Lumps, hernias, osteochondrosis - when diagnosed, patients immediately go 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 lives.The spine and surrounding muscles are part of the musculoskeletal system.Consequently, its damage is often accompanied by pain, which may 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, leading to the formation of bulges 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 more rigid structure than the intervertebral disc.Its 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.Ultimately, any irritation increases the tone of the surrounding muscles, which over time causes a separate myofascial syndrome.
As a general rule, physical activity causes back pain, especially in cases where it is pronounced or intense, or when it is 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.The body weight and physical fitness of a person 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 can be identified that contribute to the appearance of this 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, excessively 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 make an appointment with a neurologist or neurosurgeon.To establish an accurate diagnosis, a complete examination of the patient is necessary, which necessarily includes x-rays of the spine and tomography (MRI or computed tomography. The appointment of a particular study should be carried out only by the treating physician based on the specific clinical picture.
Drug treatment of spinal osteochondrosis includes not only pain relief, but also, if possible, elimination of the root causes.The doctor prescribes complex therapy (medicines, physiotherapy, acupuncture, balneotherapy).
Comprehensive therapeutic care for osteochondrosis includes the correction of nutrition and lifestyle (healthy and active lifestyle, optimal amount of physical education), the 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 therapy for 4-6 weeks, intractable pain syndrome and 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 by the peculiarities of human anatomy.The fact is that the spine is subject to stress throughout a person's entire life: from the moment he stands up 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 make them themselves and prescribe treatment themselves, without consulting a doctor.However, even behind these diagnoses, which seem to be heard by everyone, there are often reasons that only an experienced specialist can determine.
What hurts there?
The vast majority (about 95%) of pain is associated with muscles, ligaments and joints.This is popularly called back strain.These pains are unpleasant, but not dangerous, and in most cases they disappear on their own within 2 or 3 days.
Between 3% and 4% of pain is associated with radiculopathy (radiculitis), that is, damage to the spinal root.It is usually damaged by a hernia.The pain goes away when the swelling caused by the compression disappears.
Between 1 and 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 extend 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 doubt
The main indicator that you need medical attention is the regularity of the pain.If you get cramps from time to time, chances are there's nothing to worry about.If pain of low or moderate intensity follows you relentlessly, you can't 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, which most often manifest in the back area.The doctor's task is to determine exactly what type of pain bothers the patient who contacts him, because each one 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, bending over suddenly, 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 the muscles through physical exercise.This is both a treatment and a prevention of the disease in the future.
Exercise not only helps strengthen muscles, it 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 a spinal hernia enlarges 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 MRIs reveal that there is a hernia or some other type of wear in the spine, but it is not significant enough to affect the nerve.It is necessary to carefully understand the true cause of the pain.It is possible that muscle spasm is 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 as pain, but it is also the norm.
Osteochondrosis is a sign of aging of the body.But "osteochondrosis" and "pain" are not the same.Since there are practically no nerve endings in the bone tissue, bulges (the initial stage of a herniated intervertebral disc. - Author) or herniations cannot hurt on their own.Studies were even carried out: MRIs were performed on groups of people of different ages;They selected mainly those who had never consulted a doctor with complaints of back pain, but who had hernias and osteochondrosis.
In addition, the doctor gives examples of patients who received treatment and the 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 older generation.Abroad, when a patient arrives for an appointment and says their back hurts, they are diagnosed with non-specific back pain, but it is understood that the person has put stress on the muscles.
Experts usually confirm that the pain is caused by radiculitis and not by a spasm, due to a symptom in the form of pain in the back that radiates 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, as this disease damages the nervous system.Postherpetic neuralgia is characterized by stripes of rash along the damaged nerve and, consequently, pain.There are special medications to treat nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.It must be said that the name of this type of drug usually 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 your 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 you lift something heavy? No! And there is no clear localization. In this case, we can conclude that the patient has a reduced pain threshold and the pain analyzer, which is located in the brain, constantly makes itself felt. Anything can provoke pain in such a patient: overwork, stress, a feeling of fear.
Pain relievers in this case will not help.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.I recommended that he go to a psychologist and go to physical education.A few days later she returned completely healthy and 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 is oral anti-inflammatory drugs.But 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 gastric mucosa.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 normal: elastic and not tight.
