Protrusions, hernias, osteochondrosis - when they are diagnosed, patients immediately rush to the surgeon, not thinking about 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.Because of this, their damage is often accompanied by pain, which can occur after bending or turning the head and body, and is alleviated 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 by 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 in which the spinal cord is located).
Among other things, the vertebrae are connected by paired facet joints, which is a more rigid structure 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 muscles around it, which over time causes a special myofascial syndrome.
Physical activity, as a rule, leads to 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, driving a car or sitting at a desk.A person's body weight and physical fitness are of great importance, because the weight of the load is always relative.
What are the reasons for its development?
It is impossible to clearly state the reasons for the occurrence 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, prolonged stay in one position (for example, in front of a computer monitor while driving), physical inactivity, excessive flat feet.As a rule, these reasons are combined with poor nutrition.
What to do if your back hurts?
The most important rule is not to self-medicate!
Initially, you need to see 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 computer tomography. The appointment of a certain study should be performed only by a doctor based on a specific clinical picture.
Treatment of osteochondrosis of the spine with drugs includes not only pain relief, but also, if possible, the removal of the underlying causes.The doctor prescribes complex therapy (drug therapy, physiotherapy, acupuncture, balneotherapy)
Comprehensive therapeutic care of osteochondrosis includes correction of diet and lifestyle (healthy and active lifestyle, optimal amount of physical education), prescribing, in some cases, 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 lasting 4-6 weeks, the syndrome of irreversible pain, as well as increasing weakness in the legs, which in some cases can be accompanied by urinary incontinence.Untimely and improper treatment in such situations can lead to a series of unwanted 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 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", and patients often make them themselves and prescribe treatment themselves, without seeking advice from a doctor.However, even behind these diagnoses, which everyone seems to hear, there are often reasons that only an experienced specialist can determine.
What hurts?
The vast majority (about 95%) of pain 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 pass by themselves 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 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 or 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 you cramp every now and then, it's probably nothing to worry about.If the pain of low or moderate intensity relentlessly haunts you, you cannot hesitate.It is necessary to consult a doctor immediately if the pain is accompanied by a rise in temperature or the pain syndrome intensifies during treatment.
Types of pain
Doctors identify 3 types of pain, which are most often felt in the back area.The doctor's task is to determine exactly what kind of pain is bothering the patient who comes to him, because 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 computed tomography.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 has lifted something heavy, bent down suddenly, or a change in temperature (a common example is an air conditioner).This type of pain is treated with two types of drugs.
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 is alleviated, we recommend the patient to strengthen the muscles with physical exercises.This is both treatment and prevention of 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 disease is popularly known as sciatica.This type of pain in a person occurs, especially, when the vertebral hernia becomes large and compresses the nerve endings.At the same time, experts warn patients and the entire professional public against misdiagnosis in cases where an X-ray or magnetic resonance imaging reveals that there is a hernia or some 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 a muscle spasm is to blame, and that 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 is also the norm.
Osteochondrosis is a sign of aging.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 hernias cannot hurt by themselves.Even studies were conducted: groups of people of different ages were subjected to magnetic resonance imaging - they chose, for the most part, those who had never consulted a doctor with complaints of back pain, but were diagnosed with hernias and osteochondrosis.
In addition, the doctor cites examples when patients received treatment - and their pain disappeared, despite the fact that osteochondrosis remained in the picture.Today, osteochondrosis is a term 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 his back hurts, he is diagnosed with non-specific back pain, but it is understood that the person has strained his muscles.
Experts most often confirm that the pain is caused by radiculitis, and not by a spasm symptom in the form of back pain, which 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, because this disease damages the nervous system.Postherpetic neuralgia is characterized by streaks of rash along the damaged nerve and, accordingly, pain.There are specific medications to treat nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.It must be said that the name of drugs of this type 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 his psychological state.In this case, 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 - all the time. 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 that the pain analyzer, which is located in the brain, is constantly felt. Anything can cause: a feeling of extreme pain in such a patient, 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 discover 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 she go to a psychologist and go to physical education.A few days later she came back completely healthy without any medication.A psychologist helped her understand that the cause of her pain was stress: she had family problems, and physical education helped her relax.
