Protrusions, hernias, osteochondrosis - when diagnosed, patients immediately rush to the surgeon, without considering conservative methods of treatment, 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.Therefore, their damage is often accompanied by pain, which can occur after bending or turning the head and body and which is relieved by rest.Anatomically, the spine is represented by an alternation of vertebrae and intervertebral discs.The latter are prone to degeneration over time, which leads to the formation of protrusions and hernias.These structures can cause pain themselves, or they can cause pain through compression of nearby structures – nerve roots and ligaments of the spine.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 more rigid structure than the intervertebral disc.Their damage causes back pain in 15 to 65% of cases.Up to 30% of lower back pain is caused by damage to the sacroiliac joint, a twin structure connecting the sacrum and pelvic bones.Ultimately, any irritation increases the tone of the muscles around it, which over time causes a distinct myofascial syndrome.
Typically, physical activity leads to back pain, especially in cases where it is pronounced or intense, or when 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 fitness 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 contributing to the occurrence of this disease can be identified: poor physical development, metabolic disorders in the body, genetic predisposition, poor posture, prolonged stay in one position (for example, in front of a computer screen, while driving), physical inactivity, too soft bed, flat feet.As a rule, these reasons are associated with poor diet.
What to do if you have back pain?
The most important rule is not to self-medicate!
First, you must make 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 particular study should be made 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, the 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), prescription, in some cases, of 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 treatment for 4-6 weeks, intractable 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 unwanted consequences and complications, including disability.
Back pain is recognized as the most common.Experts explain this by the peculiarities of human anatomy.The fact is that the spine is under stress throughout a person's life: from the time they stand up in childhood until they die.The spine wears out, and sooner or later almost everyone has problems.The most common diagnoses made for back pain are "osteochondrosis" and "sciatica", while patients often make them themselves and prescribe treatment themselves, without seeking advice from a doctor.However, even behind these diagnoses, which seem to be heard by everyone, there are often reasons hidden that only an experienced specialist can determine.
What hurts there?
The vast majority (around 95%) of pain is associated with muscles, ligaments and joints.This is commonly called back strain.These pains are unpleasant, but not dangerous and in most cases disappear on their own within 2-3 days.
3 to 4% of pain is associated with radiculopathy (radiculitis) – an injury to the spinal root.It is usually damaged by a hernia.The pain disappears when the swelling caused by the compression 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, in which the pain syndrome can spread to the back.This is the most dangerous type of back pain.To exclude such pathologies, be sure to consult a doctor.
You can't hesitate
The main indicator of the need for medical attention is the regularity of pain.If you find yourself cramped from time to time, there's probably nothing to worry about.If pain of low or moderate intensity haunts you relentlessly, you cannot hesitate.It is necessary to urgently consult a doctor if the pain is accompanied by a rise in temperature or the pain syndrome worsens during treatment.
Types of pain
Doctors identify 3 types of pain, which are most often felt in the back.The task of the doctor is to determine exactly what kind of pain bothers the patient contacting him, because each of them will be treated exclusively in its own way.
Nociceptive painor, in simple terms, pain in the receptors - in the skin, muscles, ligaments, joints - is considered the most common.The causes that cause 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.Causes of muscle spasms can be, for example, physical exertion, when a person lifts something heavy, bends sharply or a change in temperature (a common example is air conditioning).This type of pain is treated with two types of medications.
Acute pain is treated with analgesics, anti-inflammatories and muscle relaxants.In this case, there can be no other therapy.When the pain syndrome is relieved, we recommend that the patient strengthen his muscles through physical exercises.This is both 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 condition is better known as sciatica.This type of pain in a person occurs especially when a spinal 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 X-rays or MRI reveal the existence of 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 fully 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 will also be different.What is considered osteochondrosis not only does not manifest itself in 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 bone tissue, protrusions (the initial stage of an intervertebral disc herniation. - Author) or herniations cannot hurt on their own.Even studies were carried out: groups of people of different ages were subjected to MRI scans - they selected mainly those who had never visited a doctor for complaints of back pain, but they had hernias and osteochondrosis.
Additionally, the doctor gives examples of cases where patients received treatment - and their pain disappeared, despite the fact that osteochondrosis remained present.Osteochondrosis is today a locally used concept.
There are countries where the word "osteochondrosis" is not used at all.Last year, they officially declared that this diagnosis was made by neurologists of the previous generation.Abroad, when a patient comes to an appointment and says he has back pain, he is diagnosed with non-specific back pain, but it is understood that the person has strained the muscles.
Experts most often confirm that the pain is caused by radiculitis, and not a spasm by 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 from diabetes and herpes.With diabetes, patients often complain of pain, because this disease damages the nervous system.Postherpetic neuralgia is characterized by stripes of rash along the damaged nerve and, as a result, pain.There are special medications to treat nerve pain.
