Protrusions, hernias, osteochondrosis - when they are diagnosed, patients immediately rush to the surgeon, without considering conservative treatment methods, but this is wrong.
According to statistics, 84% of people suffer from 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 degenerate over time, which leads to the formation of protrusions and hernias.These structures can cause pain by themselves or by compressing adjacent 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, this structure is more rigid than the intervertebral disc.Their damage causes back pain in 15-65% of cases.30% of lower back pain is caused by damage to the paired structure connecting the sacrum and pelvic bones, the sacroiliac joint.Ultimately, any irritation increases the tone of the surrounding muscles, which over time causes a separate myofascial syndrome.
Physical activity usually leads to back pain, especially when it is vigorous or intense, or when it is performed in an unnatural posture, or when it is forced into a prolonged position, such as driving a car or sitting at a desk.A person's body weight and physical fitness are of great importance, as the severity of the load is always relative.
What are the reasons for its development?
It is impossible to clearly name the causes of the development of osteochondrosis, but many factors can be identified that contribute to the development of the disease: poor physical development, metabolic disorders in the body, genetic predisposition, incorrect posture, prolonged stay in one position (for example, in front of a computer monitor, while driving), physical inactivity, too soft a bed, flat feet.Usually, 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 will need to make an appointment with a neurologist or neurosurgeon.In order to establish an accurate diagnosis, a comprehensive examination of the patient is required, which necessarily includes an X-ray of the spine and tomography (magnetic resonance or computer tomography. Only the attending physician can appoint a specific examination based on the specific clinical picture.
Medical treatment of osteochondrosis of the spine includes not only pain relief, but also elimination of the root causes, if possible.The doctor prescribes complex therapy (drug therapy, physiotherapy, acupuncture, balneotherapy)
The comprehensive therapeutic care of osteochondrosis includes the correction of nutrition and lifestyle (healthy and active lifestyle, optimal level of physical education), in some cases the prescription of drugs from the group of chondroprotectors that improve the condition of the cartilage tissue.
The main indication for the surgical treatment of degenerative-dystrophic diseases of the spine is the ineffectiveness of conservative drug therapy for 4-6 weeks, the syndrome of untreatable pain, and the growing weakness of the legs, which in some cases can also be accompanied by urinary incontinence.In such situations, premature and improper treatment can lead to many undesirable consequences and complications, including disability.
Back pain is recognized as the most common.Experts explain this with the peculiarities of human anatomy.The fact is that the spine is exposed to stress throughout a person's life: from the moment he stands on his feet in childhood until his death.The spine wears out, and sooner or later almost everyone has problems with it.The most common diagnoses of back pain are "osteochondrosis" and "sciatica", while patients often self-diagnose and prescribe treatment without consulting a doctor.However, even behind these diagnoses - apparently heard by everyone - there are often reasons that only an experienced specialist can determine.
What hurts there?
The vast majority of pain (about 95%) is related to muscles, ligaments and joints.This is popularly called back strain.These pains are unpleasant, but not dangerous, and in most cases they go away 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 will go away when the swelling caused by the compression goes away.
1-2% of back pain is caused by spinal injuries or inflammatory diseases, oncological processes, cardiovascular or gastrointestinal diseases, in which the pain syndrome can also spread to the back.This is the most dangerous type of back pain.In order to rule out such pathologies, be sure to consult a doctor.
You can't hesitate
The main indicator of the need for medical care is the regularity of the pain.If you cramp occasionally, you most likely have nothing to worry about.If the pain of low or moderate intensity haunts you relentlessly, you should not hesitate.A doctor should be consulted urgently if the pain is accompanied by a rise in temperature or if the pain syndrome increases during treatment.
Types of pain
Doctors identify 3 types of pain that are most often felt in the back area.The doctor's task is to determine exactly what kind of pain the patient who comes to him is suffering from, because each of them is treated exclusively in his own way.
Nociceptive painor, to put it simply, pain from the receptors - skin, muscles, ligaments, joints - is considered the most common.The causes that cause this are usually not visible on an X-ray or CT scan.In this case, the specialist makes a diagnosis based on the symptoms described by the patient.Muscle spasms can be caused, for example, by physical exertion, when a person lifts something heavy, bends sharply, or changes in temperature (air conditioning is a common example).This type of pain is treated with two types of medication.
Acute pain is treated with painkillers, anti-inflammatory drugs and muscle relaxants.In this case, there can be no other therapy.When the pain syndrome subsides, we recommend that the patient strengthen the muscles with physical exercises.This is the treatment and prevention of the disease in the future.
