Herniation, hernia, osteochondrosis - when a diagnosis is made, the patient immediately rushes to the surgeon without considering conservative treatments, but this is a mistake.
According to statistics, 84% of people experience back pain at least once in their lives.The spine and surrounding muscles are part of the musculoskeletal system.Therefore, their injuries are often accompanied by pain, which may occur after bending or turning the head and body and is relieved by rest.Anatomically, the spine is represented by alternating vertebrae and discs.The latter can degenerate over time, leading to the formation of protrusions and hernias.These structures can cause pain themselves, or they can cause pain by compressing 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).
In addition to this, the vertebrae are connected by pairs of facet joints, structures that are stronger than the intervertebral discs.In 15-65% of cases, their damage results in back pain.Up to 30 percent of low back pain is caused by damage to the sacroiliac joints, the paired structures that connect the sacrum and pelvic bones.Eventually, any irritation increases the tension in the surrounding muscles, which over time can lead to isolated myofascial syndrome.
In general, physical activity can cause back pain, especially if it is noticeable or severe, or if it is performed in an unnatural position, or if it involves being in a forced position for an extended period of time, such as while driving or sitting at a desk.A person's weight and physical health are very important, as the severity of a load is always relative.
What are the reasons for its development?
The cause of the occurrence of osteochondrosis cannot be clearly stated, but many factors that lead to the development of this disease can be identified: poor physical development, metabolic disorders in the body, genetic predisposition, incorrect posture, prolonged maintenance of one posture (for example, in front of a computer monitor, while driving), physical inactivity, too soft a bed, flat feet.Generally, these causes are related to malnutrition.
What should I do if I have back pain?
The most important rule is don’t self-medicate!
Initially, you will need to make an appointment with a neurologist or neurosurgeon.To make an accurate diagnosis, a comprehensive examination of the patient is required, which must include spinal X-rays and tomography (magnetic resonance or computed tomography).Appointments for specific examinations can only be made by the attending physician based on the specific clinical situation.
Medical treatment of spinal osteochondrosis includes not only pain relief but, if possible, elimination of the underlying cause.Doctor prescribes comprehensive therapy (drug therapy, physical therapy, acupuncture, balneotherapy)
Comprehensive therapeutic care for osteochondrosis includes correction of nutrition and lifestyle (healthy and active lifestyle, optimal amount of physical activity) and, in some cases, prescribing chondroprotective drugs that improve the condition of cartilage tissue.
The main indications for surgical treatment of degenerative dystrophic diseases of the spine are ineffectiveness of conservative medical therapy for 4-6 weeks, intractable pain syndrome, and increasing leg weakness, which in some cases may be accompanied by urinary incontinence.In this case, untimely and incorrect treatment can lead to many adverse consequences and complications, including disability.
Back pain is considered the most common.Experts explain this through the peculiarities of human anatomy.The thing is, the spine is under stress throughout a person's life: from the moment they stand in childhood until death.The spine wears out and almost everyone has problems sooner or later.The most common diagnoses for back pain are "osteochondrosis" and "sciatica," and patients often self-diagnose and prescribe treatments without seeking medical advice.However, even behind these diagnoses that everyone seems to have heard of, there is often a cause that only an experienced expert can determine.
What hurts there?
The vast majority (approximately 95%) of pain is related to muscles, ligaments, and joints.This is often called a back strain.These pains are unpleasant but not dangerous and in most cases resolve on their own within 2-3 days.
3-4% of pain is associated with radiculopathy (radiculitis) - damage to the roots of the spinal cord.It is usually damaged by a hernia.The pain will go away when the swelling caused by the compression goes away.
1-2% of back pain is caused by spinal injuries or inflammatory diseases, neoplastic processes, diseases of the cardiovascular system or gastrointestinal tract, where the pain syndrome can spread to the back.This is the most dangerous type of back pain.In order to rule out such conditions, always consult a doctor.
you can't hesitate
The main indicator that you need medical attention is the regularity of your pain.If you feel cramped from time to time, you probably have nothing to worry about.If low- or moderate-intensity pain bothers you relentlessly, you can't hesitate.If pain is accompanied by an increase in body temperature or worsening of pain symptoms during treatment, emergency medical treatment is required.
type of pain
Doctors identify 3 types of pain, the most common of which is in the back area.The doctor's task is to determine exactly the type of pain suffered by the patient who comes into contact with him, since each person will receive treatment in his own way.
nociceptive painOr, simply put, pain in receptors (skin, muscles, ligaments, joints) is considered the most common.What causes it is usually not visible on an X-ray or computed tomography scan.In this case, experts make a diagnosis based on the symptoms described by the patient.Muscle cramps can be caused by physical exertion, lifting heavy objects, bending down sharply, or changes in temperature (a common example is air conditioning).This type of pain can be treated with two medications.