Antiepileptic medications 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 one's 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 cause 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 had been complaining of back pain for six months said she had suffered.I recommended that he go to a psychologist and take physical education classes.A few days later, she returned completely healthy, without taking any medication.The psychologist helped her understand that the cause of the pain was stress: she had family problems, and physical education helped her relax.
At homeThe most effective remedy remains oral anti-inflammatories.Don't overdo it: they are only safe the first time.When taken for a long time, these medications 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 brings relief: the fixation relieves the spine, relieves spasms and limits sudden movements.Only the corset should be ordinary - elastic and not warming.
If the treatment has no effect within three days, you must consult a doctor who will administer a blockade with anti-inflammatory injections.By relieving spasms and relaxing the muscles, the pain disappears 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 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 your back yourself 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 certain situations, physiotherapy can be of great help.It is suitable for the first two types of pain: at the level of the receptors and the nerves.Physiotherapy is also prescribed for patients with drug allergies or stomach problems.
For this reason, treatment takes place, but there is no effect;Patients often consult us in serious cases, suffering from depression, which is why we approach their treatment with a multidisciplinary approach, involving different specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
Among the techniques used by domestic physiotherapists, borrowed from Russian colleaguesinterstitial electrical stimulation.Its principle is to apply 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 experts, is comfortable and does not require pain relief.The effect is generally felt after the first intervention.In total, they are assigned from 3 to 6.
Additionally, 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 worry about malfunction.The laser is used not only to treat diseases associated with spinal problems, but also to treat 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, due to this, the nutrition of the discs improves.As a result, swelling and inflammation are relieved and the pain disappears accordingly.
Blockade
The concept of “blockade” in medicine is not new.In cases of severe pain, since Soviet times, patients have been prescribed injections in the area where the pain is directly located.Since then, little has changed at local clinics.At the same time, in accordance with international recommendations, these procedures should 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: at best, a drug administered in the wrong place will not give the expected effect;at worst, it leads to serious complications.
The medication must be administered under radiological control: fluoroscopy, CT scan, MRI, ultrasound, because the medication is administered specifically to the location where the source of the pain is located.If the doctor places it in the wrong place, this results in both 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 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 pain for a while, can sleep peacefully or go about their 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 from it for consecutive years, without pain.There are many techniques: from manipulations with the most minimal intervention on the body to complex surgical operations with spinal prostheses.
For hernias that pinch a nerve, one of the most common and effective methods is something calledradiofrequency ablation.In essence, this is a kind of blockade, but instead of a drug that only temporarily relieves pain, an electric current is used that can completely solve the problem.Ablation is often carried out after blockages, thanks to which doctors clearly understand which nerve should be affected.The procedure is provided both on a paid basis and on a quota basis.
The procedure is carried out within 20 minutes.It is called an operation, but in fact it is a surgical procedure carried out under local anesthesia, always under the control of special devices.First of all, the pain syndrome is reproduced and, if the patient confirms that this is exactly the pain that he usually feels, we apply pulsed discharge - and the pain, as it were, goes away.
In special cases, methods are usedneurostimulation, including implantation of an electrode.The patient undergoes surgery: the surgeon places a small device at the site of pain that will suppress the pain impulses in real time.Patients benefit from this procedure according to a quota.
There are cases when various types of surgical interventions have already been carried out, but the pain syndrome persisted 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 carried out with a small incision.The only thing is that the patient will have to come periodically for a test check.
What are we risking?
The risk of surgical intervention, due to which it is postponed or refused altogether, is considered by many patients to be greatly exaggerated.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 persist.
The chance of pain returning after surgery is no more than 1-1.5%.Hernias in other places may indeed appear, but this is not a complication, but a spread of the disease, which is often found in young and unruly patients.As soon as the pain disappears, they return to their usual lifestyle: riding, resuming training.But it 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 show 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 the case 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 are asking themselves more and more often lately.The answer is generally clear: yes, it is necessary!The fact is that with accurate diagnosis and proper treatment, only a few operations can be performed.The rest are eliminated from pain at 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 a picture, immediately rush to a surgeon, bypassing specialists at previous stages of care.In cases where the changes are minor, no surgery is necessary.In addition, with a proper lifestyle - doing physiotherapy, swimming, monitoring weight - a person with the so-called osteochondrosis can feel healthy and not feel pain.
It is important that at each stage the patient receives 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 kind of specialized pain therapist, a doctor with the knowledge of a neurologist and an interventional anesthesiologist, able to treat without resorting to surgery, but, if surgery is still inevitable, he will quickly transfer the patient to neurosurgeons.