Back pain is the first in the structure of pain syndromes. According to experts of the World Health Organization (WHO), its prevalence in developed countries reaches 40-80%, and the annual incidence – 5%. This pathology is leading among the reasons for seeking medical help, temporary disability, disability, which has serious economic consequences for the patient as well as for society as a whole.

We present the section devoted to the treatment of back pain, clinical recommendations “Pain Syndrome: Pathogenesis, Clinic, Treatment” of the Russian Interregional Society for the Study of Pain (ML Kukushkin, GR Tabeeva, EV Podchufarova, edited by N. N. Yakhno, 2011).

Back pain can be classified by duration, localization, leading pathophysiological mechanism, taking part in its formation, its causes for causing it.

Pain lasting less than 6 weeks is considered acute, from 6 to 12 weeks – subacute and more than 12 weeks – chronic. Patients with acute, subacute and chronic back pain are differentiated by the prognosis for recovery and recovery of work capacity, as well as approaches to diagnosis and treatment.

Localization of pain, local, reflected and irradiating pain. Local pain can be associated with any pathological process that affects the pain receptors of the skin, muscles, tendons, ligaments, joints, bones and other tissues. It is usually constant, but it can change its intensity depending on the change in body position or movement. The pain is acute, blunt or aching, can have a diffuse character, but always is felt in the area of ​​tissue damage. The cause of local back pain may be, for example, facet pain syndrome, in which patients describe pain in the lumbar region of the aching nature, localized in the projection of the affected joint. It should be noted that facet joint dysfunction can simultaneously be the cause of reflected pain. The cause of local pain may be a potentially dangerous disease of the spine, for example, a compression fracture of the vertebral body with osteoporosis or a tumor lesion.

Reflected pain extends in areas lying within dermatomes associated with innervation of damaged structures. Usually, it is projected into these zones from the internal organs, for example, with diseases of the pancreas, pathology of the gastrointestinal tract, retroperitoneal space, gynecological diseases (Heda-Zakharyin phenomenon).

In some cases, the cause of reflected pain in the spine may be vascular disease. For example, with an aneurysm of the abdominal aorta, there may be pain in the lumbar spine, which is not related to physical activity. Obliterating lesion of the upper gluteal artery can lead to pain in the gluteal region, which is intermittent and depends on the distance traveled by the patient, resembling a neurogenic intermittent claudication in the lumbar stenosis. The pain is not provoked by physical activity, which increases the load on the spine: slopes, lifting of gravity, etc.

Irradiating pain, more often radicular or neural, is characterized by high intensity, distal distribution to the corresponding dermatome and associated disorders of sensitivity, reflex and motor disorders. The mechanism of this pain consists in stretching, irritation, compression of the rootlet or somatic nerve. With radicular pain, its spread almost always occurs in the direction from the spine to any part of the limb. Coughing, sneezing, or exercising are characteristic factors that increase this pain.

Chronic back pain can be formed with the participation of three pathophysiological components: nociceptive, neuropathic and psychogenic. For example, pain syndrome with compression radiculopathy often has a mixed character. Neuropathic pain is associated with damage to the spine due to its compression, edema, ischemia, and the formation of intranural inflammation. Nociceptive component takes part in the formation of pain due to the activation of nociceptors in the damaged disc and surrounding tissues containing free nerve endings (primarily in the roots and dura mater), with the initiation of immune inflammation in response to disc damage, as well as inflammatory reaction associated with the direct action of enzymes contained in the disk on the surrounding tissue. In addition, patients with compression radiculopathy often develop reflex musculoskeletal disorders, for example, muscular-tonal syndromes (in response to a change in the motor stereotype or to immobilize the affected motor segment), which, if preserved for a long time, can themselves become additional sources of nociceptive pain impulses. Thus, pain syndrome with radiculopathy is mixed. At the same time, it is shown that in patients with chronic back pain in the absence of clear clinical signs of lesion of the roots, pain formally corresponding to the characteristics of the neuropathic pain syndrome can form. Using a special questionnaire for the diagnosis of neuropathic Paindetect pain and an evaluation scale of neuropathic symptoms and signs of the University of Leeds (LANSS), it was possible to identify signs of neuropathic pain in 37-54.7% of patients with chronic back pain. According to the Russian epidemiological study of the prevalence of neuropathic pain, the development of neuropathic pain syndrome as the main cause of pain in the lumbar spine was found in 34.74% of the respondents, neck pain in 11.90%, chest pain in 3.94% of cases.

