Protrusions, hernias, osteochondrosis - when they are diagnosed, patients immediately rush to the surgeon, without considering conservative treatment methods, but this is wrong.
According to statistics, 84% of people have back pain at least once in their lives.The spine and surrounding muscles 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 themselves cause pain, or they can cause pain through compression of 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 more rigid 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 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.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 contributing to the occurrence 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), 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 need to come to 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 for spinal osteochondrosis 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), 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 for degenerative-dystrophic diseases of the spine is the ineffectiveness of conservative drug therapy for 4-6 weeks, intractable 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, including disability.
Back pain is recognized as the most common.Experts explain this by the peculiarities of human anatomy.The thing is that the spine is subject to stress throughout a person’s life: from the very moment he gets on his feet in childhood until his death.The spinal column wears out, and sooner or later almost everyone has problems with it.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 doctors.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 a back strain.These pains are unpleasant, but not dangerous and in most cases go away on their 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 disappears 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 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 pain.If you get cramped from time to time, there is most likely 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 increases during treatment.
Types of pain
Doctors identify 3 types of pain, which most often make themselves felt in the back area.The doctor’s task is to determine exactly what type of pain is bothering the patient who contacts 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 lifted something heavy, bent over sharply, or a temperature change (a common example is air conditioning).This type of pain is treated with two types of medications.
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 relieved, we recommend that the patient strengthen the muscles through physical exercise.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, popularly this disease is better known as sciatica.This type of pain in a person occurs, in particular, when a vertebral 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 that there is a hernia or some other type of wear on 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 for it will also be different.What is considered to be 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 bone tissue, protrusions (the initial stage of a herniated intervertebral disc. - Author) or hernias cannot hurt on their own.Even studies were carried out: groups of people of different ages were given MRIs - they selected, mainly those who had never consulted a doctor with complaints of back pain, but they were found to have hernias and osteochondrosis.
In addition, the doctor gives examples when patients received treatment - and their pain went away, 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 to an appointment and says that his back hurts, he is diagnosed with nonspecific back pain, but it is understood that the person has put stress on 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.With diabetes, patients often complain of pain, as this disease damages the nervous system.Postherpetic neuralgia is characterized by stripes of 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 drugs of this type, it must be said, often frightens 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 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, constantly makes itself felt. Anything 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 suffered.I recommended that she go to a psychologist and go to physical education.A few days later she came back completely healthy without taking any medications.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.Just don’t overdo it – they are only safe the first time.When taken for a long time, such drugs 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 ordinary - elastic, and not warming.
If the treatment does not have 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 goes away immediately and often forever.
Forbidden!
Baths and massages are strictly prohibited.They increase swelling and pain.
Contact chiropractors through advertisements in the newspaper.Manual therapy is an area 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 correct treatment tactics.This should be done by a neurologist or neurosurgeon.Treating your back on your own 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 drug treatment prescribed by a 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 allergies to medications or stomach problems.
Because of this, 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, involving various 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 disposable special 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, they are assigned from 3 to 6.
In addition, 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 that a malfunction will occur.The laser is used not only to treat diseases associated with spinal problems, but also as a treatment for 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, accordingly, goes away.
Blockade
The concept of “blockade” in medicine is not new.For severe pain, since Soviet times, patients have been prescribed injections into 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: at best, a medicine administered in 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, because the drug is administered specifically to the area where the source of pain is.If the doctor gets to the wrong place, this is fraught with both respiratory arrest in the patient and total spinal anesthesia.
The essence of the blockade is that the administered medicine from several months to six months prevents the spread of the impulse along the nerve that 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: 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 ineffective, neurosurgeons come to the rescue.Modern technologies allow these specialists to return patients who have suffered from it for years in a row back to life without pain.There are many techniques: from manipulations with the most 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 kind of blockade, only instead of a medicine that relieves pain only temporarily, an electric current is used that can completely solve the problem.Ablation is often done after blockades, thanks to which doctors get a clear understanding of which nerve needs to 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 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 that he usually experiences, we apply a pulse discharge - and the pain, so to speak, turns off.
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 pain impulses in real time.Patients receive this procedure according to a 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 the stimulator - first in test mode, and if the desired effect is achieved, then we install it permanently.This is an operation that is performed with a small incision.The only thing is that the patient will need to come periodically for test control.
What are we risking?
The risk of surgery, 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 likelihood 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 a spread of the disease, which is often found in young, undisciplined patients.As soon as the pain goes away, they return to their usual lifestyle: drive, resume 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 old 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 otherwise?
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 patients have been asking more and more often lately.The answer is usually clear: yes, it is necessary!The thing is that with accurate diagnosis and proper treatment, only a few reach operations.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 protrusion or hernia in an image, immediately run to see a surgeon, bypassing specialists at the previous stages of care.In cases where the changes are minor, surgery is not required.Moreover, with the right lifestyle - doing physical therapy, swimming, watching your body weight - a person with so-called osteochondrosis can feel healthy and not experience 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, such as an algologist - this is a kind of therapist specializing in pain, a doctor with the knowledge of a neurologist and interventional anesthesiologist, capable of treating without bringing the matter to surgery, but, if surgical intervention is still inevitable, will promptly transfer the patient to neurosurgeons.