Protrusions, hernias, osteochondrosis - when diagnosed, patients immediately rush 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 the muscles surrounding it 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 are subject 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 adjacent structures - nerve roots and spinal ligaments.In some cases, they 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, a structure that is stiffer than the intervertebral disc.Their damage causes back pain in 15-65% of cases.Up to 30% of lower back pain is caused by damage to the sacroiliac joint, a paired structure that connects the sacrum and pelvic bones.Ultimately, any irritation increases the tone of the surrounding muscles, which over time leads to a separate myofascial syndrome.
Physical activity usually leads to back pain, especially if it is severe or intense, is carried out in an unnatural position, or if prolonged strain occurs in a forced position, for example when 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 can be identified that contribute to the occurrence of this disease: 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 a car), physical inactivity, too soft bed, flat feet.As a rule, these reasons are associated 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.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 imaging or computed tomography).The appointment of a specific examination should only be made by the attending physician based on the specific clinical picture.
Drug treatment of spinal osteochondrosis includes not only relieving pain, but also, if possible, eliminating the root causes.The doctor prescribes complex therapy (drug therapy, physiotherapy, acupuncture, balneotherapy).
Comprehensive therapeutic care for osteochondrosis includes correction of diet and lifestyle (healthy and active lifestyle, optimal level of physical education), as well as in some cases the prescription 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 therapy for 4-6 weeks, persistent 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, up to and including disability.
Back pain is considered the most common.Experts explain this with the peculiarities of human anatomy.The fact is that the spine is exposed to stress throughout life: from the moment he gets up 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”, although patients often make these themselves and prescribe the treatment themselves without seeking the advice of a doctor.But even behind these diagnoses, which seemingly everyone listens to, there are often reasons that only an experienced specialist can clarify.
What hurts there?
The majority (about 95%) of pain is associated with muscles, ligaments and joints.This is popularly known as a back strain.This pain is unpleasant but not dangerous and in most cases goes away on its 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 goes away as 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 that you need medical attention is the regularity of the pain.If shortages occur every now and then, there is most likely nothing to worry about.If pain of low or moderate intensity pursues you relentlessly, you cannot hesitate.If the pain is accompanied by an increase in temperature or the pain syndrome increases during treatment, an urgent visit to the doctor is necessary.
Types of pain
Doctors differentiate between three types of pain, which are most often felt in the back area.The doctor's task is to determine exactly what kind of pain bothers the patient who contacts him, since each of them is treated exclusively in his own way.
Nociceptive painor, more simply, pain in the receptors - in the skin, muscles, ligaments, joints - is considered the most common.The causes that lead to this are usually not visible on x-rays or computer tomography.In this case, the specialist makes a diagnosis based on the symptoms described by the patient.The causes of muscle cramps can include, for example, physical exertion, when a person lifts something heavy, bends sharply, or a change in temperature (a common example is an air conditioner).This type of pain is treated with two types of medications.
Acute pain is treated with painkillers, anti-inflammatory medications and muscle relaxants.In this case, no other therapy can be given.When the pain syndrome subsides, we recommend that the patient strengthen the muscles through physical exercise.This is for both treatment and prevention of the disease in the future.
Exercise not only strengthens muscles, but also contributes to the production of endorphins as well as serotonin and norepinephrine in the body.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 humans occurs especially when a vertebral fracture becomes large and pinches the nerve endings.At the same time, experts warn patients and the entire professional community against misdiagnosis if an inguinal hernia or other signs of wear and tear on the spine are detected in an X-ray or MRI, but this is not so severe that it affects the nerve.It is necessary to carefully understand the true cause of the pain.A muscle spasm may be to blame and it is a completely different type of pain and the treatment for it will be different too.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, bulges (the initial stage of a herniated disc. - Author) or hernias cannot cause harm on their own.Studies were even conducted: groups of people of different ages were subjected to MRI - they selected mainly those who had never visited a doctor with complaints of back pain, but were found to have hernias and osteochondrosis.
In addition, the doctor gives examples where patients were treated - and their pain disappeared, although osteochondrosis was still in the picture.Today, osteochondrosis is a concept that is used locally.
There are countries where the word “osteochondrosis” is not used at all.Last year it was officially said that this diagnosis was made by neurologists of the previous generation.If a patient comes to an appointment abroad and says that his back hurts, he will be diagnosed with non-specific back pain, but it will be assumed 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 caused by diabetes and herpes.Patients with diabetes often complain of pain because this disease damages the nervous system.Postherpetic neuralgia is characterized by a strip-like rash along the damaged nerve and, accordingly, pain.There are special medications to treat nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.The name of such drugs often frightens 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 a change in his mental state.In this case, the symptoms torment the patient for a long time.In this case, it's usually not just the back that hurts.
It happens that people come and say: "Everything hurts - my head, my back - all the time. They ask: Did they lift something heavy? No! And there is no clear localization. In this case, we can conclude that the patient has a low pain threshold and the pain analyzer, which is located in the brain, is constantly making itself felt. Anything can cause pain in such a patient: overwork, stress, a feeling of fear."
Painkillers do 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 suffered from it.I recommended that she see a psychologist and do some exercise.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.
HomeThe most effective remedy 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 pressure on the spine, relieves cramps and limits sudden movements.Only the corset should be normal - elastic and not warming.
