Protrusions, hernias, osteochondrosis - when they are diagnosed, patients immediately rush to the surgeon without considering 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.Therefore, their damage is often accompanied by pain, which can appear 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 are subject to degeneration over time, which leads to the formation of protrusions and hernias.These structures can cause pain on their own, or they can cause pain by compressing 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 structure stiffer than the intervertebral disc.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 connecting the sacrum and pelvic bones.Ultimately, any irritation increases the tone of the muscles around it, which over time causes a separate 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 posture, or when it involves prolonged exposure to a forced posture, for example, 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 reasons for the development of osteochondrosis, but a number of factors contributing to the appearance of this disease can be identified: 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), lack of physical activity, overly soft bed, 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 should come to an appointment with a neurologist or neurosurgeon.To establish an accurate diagnosis, a comprehensive examination of the patient is required, which necessarily includes X-rays of the spine and tomography (magnetic resonance or computer tomography. The appointment of a specific examination should be carried out only by the attending physician based on the specific clinical picture.
Drug treatment of 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, which 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, unbearable pain syndrome, as well as increasing weakness in the legs, which in some cases can 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.Specialists explain this with the peculiarities of human anatomy.The fact is that the spine is under stress throughout a person's life: from the moment he stood 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 for back pain are "osteochondrosis" and "sciatica", and patients often make them themselves and self-prescribe treatment without seeking advice from a doctor.However, even behind these diagnoses, which seem to be heard by everyone, there are often reasons that only an experienced specialist can identify.
What hurts there?
The majority (about 95%) of pain is related to muscles, ligaments and joints.This is popularly called a back stretch.These pains are unpleasant, but not dangerous and in most cases disappear on their own in 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 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 the 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 help is the regularity of the pain.If it's pinching you from time to time, it's probably nothing to worry about.If the pain of low or moderate intensity pursues you relentlessly, 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 that are most often felt in the back area.The doctor's task is to determine exactly what type of pain bothers the patient who contacts him, since 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 causes that cause it 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, for example, physical exertion, when a person lifts something heavy, bends down sharply, 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 both treatment and prevention of the disease in the future.
Exercise not only helps strengthen muscles, but it also helps produce endorphins in the body, as well as serotonin and norepinephrine.These substances raise the 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 spinal hernia becomes large and pinches the nerve endings.At the same time, experts warn patients and the entire professional community not to make a misdiagnosis in cases where X-rays or MRIs show that there is a herniation 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.A muscle spasm may be 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 manifest itself 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 intervertebral disc herniation. - Author) or herniation cannot injure by themselves.Even research was 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 it turned out that they had a hernia and osteochondrosis.
In addition, the doctor gives examples when patients received treatment - and their pain disappeared, despite the fact that osteochondrosis remained in the picture.Osteochondrosis today 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 for an examination and says that he has lower back pain, they give him a non-specific pain in the back, but it is understood that the person has strained the muscles.
Experts most often confirm that the pain is caused by sciatica, and not by a spasm of 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.With diabetes, patients often complain of pain, as this disease damages the nervous system.Postherpetic neuralgia is characterized by a striped rash along the damaged nerve and corresponding pain.There are special medications to treat 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 antidepressants raise 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, not only the back 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. Everything can provoke pain in such a patient: overwork, stress, a feeling of fear.
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 says she is suffering.I recommended that she go to a psychologist and a physical therapist.A few days later she was back completely healthy without taking any medication.The psychologist helped her understand that the cause of the pain was stress: there were family problems, and physical education helped her relax.
at homeThe most effective drug is oral anti-inflammatory drugs.Just don't overdo it - they're 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 relieves the spine, relieves spasms and limits sudden movements.Only the corset should be ordinary - elastic, not warming.
If the treatment has no effect within three days, you should consult a doctor who will apply a blockade with anti-inflammatory injections.By relieving spasms and relaxing the muscles, the pain disappears 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 quacks.If you really want to find a good doctor, you should contact certified clinics where certified specialists work.
