Protrusion, hernia, osteochondrosis - when diagnosed, patients immediately rush to the surgeon, not considering conservative 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. Consequently, their damage is often accompanied by pain, which can occur after bending or turning the head and body and relieve at rest. Anatomically, the spine is represented by alternating vertebrae and intervertebral discs. The latter are subject to the process of degeneration over time, which leads to the formation of protrusions and hernias. These structures can themselves cause pain, or they can cause pain by compressing adjacent structures - the 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 structure that is more rigid than an 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 that connects the sacrum and pelvic bones. Ultimately, any irritation increases the tone of the muscles around, which over time causes a separate myofascial syndrome.
As a rule, physical activity leads to back pain, especially in those cases when it is pronounced or intense, or when it is performed in an unnatural posture, or when it is associated with a prolonged stay in a forced position, for example, driving a car or workingtable. 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 unequivocally name the reasons for the development of osteochondrosis, but it is possible to identify a number of factors that contribute to the onset of this disease: poor physical development, metabolic disorders in the body, genetic predisposition, improper posture, prolonged stay in one position (for example, in front of a computer monitor, driving), physical inactivity, too soft bed, flat feet. As a rule, these reasons are combined with poor nutrition.
What to do if back pain occurs?
The most important rule is not to self-medicate!
Initially, you need to visit a neurologist or neurosurgeon. To establish an accurate diagnosis, a comprehensive examination of the patient is required, which necessarily includes x-ray of the spine and tomography (magnetic resonance imaging or computer x-ray. The appointment of a particular study should be made only by the attending physician based on a specific clinical picture.
Medication for spinal osteochondrosis includes not only the removal of pain, but, 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 exercise), prescription, in some cases - drugs of the chondroprotective group 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, up to and 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 as soon as 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 for back pain are: "osteochondrosis" and "radiculitis", while often patients make them themselves and themselves prescribe treatment without consulting a doctor. However, even behind these diagnoses, which, it would seem, are on everyone's lips, there are often reasons that only an experienced specialist can determine.
What's hurting there?
The vast majority (about 95%) of pain is associated with muscles, ligaments and joints. This is popularly called back pulling. These pains are unpleasant, but not dangerous and in most cases go away on their own in 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 edema caused by the pressure passes.
1–2% of back pain is caused by an injury or inflammatory disease of the spine, cancer, 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 cannot delay
The main indicator that you need medical attention is the regularity of pain. If you get twisted from time to time - most likely, there is nothing wrong. If pain of low to moderate intensity pursues you relentlessly, you cannot hesitate. An urgent need to 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 that most often make themselves felt in the back area. The task of the doctor 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, more simply, pain in receptors - in the skin, muscles, ligaments, joints - is considered the most common. The reasons that cause it are usually not visible on X-rays or with the help of computed tomography. In this case, the specialist makes the diagnosis based on the symptoms that the patient tells about. The causes of muscle spasm can be, for example, physical activity, when a person lifted something heavy, leaned sharply, or a temperature drop (a common example is blown by an air conditioner). This type of pain is treated with two types of medication.
Acute pain is treated with pain relievers, 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 with physical education. This is both treatment and prevention of the disease for the future.
Exercise not only helps to strengthen muscles, but also promotes the production of endorphins in the body, as well as serotonin and norepinephrine. These substances increase a person's pain threshold and relieve a depressive mood.
Neuropathic painor nerve pain, popularly known as sciatica. This type of pain in humans occurs, in particular, 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 it turns out on X-rays or using MRI that a hernia or some other type of spinal wear is present, but it is not so significant as to affect the nerve. It is necessary to carefully understand the true cause of pain. It is possible that muscle spasm is to blame, and this type of pain is completely different, and the treatment for it will also be different. What is considered to be osteochondrosis, not only does not manifest itself in 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 (the initial stage of herniated intervertebral disc - Auth. ) Or hernias cannot hurt by themselves. There were even studies: groups of people of different ages underwent MRI - they chose mainly those who never went to the doctor with complaints of back pain, but they found both hernias and osteochondrosis.
In addition, the doctor gives examples when patients received treatment - and their pain went away, despite the fact that osteochondrosis remained on the x-ray. Osteochondrosis today 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 past 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 assumed that the person exerted stress on the muscles.
Confirmation that pain is caused by radiculitis, and not spasm, for specialists most often serves as a symptom in the form of pain in the back, radiating along a nerve to the leg.
Complications caused by diabetes and herpes can also cause nerve pain. With diabetes, patients often complain of pain, as this disease damages the nervous system. Postherpetic neuralgia is characterized by streaks 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 the drugs of such a focus, I must say, 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 its mental state changes. Symptoms torment the patient in this case for a long time. At the same time, as a rule, not only the back hurts.
Sometimes people come and say: "Everything hurts me - my head, my back - all the time. 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 painthe threshold and 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 medications will not help in this case. For patients with chronic pain, specialists usually prescribe antidepressants, 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: she said she suffered for six months. I recommended that she go to a psychologist and physical education. A few days later she came back completely healthy without taking any medication. The psychologist helped her understand that the cause of pain is stress: she had family problems, physical education helped her to relax.At home
The most effective remedy is oral anti-inflammatory drugs. Just do not overdo it - they are safe only the first time. With prolonged use, these drugs can cause ulcers and bleeding in the stomach lining. Traditional home treatments - non-steroidal ointments - can only be used as an additional measure. They are harmless, but ineffective. Wearing a corset also gives relief - fixation relieves the spine, relieves spasms and restricts sudden movements. Only the corset should be normal - elastic, not warming up.