Exercise not only strengthens the muscles, but also promotes the production of endorphins, serotonin and norepinephrine in the body.These substances increase a person's pain threshold and relieve depression.
Neuropathic painor nerve pain, this disease is popularly called sciatica.This type of pain in humans occurs especially when the vertebral hernia becomes large and pinches the nerve endings.However, experts caution patients and the entire professional community against misdiagnosis in cases where an X-ray or MRI shows that there is a hernia or 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 the muscle spasm is to blame, and this is a completely different type of pain, and the treatment will be different.Considered osteochondrosis, it is not only manifested as pain, but also the norm.
Osteochondrosis is a sign of the 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 (initial stage of intervertebral disc herniation. - Author) or herniation cannot hurt by themselves.They even conducted studies: groups of people of different ages were given MRIs - mainly those who had never seen a doctor with complaints of back pain, but had hernias and osteochondrosis.
In addition, the doctor gives examples of when patients received treatment - and their pain disappeared, despite the fact that osteochondrosis remained in the picture.Today, osteochondrosis is a locally used term.
There are countries where the word "osteochondrosis" is not used at all.Last year, it was officially announced 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 known that the person has strained the muscles.
Most often, experts confirm that the pain is caused by radiculitis, and not a spasm, a symptom like back pain that radiates along the nerve to the leg.
Nerve pain can also be caused by complications from diabetes and herpes.Patients with diabetes often complain of pain, as this disease damages the nervous system.Postherpetic neuralgia is characterized by rashes along the damaged nerve and corresponding pain.There are specific medications to treat nerve pain.
Antiepileptics and antidepressants are used to treat neuropathic pain.The name of this type of medication, it must be said, often frightens patients, so it is important to explain to them that antidepressants increase the pain threshold.These are the standards of pain management.
Psychogenic painor chronic.This type of pain is not caused by physical changes in the human body, but by a change in the mental state.In this case, the symptoms torment the patient for a long time.In this case, it is usually not just the back that hurts.
Sometimes they come and say: "Everything hurts - my head, my back - all the time. Are you asking: did they lift something heavy? No! And there is no clear localization. In this case, we can conclude that the patient's pain threshold has decreased, and the pain analyzer in the brain is constantly making itself felt. In such a patient, anything can cause pain, stress, and fear.
Painkillers do not help in this case.Patients with chronic pain are usually prescribed antidepressants and exercise by specialists, 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 she has been suffering.I suggested that he go to a psychologist and go to physical education.A few days later, he returned completely healthy, without drugs.The psychologist helped him understand that the cause of the pain was stress: he had family problems, and physical education helped him relax.
homeThe most effective remedy is oral anti-inflammatory drugs.Just don't overdo it - they're only safe the first time.If taken for a long time, such drugs can cause ulcers and bleeding in the lining of the stomach.Traditional home treatment - non-steroidal ointments - can only be used as an additional measure.They are harmless, but ineffective.Wearing a corset is also a relief - the fastening relieves the spine, relieves spasms and limits sudden movements.Only the corset should be ordinary - elastic and not warming.
If the treatment does not work within three days, see 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 forever.
Forbidden!
Baths and massages are strictly prohibited.They increase swelling and pain.
Contact chiropractors through newspaper ads.Manual therapy is a field where every professional has three hundred charlatans.If you really want to find a good doctor, contact certified clinics with certified specialists.
It is important to immediately determine the appropriate treatment tactics.This should be done by a neurologist or neurosurgeon.Treating your back on your own is dangerous.In the neurosurgery department, 30% of patients tried home treatment methods and ended up in a hospital bed.
When pills don't help
If the drug treatment prescribed by the therapist or neurologist does not bring 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 certain situations, physical therapy can be a significant help.It is suitable for the first two types of pain: in receptors and nerves.Physiotherapy is also prescribed for patients who are allergic to medicines or suffer from stomach problems.
Because of this, 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: neurologist, psychologist, physiotherapist, neurosurgeon.
Among the techniques used by domestic physiotherapists, borrowed from Russian colleaguesinterstitial electrical stimulation.Its principle is that the current is directed directly to the source of pain through a disposable special needle electrode, bypassing the skin barrier.Diagnoses for which this procedure is prescribed include protrusion and hernia.According to experts, the procedure is comfortable and does not require pain relief.The effect is usually felt after the first procedure.They are assigned from 3 to 6 in total.