If the treatment does not produce an effect within three days, you should consult a doctor who will administer a blockade with anti-inflammatory injections.By relieving spasms and relaxing muscles, the pain disappears immediately and often forever.
Forbidden!
Baths and massages are strictly prohibited.Swelling and pain increase..
Contact chiropractors through newspaper ads.Manual therapy is an area in which 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 correct 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 to 6 months and the pain continues to torment the patient, the doctor is obliged to transfer him 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 for those patients who have drug allergies or stomach problems.
Because of this, the treatment is carried out, but no effect is produced;Patients usually come to us in serious cases, with depression, so we approach their treatment with a multidisciplinary approach, involving several 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 usually felt after the first procedure.In total, 3 to 6 are assigned.
Furthermore, it is usedlaser therapy.This technique is also convenient because patients can be prescribed various stimulants, including cardio, and there is no need to worry about malfunctions occurring.The laser is used not only to treat diseases associated with spinal problems, but also as a treatment for the 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, thanks to this, improves the nutrition of the discs.As a result, swelling and inflammation are relieved and, consequently, the pain disappears.
Blockade
The concept of “blocking” in medicine is not new.For severe pain, since Soviet times, patients have been prescribed injections in the area where the pain is directly located.Little has changed at local clinics since then.Meanwhile, 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 a failed injection can be very different: in the best case, a drug administered in the wrong place will not produce the desired effect;At worst, it is fraught with serious complications.
The drug must be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, because the drug is administered specifically to the area where the source of the pain is located.If the doctor reaches the wrong place, this leads to both respiratory arrest of the patient and complete spinal anesthesia.
The essence of the blockade is that the drug administered for several months to six months prevents the spread 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 his business.
Surgery – pain relief
When medications do not help, neither pills nor injections, when physical treatment is not effective, neurosurgeons come to the rescue.Modern technologies allow these specialists to bring back pain-free life to patients who have suffered from it for years in a row.There are many techniques: from manipulations with minimal intervention in the body to complex surgical operations with spinal prostheses.
For hernias that pinch a nerve, one of the most common and effective methods is calledradiofrequency ablation.In essence, this is a kind of blockade, only instead of a drug that relieves pain only temporarily, an electric current is used that can completely solve the problem.Ablation is often performed after blocks, giving doctors a clear idea of which nerve should be affected.The procedure is provided both on a paid basis and on a fee basis.
The procedure is carried out in 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 of all, the pain syndrome is reproduced and, if the patient confirms that this is exactly the pain he usually experiences, we apply a pulsed shock and the pain, so to speak, disappears.
In special cases, methods are used.neurostimulation, including implantation of an electrode.The patient undergoes surgery: the surgeon places a small device at the site of pain that will suppress pain impulses in real time.Patients receive this procedure on a fee basis.
There are cases when various types of surgical interventions have already been performed, but the pain syndrome persisted to one degree or another, then we install the stimulator, first in trial 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 must come periodically to control the tests.
What are we risking?
Many patients consider the risk of surgery, which is why it is postponed or rejected altogether, 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 remain.
The probability of pain returning after surgery is no more than 1-1.5%.It is true that hernias may appear in other places, but this is not a complication, but rather a spread of the disease, which is often found in young and undisciplined patients.As soon as the pain disappears, they return to their usual 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 25 years of age 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 this and not any other way?
Is it necessary to spend time, effort and money on treatments: pills, injections, physiotherapy, is it possible to immediately undergo a small operation and get rid of the pain once and for all?– This is a question that patients are asking more and more frequently lately.The answer is usually clear: yes, it is necessary!The fact is that with an accurate diagnosis and adequate treatment, only a few reach the operation.The rest eliminate pain in the early stages of care;On average, 30% of patients are eliminated at each stage.
It is a mistake when people, seeing a lump or hernia in an image, immediately run to a surgeon, avoiding specialists in the previous stages of care.In cases where the changes are minor, surgery is not required.In addition, with a proper lifestyle (doing physiotherapy, swimming, monitoring body weight), a person with the so-called osteochondrosis can feel healthy and not feel 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 a new specialization, for example, an algologist: he is a kind of therapist specialized in pain, a doctor with knowledge of a neurologist and interventional anesthesiologist, capable of treating without bringing the matter to surgery, but, if surgical intervention is still inevitable, he will quickly transfer the patient to neurosurgeons.