Acute pain can be treated with analgesics, anti-inflammatory drugs, and muscle relaxants.In this case, no other treatment is possible.When pain symptoms subside, patients are advised to strengthen their muscles through physical exercise.This both treats and prevents future disease.
Not only does exercise help build 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, often the condition is called sciatica.Particularly when a vertebral hernia becomes large and pinches nerve endings, a person can experience this type of pain.In the meantime, experts are warning patients and the professional community at large not to misdiagnose if an X-ray or MRI shows a hernia or other type of wear and tear on the spine, but it's not severe enough to affect the nerves.It is necessary to carefully understand the real cause of pain.It's possible that it's caused by muscle spasm, which is a completely different type of pain and will be treated differently.What is considered osteochondrosis is not only not painful but is also normal.
Osteochondrosis is a sign of physical aging.But “osteochondrosis” and “pain” are not the same thing.Since there are almost no nerve endings in the bone tissue, a herniation (initial stage of disc herniation. - Author) or hernia itself does not cause harm.There have even been studies done where MRIs were done on people of different ages - mostly people who had never consulted a doctor for back pain, but found to have hernias and osteochondrosis.
Additionally, the doctor cited examples of patients receiving treatment whose pain disappeared even though osteochondrosis remained.Today, osteochondrosis is a topical concept.
Some countries do not use the term "osteochondrosis" at all.Last year they officially said the diagnosis was made by an earlier generation of neurologists.Abroad, when a patient came for an appointment and said he had back pain, he was diagnosed with non-specific back pain, but it was understood that the person was putting pressure on the muscles.
Experts most often identify the pain as being caused by radiculitis, rather than spasmodic symptoms of back pain radiating down the nerves into the legs.
Nerve pain can also be caused by complications from diabetes and herpes.People with diabetes often complain of pain because the disease damages the nervous system.Postherpetic neuralgia is characterized by a painful, streaky rash on damaged nerves.There are special medications for nerve pain.
Antiepileptic drugs and antidepressants are used to treat neuropathic pain.It must be noted that the names of such drugs often frighten patients, so it is important to explain to them antidepressants that increase the pain threshold.These are the standards for pain management.
psychogenic painor chronic.This pain is not caused by physical changes in the human body, but by changes in his mental state.In this case, symptoms can plague the patient for a long time.In this case, usually, it's not just the back that hurts.
It happens that people come and say: "Everything hurts - my head, my back - hurts constantly. You ask: did they lift something heavy? No! And there is no clear positioning. In this case, we can conclude that the patient has a low pain threshold, and the pain analyzer located in the brain constantly senses itself. Anything can cause pain in such a patient: overexertion, stress, feelings of fear."
In this case, painkillers won't help.For patients with chronic pain, experts often prescribe antidepressants and exercise, but sometimes finding the cause with the help of a psychologist or psychiatrist is enough.
A young woman has been complaining of back pain for six months, from which she says she suffers.I suggested she see a psychiatrist and go to gym class.After a few days, she made a full recovery without taking any medication.A psychologist helped her realize that the cause of her pain was stress: she had family problems, and gym class helped her relax.
at homeThe most effective treatment is oral anti-inflammatory drugs.Just don’t overdo it – only the first time is safe.Long-term use of such drugs can cause ulcers and bleeding in the gastric mucosa.Traditional home treatments - non-steroidal ointments - should only be used as complementary measures.They are harmless, but ineffective.Wearing a corset can also provide relief - this immobilization relieves pressure on the spine, relieves spasms and limits sudden movements.Only the corset should be plain - stretchy, not warm.
If treatment does not work within three days, you should consult your doctor, who will inject anti-inflammatory drugs for blockade.By relieving spasms and relaxing muscles, the pain disappears immediately and often permanently.
prohibit!
Bathing and massage are strictly prohibited.They can increase swelling and pain.
Contact a chiropractor through an ad in the newspaper.In the field of manual therapy, there are three hundred charlatans for every expert.If you really want to find a good doctor, you should contact a certified clinic where certified specialists work.
It is important to determine the correct treatment strategy immediately.This should be done by a neurologist or neurosurgeon.Treating your back on your own can be dangerous.Thirty percent of neurosurgery patients who try home treatments end up in a hospital bed.
When medicine doesn't help
If the medication prescribed by a therapist or neurologist does not work within 3-6 months and the pain continues to afflict the patient, the doctor is obliged to transfer the patient to another specialist.In some cases, physical therapy can be of great help.It applies to the first two types of pain: receptor pain and nerve pain.Physical therapy is also available for those with medication allergies or stomach problems.
Therefore, treatments were carried out, but without effect; severe cases with depression often come to us, so we treat them with a multidisciplinary approach that includes various specialists: neurologists, psychologists, physiotherapists, neurosurgeons.