If the treatment does not work within three days, you should see a doctor who will block with anti-inflammatory injections. By relieving spasms and relaxing the muscles, the pain goes away immediately and often forever.
Bath and massage are strictly prohibited. They increase swelling and pain.
Contact chiropractors using newspaper advertisements. Manual therapy is an area where there are three hundred charlatans for every specialist. If you really want to find a good doctor, you should go to certified clinics where graduates work.
It is important to immediately correctly determine the tactics of treatment. This should be done by a neurologist or neurosurgeon. It is dangerous to treat your back on your own. 30% of patients in the neurosurgical department have tried home treatment methods and thus brought themselves to a hospital bed.
When pills don't work
If the medication prescribed by the therapist or neurologist does not give results for 3-6 months and the pain continues to torment the patient, the doctor must transfer the patient to another specialist. In some situations, physiotherapy can be of great help. It is suitable for the first two types of pain: receptors and nerves. Physiotherapy is also prescribed for those patients who have drug allergies or stomach problems.
Because of this, the treatment passes, but there is no effect, patients often come to us with severe depression, therefore we approach their treatment in a multidisciplinary manner, with the involvement of various specialists: neuropathologists, psychologists, physiotherapists, neurosurgeons.
Among the techniques used by domestic physiotherapists, interstitial electrical stimulationborrowed from Russian colleagues. Its principle is that through a disposable special needle-electrode, bypassing the skin barrier, supply current directly to the painful focus. Diagnoses in which this procedure is prescribed, including protrusion and hernia. The procedure, according to experts, is comfortable and does not require anesthesia. The effect is usually felt after the first procedure. In total, they are assigned from 3 to 6.
In addition,laser therapyis used. This technique is also convenient in that it can be prescribed to patients with various stimulants, including cardio, and do not worry that a failure will occur. The laser is used not only for the treatment of diseases associated with spinal problems, but also as a treatment for complications of diabetes mellitus and herpes, which have already been discussed.
Laser promotes good healing. In addition, the device improves microcirculation in the spine itself, and due to this, disc nutrition is improved. As a result, swelling and inflammation are relieved, and the pain, accordingly, goes away.
Such a concept as "blockade" is not new in medicine. With severe pain, since Soviet times, patients have been prescribed injections into the area where the painful focus is directly located. Since then, little has changed in local polyclinics. Meanwhile, in accordance with international recommendations, these procedures must be carried out 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 injected 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 injected purposefully into the area where the source of pain is. If the doctor gets in the wrong place, it is fraught with respiratory arrest in the patient, and total spinal anesthesia.
The essence of the blockade lies in the fact that the injected drug from several months to six months prevents the propagation of the impulse along the nerve, which 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: a person for a while completely forgets about pain, can sleep peacefully or go about his business.
Operation - pain relief
When medications do not help - neither pills nor injections, when physiotherapy is ineffective, neurosurgeons come to the rescue. Modern technologies allow these specialists to bring back pain-free patients who have suffered from it for more than one year in a row. There are many methods: 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 techniques is the so-calledradiofrequency ablation. In fact, this is a kind of blockade, only instead of a medicine that relieves pain only for a while, an electric current is used that can completely solve the problem. Often, ablation is done after blockages, 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 manipulation that is done 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 a pulse discharge - and the pain, so to speak, turns off.
In special cases,neurostimulationmethods are used, including implantation of an electrode. The patient is operated on: the surgeon places a small device in the painful area that will suppress pain impulses in real time. Patients receive this procedure on a quota.
There are cases when they seem to have done various types of surgical interventions, but the pain syndrome persists to one degree or another, then we put the stimulator - first in a test mode, and if the desired effect is achieved, then we put it on for good. This is an operation performed with a small incision. The only thing is that the patient will need to come periodically for test control.
The risk of surgery, due to which it is postponed or abandoned altogether, is considered by many patients to be grossly 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 recurrence after surgery does not exceed 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 undisciplined patients. As soon as the pain goes away, they return to their usual way of life: get behind the wheel, resume training. And it is absolutely impossible to do this.
Is osteochondrosis to blame for everything?
Osteochondrosis is a chronic degenerative-dystrophic change in the intervertebral space. All people over 25 have signs of osteochondrosis. It is impossible to avoid osteochondrosis, but you can save yourself from its complications, which are the cause of back pain.
Why this and not otherwise?
Do you need to spend time, effort and money on treatment: with pills, injections, physiotherapy, if you can immediately do a small operation and get rid of the pain once and for all? - this question has been asked more and more by patients lately. The answer is usually unequivocal: yes, you need to! The thing is that with accurate diagnostics 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.
An error when people, seeing a protrusion or hernia in the picture, immediately run to the surgeon's appointment, bypassing the specialists of 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, keeping track of his body weight - a person with so-called osteochondrosis can feel healthy and not experience pain.
It is important that the patient is accurately diagnosed and treated correctly at every stage. This can only be achieved collectively. It is also proposed, based on the example of foreign experience, to introduce a new specialization, such as an algologist - this is a kind of a therapist specializing in pain, a doctor who has knowledge of a neurologist and an interventionist-anesthesiologist, who is able to heal without bringing the matter to an operation, but if surgery is allit will inevitably, timely transfer the patient to neurosurgeons.