Back pain is a symptom, not a nosological form. Therefore, when its classification is often used anatomotopographic terms that do not reflect the essence of the pathological process, and denote the area in which pain is localized. So, local pain in the neck is designated as “cervicalgia”, in the thoracic spine – “thoracalgia”, in the lumbosacral region – “lumbalgia”. For pain radiating from the cervical spine to the arm, the term “cervicobrahialgia” is used, in the occipital or other area of ​​the head – “cervicocranium”, and pain that spreads from the lumbosacral region to the leg is called “lumbo-schiaalgia”. In the literature, these terms are understood, first of all, skeletal-muscular pain syndromes, i.e. states in which the sources of pain can be muscles, joints and ligaments. Pain associated with lesions of the cervical, thoracic, lumbar or sacral roots, described in the radiculopathy.

PATIENT EXAMINATION

Analysis of complaints and anamnesis.

Despite the considerable variety of descriptions of pain by different patients, it is important to actively identify characteristics that allow us to assume the pathophysiological mechanism underlying the formation of the sensation of pain. Thus, the development of acute, clearly localized pain, rapidly regressing spontaneously or against the background of taking analgesics, not accompanied by a change in surface sensitivity, is characteristic of nociceptive pain syndromes associated with damage to the joints of the spine, ligamentous apparatus and muscles. The emergence of shooting, burning pain, irradiating in the limb and accompanied by a change in sensitivity, is typical for neuropathic pain syndrome associated with compression radiculopathy. In this case, even when the patient is questioned, it is often possible to identify the symptoms of sensitive disorders: allodynia, hyperpathy, paresthesia and dysesthesia.

The nociceptive component can play a leading role in the formation of a chronic pain syndrome, associated, for example, with joint damage (articular joints or sacroiliac articulations). Such pain is usually aching in nature, occurs or worsens with the load on the altered joints and short-term (for the duration of the drug) decreases after the introduction of the local anesthetic into the affected joint. In all cases, it is necessary to analyze the situation in which pain has arisen, the factors that enhance and weaken it, the features of the preceding exacerbations. Pain in the defeat of the internal organs (visceral pain) is often poorly localized, may be accompanied by nausea, changes in the color of the skin, excessive sweating, is of a spasmodic type, often radiating to the opposite half of the body.

The bizarre descriptions of pain, senestopathy allow one to suspect the presence of psychogenic pain syndrome, but its diagnosis is possible only on the basis of the complete exclusion of other causes of pain. It should be noted that pain in the lumbar spine without irradiation in the limb in a patient under the age of 50 years, in the absence of a malignant neoplasm in the anamnesis, clinical signs of systemic disease and neurological deficiency, with a probability of more than 99% is due to benign musculoskeletal disorders, for example, myofascial pain syndrome MFBS) or joint dysfunction. Nevertheless, even at the first examination of the patient it is important to identify symptoms indicating that back pain can be a symptom of a more serious, usually somatic, pathology. So, one should pay attention to the presence of fever, local soreness and an increase in the local temperature in the paravertebral area, which are characteristic for infectious lesions of the spine. His risk is also increased in patients receiving immunosuppressive therapy, intravenous (IV) infusions, who are HIV-infected and addicted. The presence of a tumor (primary or metastatic) can be indicated by an unreasonable decrease in body weight, a malignant neoplasm of any localization in the anamnesis, the preservation of pain at rest and at night, and the age of the patient over 50 years old. Compression fracture of the spine is more often observed in cases of injuries, with the use of corticosteroids and in patients older than 50 years. Spondyloarthritis can be suspected if there is concomitant uveitis and arthralgia (including anamnesis).

Physical examination

includes neurological, neuro-orthopedic and somatic examination. With pain in the back and extremities, a properly conducted clinical examination allows in most cases to identify the source or sources of pain, the pathogenesis of the pain syndrome, to presume or accurately determine the nature of the underlying pathological process.

When examining a patient, it is important to pay attention to changes in posture, posture, gait, the presence of contractures, deformities and asymmetry of the limbs. It is necessary to evaluate the configuration of the spinal column, the safety or changes in physiological kyphosis in the thoracic and lordosis in the cervical and lumbar spine, their change (strengthening or flattening), the presence of scoliosis in standing, sitting and lying. As guidelines, the position of the shoulder-blades, the angles of the shoulder blades, the awns, the crests of the iliac bones, the distortion of the Michaelis rhombus, the asymmetry of the gluteal folds, and the deformation of the joints are assessed.

When analyzing the gait, attention should be paid to its features, such as avoiding the transfer of body weight to the diseased leg, which shortens the time to rest on it (antalgic gait). To reduce the burden on the patient’s leg, a number of patients resort to the use of additional means of support – surrounding objects, walking stick, crutches.