The techniques used by domestic physiotherapists have been borrowed from their Russian colleaguesinterstitial electrical stimulation.The principle is to apply an electric current through a disposable special needle electrode, bypassing the skin barrier and reaching the source of pain directly.Diagnoses prescribing this surgery include herniation and hernia.Experts say the procedure is comfortable and requires no pain relief.Results are usually felt after the first surgery.In total, they are allocated between 3 and 6.
Additionally, uselaser treatment.The technology is also convenient because it can be prescribed to patients for a variety of stimulants, including aerobics, without fear of malfunctioning.Lasers are used not only to treat conditions related to spinal problems, but also to treat complications of diabetes and herpes, which have already been discussed.
Laser promotes good healing.In addition, the device improves microcirculation in the spine itself, thereby improving nutrition of the intervertebral discs.As a result, swelling and inflammation are relieved, and pain disappears accordingly.
blockade
The concept of “lockdown” in medicine is not new.For severe pain, since Soviet times, patients have been asked to get an injection in the area directly where the pain is.Little has changed at local clinics since then.At the same time, in accordance with international recommendations, these procedures must be performed completely 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, injecting the drug in the wrong place does not have the desired effect; at worst, it is fraught with serious complications.
The drug should be administered under radiological control: fluoroscopy, CT, MRI, ultrasound, since the drug specifically targets the area where the source of pain is located.If the doctor looks in the wrong place, it can lead to respiratory arrest and general anesthesia for the patient.
The essence of a blockade is that it is administered over a period of several months to six months to prevent nerve impulses from traveling along the nerves involved in nerve impulse conduction.Although the procedure does not guarantee permanent results, it significantly improves the patient's quality of life: the patient temporarily forgets about the pain and can sleep peacefully or continue doing his or her own thing.
Surgery – pain relief
When medicine, whether drugs or injections, doesn't work, when physical therapy doesn't work, neurosurgeons come to the rescue.Modern technology allows these specialists to painlessly rejuvenate patients who have suffered from this disease for many years.There are many techniques: from procedures with minimal intervention on the body to complex surgical procedures using vertebral prostheses.
For hernias that squeeze the nerve, one of the most common and effective methods is the so-calledradiofrequency ablation.Essentially, it's a blockade, except instead of using drugs to temporarily relieve pain, you use electrical current to completely resolve the problem.Ablation is usually performed after a blockade so that the doctor can clearly understand which nerve needs to be affected.The program is available on a paid and quota basis.
The procedure is completed in 20 minutes.It's called surgery, but it's actually a surgical procedure performed under local anesthesia, always under the control of special equipment.First, the pain syndrome is reproduced, and if the patient confirms that this is the pain he normally experiences, we apply a pulse discharge - and the pain goes away, so to speak.
In special cases, you can use the methodneurostimulation, including implanted electrodes.The patient undergoes surgery: The surgeon places a small device over the painful area that suppresses painful impulses in real time.Patients receive this procedure according to quotas.
In some cases, various types of surgical intervention have been performed, but the pain syndrome persists to a certain extent, then we install the stimulator - first in test mode, and if the desired effect is achieved, then we install it permanently.This is a surgery performed through a small incision.The only problem is that patients need to come in regularly for test controls.
What risks do we take?
Many patients feel that the risk of surgery being delayed or refused altogether is exaggerated.In the field of neurosurgery, there are technologies that can accurately calculate the effectiveness of surgery and which symptoms will disappear after surgery and which symptoms will remain.
The chance of pain returning after surgery is no more than 1-1.5%.Hernias elsewhere do occur, but this is not a complication but the spread of disease, which is more common in younger, undisciplined patients.Once the pain subsides, 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 the age of 25 have signs of osteochondrosis.It's impossible to avoid osteochondrosis, but you can protect yourself from its complications, which are causes of back pain.
Why is this the case and not otherwise?
Do you need to spend time, energy, and money on treatment: taking medicine, injections, and physical therapy? What if you can do a minor surgery immediately to get rid of the pain once and for all?– This is a question patients are asking more and more recently.The answer is usually clear: yes, it is necessary!The problem is, with accurate diagnosis and appropriate treatment, only a few can perform surgery.The remaining patients were pain-free in the first phase of treatment—on average, 30% of patients were eliminated at each phase.
It is a mistake for people to immediately run to the surgeon when they see a herniation or hernia in an image, bypassing the experts at the previous stage of care.If the changes are minimal, surgery is not needed.Additionally, with the right lifestyle—getting physical therapy, swimming, watching your weight—people with osteochondrosis can feel healthy and pain-free.
It is important at every stage to accurately diagnose the patient and develop the right treatment plan.This can only be achieved collectively.It is also recommended, following the example of foreign experience, to introduce a new specialty, such as a phycologist - a therapist specialized in pain, a doctor with knowledge of a neurologist and an interventional anesthetist, able to perform treatment without surgery, but if surgical intervention is still unavoidable, the patient is immediately transferred to a neurosurgeon.