If the treatment does not have any effect within three days, you should consult a doctor who will carry out 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 advertisements.Manual therapy is a field in which there are three hundred charlatans 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 yourself is dangerous.30% of patients in the neurosurgical 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 show results within 3-6 months and the pain continues to torment the patient, the doctor is obliged to refer the patient to another specialist.In some situations, physical therapy can be of great help.It is suitable for the first two types of pain: in receptors and nerves.Physiotherapy is also prescribed to patients with medication allergies or stomach problems.
For this reason, treatment takes place, but there is no effect.Patients often come to us with severe cases of depression, so we approach their treatment with a multidisciplinary approach involving various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
The techniques used by domestic physiotherapists include those adopted by Russian colleaguesinterstitial electrical stimulation.The principle is to direct current through a special disposable needle electrode directly to the source of pain, bypassing the skin barrier.Diagnoses for which this procedure is prescribed include protrusion and hernia.According to experts, the procedure is pleasant and does not require pain relief.The effect is usually noticeable after the first procedure.In total they are assigned 3 to 6.
In addition, it is usedLaser therapy.This technique is also convenient because it can be prescribed to patients on various stimulants, including cardio, and there is no fear of malfunction.The laser is used not only to treat diseases of the spine, but also to treat the already discussed complications of diabetes and herpes.
The laser promotes good healing.In addition, the device improves microcirculation in the spine itself and thereby the nutrition of the intervertebral discs.This reduces swelling and inflammation and the pain disappears accordingly.
blockade
The concept of “blockade” in medicine is not new.Since Soviet times, in cases of severe pain, patients have been prescribed injections into the area where the pain is directly localized.Since then, little has changed in the local clinics.Meanwhile, in accordance with international recommendations, these procedures must be carried out exclusively under control and with special equipment that allows real-time monitoring of the process.The consequences of a failed injection can be very different: in the best case, a drug administered in the wrong place will not produce the desired effect;in the worst case, it is associated with serious complications.
The drug should be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, since the drug is administered specifically to the area where the source of pain is located.If the doctor gets to the wrong place, this is associated with both the patient's respiratory arrest and total spinal anesthesia.
The essence of the blockade is that the administered drug prevents the propagation of the impulse along the nerve involved in the transmission of the nerve impulse for several months to six months.Although this procedure does not guarantee a permanent effect, it significantly improves the patient's quality of life: the patient completely forgets about the pain for a while, can sleep peacefully or go about his 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 enable these specialists to bring patients who have suffered for years back to life without pain.There are many techniques: from manipulations with minimal intervention in the body to complex surgical interventions with vertebral prostheses.
For hernias that pinch a nerve, one of the most common and effective methods is the so-calledRadiofrequency ablation.Essentially, it's a type of blockage, except instead of using a medication that only temporarily relieves the pain, it uses an electrical current that can solve the problem completely.Ablation is often performed after blockages, giving doctors a clear idea of which nerve must be affected.The procedure is offered both for a fee 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 and always under the control of special equipment.First, the pain syndrome is reproduced and when the patient confirms that this is exactly the pain he normally feels, we apply impulse discharge - and the pain, so to speak, turns off.
In special cases, methods are usedNeurostimulation, including the implantation of an electrode.The patient undergoes surgery: the surgeon places a small device at the site of pain, which suppresses the 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 remained to some extent.Then we install the stimulator - initially in test mode, and if the desired effect is achieved, we install it permanently.This is an operation that is performed with a small incision.The only thing is that the patient has to come regularly for testing checks.
What are we risking?
Many patients believe that the risk of an operation being postponed or rejected entirely is 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 persist.
The probability that pain will return after surgery is no more than 1-1.5%.Although hernias can also occur in other places, this is not a complication but rather a spread of the disease, which often occurs in young, undisciplined patients.As soon as the pain disappears, they return to their usual lifestyle: driving, continuing training.But that is absolutely impossible.
Is osteochondrosis to blame for everything?
Osteochondrosis is a chronic degenerative-dystrophic change in the intervertebral space.All people over 25 years old have signs of osteochondrosis.It is impossible to avoid osteochondrosis, but you can protect yourself from the complications that cause back pain.
Why is it like this and not otherwise?
Is it necessary to spend time, effort and money on treatment: pills, injections, physiotherapy, when you can immediately undergo a small operation and get rid of the pain once and for all?– Patients have been asking themselves this question more and more recently.The answer is usually clear: yes, it is necessary!The fact is that with an accurate diagnosis and the right treatment, few get surgery.The rest eliminate pain in the first stages of treatment - on average, 30% of patients are eliminated at each stage.
It is a mistake when people, seeing a protrusion or a hernia in a picture, immediately run to a surgeon, bypassing the specialists of the previous stages of treatment.If the changes are minor, surgery is not necessary.In addition, with a correct lifestyle - physiotherapy, swimming, watching body weight - a person with so-called osteochondrosis can feel healthy and not feel pain.
It is important that an accurate diagnosis is made to the patient at each stage and the correct treatment is prescribed.This can only be achieved together.It is also proposed, using the example of foreign experience, to introduce a new specialization, for example, an algologist - this is a type of therapist specializing in pain, a doctor with the knowledge of a neurologist and an interventional anesthesiologist, who is able to treat without bringing the matter into surgery, but, if surgical intervention is nevertheless unavoidable, immediately refers the patient to neurosurgeons.