With a neurological examination, it is necessary to clarify the presence and nature of motor disorders, sensitive and trophic disorders, and changes in tendon reflexes. When lesions of the lumbar and sacral roots, along with positive sensory disorders in the form of pain, paresthesia and dysesthesia, it is necessary to identify negative sensory symptoms (hypesthesia, anesthesia or dysesthesia of certain types of sensitivity: tactile, painful, temperature, vibrational or joint-muscular). Both sensitive, motor and vegetative disorders are localized in the innervation zone of the affected root. Signs of the neuropathic nature of the pain syndrome is a combination of positive (paresthesia, dysesthesia, hyperalgesia, allodynia) and negative symptoms (hypoesthesia, anesthesia). To identify hyperalgesia, which, depending on the type of stimulus that caused it, can be thermal, cold, mechanical and chemical, stimuli of the appropriate modality are used: gradual warming or cooling of the affected area, mechanical and chemical effects. Mechanical hyperalgesia is divided into hyperalgesia associated with brush irritation (“brush hyperalgesia”), needle hyperalgesia (both are combined with the term “dynamic hyperalgesia”) and static hyperalgesia caused by a slight blunt pressure.

The most frequent clinical sign of a neuropathic pain syndrome is sensory disorders in the form of hypesthesia and anesthesia of certain types of sensitivity: tactile, painful, temperature, vibrational or joint-muscular. The temperature sensitivity in the area of ​​the corresponding dermatome is conveniently studied using a special cylinder with plastic and metal ends or tubes with warm and cold water. Pain sensitivity is examined by applying a light prick. The joint-muscular sensitivity is studied in the joints of terminal phalanges of fingers and toes. Assessment of the degree of disturbance of vibration sensitivity is performed using a graduated 128 Hz tuning fork on an 8-point scale on the protruding parts of the bone in the innervation zone of the affected root.

A number of scales can be used to assess the “neuropathic” component of back pain: a questionnaire for diagnosing neuropathic pain DN4, a Neuropathic Pain Scale (NPS) scale, a PainDETECT questionnaire, an evaluation scale of neuropathic symptoms and signs of the University of Leeds (Leeds Assessment of Neuropathic Symptoms and Signs – LANSS).

Motor disorders are more often represented by weakness and hypotrophy of muscles in the innervation zone of the affected roots. Muscle strength is estimated according to the following conventional scale: 0 – normal; 1 – reduced by 25% compared with the intact side; 2 – reduced to 50% (for example, the patient can not walk on the heels – for extensors of the feet, on the toes – for flexors); 3 – decrease by 75% (movements are possible only without resistance); 4 – a reduction of more than 75% (muscle strength does not overcome gravity – only downward and downward movements are possible); 5 points – plegy (impossibility of contraction of muscles innervated by the affected nerve).

Evaluation of tendon reflexes is performed separately for each limb. On the feet – Achilles and knees, on the hands – carporadial, as well as reflexes from the biceps and triceps muscles. When assessing vegetative and trophic disorders, it is necessary to pay attention to changes in color and turgor of the skin, the presence of hyperkeratosis, peeling, hypo and hypertrichosis, a change in the growth rate of the nails.

For the convenience of the examination it is necessary to know the so-called “indicator” muscles innervated by the corresponding roots, and the typical zones of the sensory disorders in the corresponding affected spine of the dermatomes.

It is extremely important to identify symptoms of damage to the caudal peduncle in patients with pain in the lumbar spine, which include sensitivity disorders (anesthesia) in the anogenital region and distal sections of the legs, peripheral paresis of the leg muscles, prolapse of achilles reflexes and pelvic disorders in the form of a lack of urge to urinate / defecation, retention or incontinence of urine and feces. For skeletal-muscular pain syndromes, there are no changes in the neurological status of the patient, but in some cases, the MSFE, when the strained muscle compresses the vascular bundle or nerve, there are paresthesias, less often – gipalgesia or hyperalgesia in the innervation zone of the corresponding nerve. Transient vegetative disorders can be noted in the form of puffiness and a non-rough change in the color of the skin in the distal parts of the limb. The non-anatomical distribution of sensory and motor disturbances reflects their psychogenic origin.

With nevorortopedic examination, palpation is determined by the soreness of the muscles, joints and ligament apparatus. With light palpation with a pressure of about 4 kg, you can identify multiple painful areas that are localized in different parts of the body – gender points characteristic of fibromyalgia. Trigger zones (TZ) – areas of local soreness in the form of a tight strand, located along the muscle fibers, revealed by palpation of the muscles, are characteristic of the MFBS. The common soreness of soft tissues, even with mild, superficial palpation, reflects the presence of psychological ill-being (inadequate pain behavior). It is also necessary to evaluate active and passive movements in the cervical, thoracic and lumbosacral spine. Normally, in the cervical spine, rotation is 80 °, lateral inclinations – 45 °, extension – 75 °, bending – 60 °. In the shoulder joint, the amplitude of movements in the sagittal plane is 180 ° (total flexion and extension).