At homeThe most effective medicine 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 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 plain - elastic, not warming.
If the treatment has no effect within three days, it is necessary to consult a doctor who will give you a blockade with anti-inflammatory injections.By removing the 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 there are three hundred charlatans for every specialist.If you really want to find a good doctor, 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.Self-treatment of the back 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 therapy prescribed by the therapist or neurologist does not produce 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: in receptors and nerves.Physiotherapy is also prescribed for those patients who have drug allergies or stomach problems.
This is why 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, including various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
Among the techniques used by domestic physiotherapists, they are borrowed from Russian colleaguesinterstitial electrical stimulation.Its principle is to deliver current through a disposable special needle-electrode, bypassing the skin barrier, directly to the source of pain.Diagnoses for which this procedure is prescribed, including protrusions and hernias.According to experts, the procedure is comfortable and does not require pain relief.The effect is usually felt after the first procedure.They were assigned 3 to 6 in total.
In addition, it is usedlaser therapy.This technique is also convenient because it can be prescribed to patients with a variety of stimuli, including cardio, and there is no worry of malfunction.The laser is used not only to treat diseases related to 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, which improves the nutrition of the discs.As a result, swelling and inflammation are alleviated, and pain, accordingly, disappears.
Blockade
The concept of "blockage" 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 in local clinics since then.Meanwhile, in accordance with international recommendations, these procedures must be performed 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 given in the wrong place will not give the desired effect;at worst, it is fraught with serious complications.
The medicine should be given under radiological control: fluoroscopy, CT, MRI, ultrasound, because the medicine is applied specifically to the area where the source of pain is.If the doctor gets to the wrong place, it is fraught with respiratory arrest in the patient and complete spinal anesthesia.
The essence of the blockade is that the applied medicine prevents the propagation of the impulse along the nerve involved in the conduction of the nerve impulse for several months 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
When medicines do not help - neither pills nor injections, when physical treatment is ineffective, neurosurgeons come to the rescue.Modern technologies allow these specialists to return patients who have suffered from it for years to a pain-free life.There are many techniques: from manipulations with minimal intervention in the body to complex surgical operations with vertebral prosthesis.
For hernias that pinch a nerve, one of the most common and effective methods is the so-calledradiofrequency ablation.In essence, it is a kind of blockage, 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 blockades, thanks to which the doctors clearly understand which nerve needs to be affected.The procedure is provided on both a paid and quota basis.
The procedure is performed within 20 minutes.It's called surgery, but it's actually a surgical procedure 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 the pulse discharge - and the pain, so to speak, stops.
In special cases, methods are usedneurostimulation, including electrode implantation.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 according to quota.
There are cases when various types of surgical interventions have already been performed, but the pain syndrome has persisted to one degree or another, then we install a stimulator - first in test mode, and if the desired effect is achieved, then 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 periodically come for control tests.
What are we risking?
The risk of surgery, which is why it is postponed or completely rejected, 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 of pain returning after surgery does not exceed 1-1.5%.Hernias in other places can indeed appear, but this is not a complication, but the spread of the disease, which is often found in young, undisciplined patients.As soon as the pain disappears, they return to their usual way of life: they drive, continue training.But that 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 are the cause of back pain.
Why is this and not the other way around?
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?- This is a question that patients have been asking more and more recently.The answer is usually clear: yes, it is necessary!The fact is that with an accurate diagnosis and proper treatment, only a few people get surgery.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 a hernia in the picture, immediately run to the surgeon, bypassing specialists in the previous stages of care.In cases where the changes are small, surgery is not required.Moreover, with the correct lifestyle - physical therapy, swimming, monitoring body weight - a person with so-called osteochondrosis can feel healthy and not feel pain.
It is important that at every stage the patient is given an accurate diagnosis and the correct treatment is prescribed.This can only be achieved collectively.It is also proposed to introduce a new specialization based on the example of foreign experiences, such as an algologist - this is a type of therapist specializing in pain, a doctor with knowledge of neurology and interventional anesthesiologist, capable of treating without bringing matter to surgery, but, if surgical intervention is still unavoidable, he will urgently transfer the patient to a neurosurgeon.