It is important to determine the correct treatment tactics immediately.This should be done by a neurologist or neurosurgeon.Treating your back yourself is dangerous.30% of neurosurgery patients have tried home remedies 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: receptor and nerve pain.Physiotherapy is also prescribed for those patients who have drug allergies or stomach problems.
Therefore, treatment is carried out, but there is no effect;patients often come to us in severe cases, with depression, therefore we approach their treatment with a multidisciplinary approach, including various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
Among the techniques used by local physiotherapists, borrowed from Russian colleaguesinterstitial electrical stimulation.Its principle is to deliver current through a special disposable needle electrode, 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 specialists, is convenient and does not require anesthesia.Usually the effect is felt after the first procedure.In total, they are distributed from 3 to 6.
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 worry that a malfunction will occur.The laser is used not only to treat diseases related to spinal problems, but also as a treatment for complications from diabetes and herpes, which have already been discussed.
The laser promotes good healing.In addition, the device improves microcirculation in the spine itself and, therefore, the nutrition of the discs is improved.As a result, the swelling and inflammation are relieved and, accordingly, the pain disappears.
Blockade
The concept of "blockade" in medicine is not new.With severe pain from Soviet times, patients are prescribed injections in the area where the pain is localized.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, the medicine applied to 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, as the drug is applied specifically to the area where the source of pain is.If the doctor gets in the wrong place, it is fraught with both stopping the patient's breathing and complete spinal anesthesia.
The essence of the blockade is that the administered drug for several months to six months prevents the propagation of the impulse along the nerve, which 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: a person completely forgets about the pain for a while, can sleep peacefully or go about his work.
Surgery - pain relief
When drugs do not help - neither pills nor injections, when physical treatment is ineffective, neurosurgeons come to the rescue.Modern technology allows these specialists to return pain-free to patients who have suffered from it for years.There are many techniques: from manipulations with minimal intervention in the body to complex surgical operations with vertebral prosthetics.
For hernias that pinch a nerve, one of the most common and effective methods is the so-calledradiofrequency ablation.In essence, this is a type 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 done after blocks, thanks to which doctors get a clear idea of which nerve should be affected.The procedure is provided on both a paid and quota basis.
The procedure is performed within 20 minutes.It is called an operation, but it is actually a surgical procedure that is performed under 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 discharge - and the pain is turned off, so to speak.
In special cases, methods are usedneurostimulation, including electrode implantation.The patient undergoes an operation: the surgeon places a small device at the site of pain, which suppresses pain impulses in real time.Patients receive this procedure on a quota basis.
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, 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 are we risking?
The risk of an operation, due to which it is postponed or refused 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 probability that the pain will return after surgery does not exceed 1–1.5%.Indeed, hernias may appear elsewhere, but this is not a complication, but a spread of the disease, which often occurs in young, undisciplined patients.As soon as the pain disappears, they return to their usual way of life: drive, resume training.But this is absolutely impossible to do.
Is osteochondrosis to blame for everything?
Osteochondrosis is a chronic degenerative-dystrophic change of 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 is it so and not otherwise?
Is it necessary to spend time, effort and money on treatment: pills, injections, physical therapy, if you can immediately undergo a minor operation and get rid of the pain once and for all?– This is a question that patients are asking themselves more and more recently.The answer is usually clear: yes, it is necessary!The thing is, with an accurate diagnosis and proper treatment, surgery is rarely needed.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 bulge or hernia in a photo, immediately run to a surgeon, bypassing specialists at the previous stages of care.In cases where the changes are minor, no surgery is required.In addition, with the right lifestyle - conducting physiotherapy, swimming, monitoring body weight - a person with so-called osteochondrosis can feel healthy and not feel pain.
It is important to make an accurate diagnosis at each stage of the patient and to prescribe the correct treatment.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 knowledge of a neurologist and an interventional anesthesiologist, able to treat without bringing the matter to surgery, but if surgical intervention is still unavoidable, he will immediately transfer the patient to the neurosurgeons.