It is also usedlaser therapy.This technique is also convenient because it can be prescribed to patients with various stimulants, including cardio, and there is no fear of failure.The laser is used not only to treat diseases associated with spinal problems, but also to treat the complications of diabetes and herpes, which have already been discussed.
The laser promotes good healing.In addition, the device improves the microcirculation of the spine itself, and thanks to this, the nutrition of the discs improves.As a result, the swelling and inflammation are reduced and the pain goes away accordingly.
Blockade
The concept of "blockade" in medicine is not new.In case of severe pain, since Soviet times, patients have been prescribed injections in the area where the pain is directly located.Little has changed since then at the local clinics.Meanwhile, in accordance with international recommendations, these procedures must be carried out exclusively under control, with special equipment that allows the process to be monitored in real time.The consequences of an unsuccessful injection can be very different: in the best case, the drug injected in the wrong place does not bring the desired effect;in the worst case, it leads to serious complications.
The medicine must be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, because the medicine is administered specifically to the area where the source of the pain is.If the doctor gets to the wrong place, the patient will stop breathing and undergo complete spinal anesthesia.
The essence of the blockade is that the administered drug prevents the propagation of the impulse along the nerve involved in the conduction of the nerve impulse for several to six months.Although this procedure does not guarantee a lasting 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 their business.
Surgery - pain relief
If medicines do not help - neither pills nor injections, if physical treatment is ineffective, neurosurgeons help.Modern technologies allow these specialists to bring patients who have been suffering for years back to life without pain.There are many techniques: from manipulations with minimal intervention of the body to complex surgeries with vertebral prosthesis.
One of the most common and effective methods for hernias pinching a nerve is the so-calledradiofrequency ablation.In essence, this is a kind of blockade, only instead of a drug that only temporarily relieves the pain, an electric current is used that can completely solve the problem.Ablation is often performed after blocks, which gives doctors a clear understanding of which nerve to target.The procedure is provided both on a fee-for-service and quota basis.
The procedure is performed within 20 minutes.It's called an operation, but it's actually a surgical intervention, which is performed under local anesthesia, always under the guidance of special devices.First, the pain syndrome is reproduced, and if the patient confirms that he is experiencing exactly this pain, then we apply pulse discharge - and the pain, so to speak, goes away.
Methods are used in special casesneurostimulation, including electrode implantation.The patient undergoes surgery: the surgeon places a small device at the site of pain, which suppresses pain impulses in real time.Patients receive this procedure according to a quota.
There are cases when various types of surgical interventions have already been performed, but the pain syndrome has remained to this or that extent, then we install the stimulator - first in test mode, then when the desired effect is achieved, we install it permanently.This is an operation performed through a small incision.The only thing is that the patient has to come regularly to check the examination.
What are we risking?
Many patients consider the risk of postponing or completely rejecting surgery to be greatly exaggerated.In neurosurgery, there are technologies that can be used to accurately calculate the success of the operation and which symptoms will disappear and which will remain.
The probability of pain returning after surgery does not exceed 1-1.5%.Hernias in other places may indeed appear, but this is not a complication, but an extension of the disease, which often occurs in young, undisciplined patients.As soon as the pain goes away, they return to their usual lifestyle: drive, continue 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 cause back pain.
Why this and why not?
Is it necessary to spend time, effort and money on treatment: pills, injections, physiotherapy, if you can immediately undergo a minor operation and get rid of the pain once and for all?– Patients are asking this question more and more recently.The answer is usually clear: yes, it is necessary!The fact is that with an accurate diagnosis and appropriate treatment, only a few people achieve surgery.The rest get rid of pain at the first stage of care - on average, 30% of patients are eliminated at each stage.
It is a mistake when people see a protrusion or hernia in the picture and immediately run to the surgeon, bypassing the specialists in the earlier stages of care.In cases where the changes are minor, surgery is not required.Moreover, with a suitable lifestyle - physical therapy, swimming, monitoring body weight - a person suffering from so-called osteochondrosis can feel healthy and not feel pain.
It is important that the patient receives an accurate diagnosis at each stage and prescribes appropriate treatment.This can only be achieved together.Using the example of foreign experience, we also recommend the introduction of a new field of expertise, for example the algologist - this is a type of therapist specializing in pain therapy, a doctor with expertise in neurology and interventional anesthesiology, who can treat the case without taking the case to surgical intervention, but if surgical intervention is still unavoidable, he will immediately transfer the patient to a neurosurgeon.