effective methods is the so-calledradiofrequency ablation.Basically, this is a kind of blockade, only instead of drugs that relieve pain only temporarily, an electric current is used that can solve the problem completely.Ablation is often performed after the blockade, thanks to the doctor who gets a clear understanding of which nerves need to be affected.This procedure is provided for a fee and is based on a quota.
The procedure is carried out in 20 minutes.It is called an operation, but in fact it is a surgical procedure performed under local anesthesia, always under the control of a special device.First, the pain syndrome is reproduced and, if the patient confirms that this is exactly the pain he usually experiences, we use pulse discharge - and the pain, so to speak, is turned off.
In special cases, methods are usednerve stimulation, including electrode implantation.The patient undergoes surgery: the surgeon places a small device at the site of pain that will block pain impulses in real time.Patients receive this procedure according to quota.
There are cases when various types of surgical interventions have been performed, but the pain syndrome has persisted to one degree or another, then we install a stimulator - first in test mode, and if the desired effect is achieved, then we install it permanently.This is an operation performed with small incisions.The only thing is that the patient has to come periodically for test control.
What are we betting on?
The risks of surgery, for which it is delayed or rejected altogether, are considered by many patients to be greatly exaggerated.In neurosurgery, there is technology that makes it possible to accurately calculate the effectiveness of the operation and the symptoms that will disappear afterwards 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 the spread of the disease, which is often found in undisciplined young patients.As soon as the pain is gone, they return to their normal lifestyle: driving, resuming 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 the age of 25 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 this and not the other way around?
Is it worth spending 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 have been asking more and more lately.The answer is usually clear: yes, it is necessary!The problem is that with an accurate diagnosis and proper treatment, only a few operations achieve.The rest eliminates pain at the first stage of care - on average, 30% of patients are eliminated at each stage.
It is a mistake when people, seeing a bulge or hernia in the image, immediately run to see a surgeon, bypassing the specialist at the previous level of care.In cases where the changes are minor, surgery is not required.Moreover, with the right lifestyle - doing physical therapy, swimming, watching your weight - a person with so-called osteochondrosis can feel healthy and not experience pain.
It is important that at each stage the patient is given an accurate diagnosis and the correct treatment is prescribed.This can only be achieved collectively.It is also proposed, using the example of foreign experience, to introduce new specializations, such as an algologist - this is a type of therapist who specializes in pain, a doctor with the knowledge of a neurologist and an interventional anesthetist, able to treat without taking the matter to surgery, but, if surgical intervention is still unavoidable, will immediately transfer the patient to a neurosurgeon.