With lumboschialgic syndromes, the determination of the angle of the straight leg lift (Laceg’s symptom) is of clinical importance. Compression radiculopathy is characterized by its limitation from 30 ° to 50 °, irradiation of pain from the lumbosacral region along the posterolateral surface of the foot to the toes of the foot and its strengthening with the rear folding of the foot and the inclination of the head forward. It should be noted that the positive symptom of Lasega should not be interpreted solely as a result of the tension of the rootlet or nerve trunks. The most common causes of its appearance is the stretching of the posterior group of hamstrings and gluteus muscles, especially if they have T3. In cases of pain in the buttocks and sacrum, which occurs when testing the Lasega symptom, the mechanism of its formation can be the stretching of the capsule of the blocked sacroiliac joint and the subsequent reflex tension of the muscles of the lumbosacral region.

A somatic examination is aimed at excluding visceral pathology as a cause of pain in the back and extremities. It includes the identification of causeless weight loss, fever, skin discoloration, palpation of the abdominal cavity and pelvis, auscultation of the heart and lungs. Patients with pain in the pelvic and sacral region should carry out a rectal examination to exclude gynecological or urological pathology. In all cases of suspicion of a visceral source of pain, it is necessary to refer the patient to a consultation with the appropriate specialist (urologist, proctologist, gynecologist, cardiologist).

Instrumental methods of examination.

After the clinical neurological and neurological examination to clarify the sources of pain impulses in a number of cases, it is necessary to conduct instrumental survey methods. With pain in the lumbar spine and extremities, visualization methods are of particular importance, the usefulness of which is determined by the duration of the pain syndrome, anamnestic features and the presence of changes in the neurological and somatic status of patients. In the overwhelming majority of cases, acute and chronic back pain is a benign condition, and most patients do not need additional instrumental examinations. However, the presence of severe neurological and somatic disorders may require an urgent paraclinical examination. For example, weakness in the leg muscles, decreased sensitivity in the anogenital area (saddle anesthesia), pelvic disorders indicate the presence of compression of the cauda equina roots and require immediate MRT or CT scan, followed by a neurosurgeon’s examination of the need for urgent surgical intervention. The absence of a link between pain and movement, its preservation at night, the presence of a malignant neoplasm in the anamnesis, HIV infection, the use of immunosuppressants, intravenous infusions, unconscionable weight loss, fever and nocturnal hyperhidrosis, and the age of a patient under 20 and over 50 require additional methods of research already at the first reference of the patient with the purpose of excluding, first of all, infectious and neoplastic lesions of the spine. In all these cases, a spine X-ray is necessary in the direct and lateral projection, a general analysis of blood and urine, and if there is a suspicion of osteomyelitis, an epidural abscess or a lesion of the cauda equina roots, a MRI of the lumbosacral spine. If it is necessary to clarify the state of bone structures after carrying out X-rays, scintigraphy is shown in a number of cases. If you suspect a malignant neoplasm of the prostate, you need to investigate the level of specific antigen of the prostate (PSA). In the presence of a trauma in a recent history (a fall from height, traffic accidents, etc.), as well as long-term use of corticosteroids and the age of patients older than 55 years, it is necessary to conduct a radiograph of the spine, and if its informativeness and duration of pain over 10 days are insufficient – scintigraphy or CT of the spine. All patients with acute pain syndrome lasting more than 1 month, as well as all patients with chronic back pain, are shown to perform a spine X-ray in the direct and lateral projections in order to exclude tumor lesion of the spine. In the presence of clinical symptoms of compression of rootlets or spinal cord and in other diagnostic doubtful cases, the MRI of the corresponding spine department is shown to clarify the state of the structures of the spinal canal and determine the further tactics of patient management. Table 3 shows the main markers of a potentially dangerous pathology in acute back pain and associated with their presence of the disease.

TREATMENT

Acute skeletal-muscular pain.

The degree of evidence of the treatment method is a level 4 system where high-level evidence is consistent with the reproducible data of qualitatively conducted numerous randomized controlled trials, moderate – reproducible data from less qualitative multiple randomized controlled trials (mainly due to small patient samples), low – data from one randomized controlled research or conflicting data from numerous studies with the use of control groups, lack of evidence – studies conducted without comparison groups, theoretical assumptions, expert opinions. The optimal tactics of managing a patient with acute pain in the lumbosacral region, based on the principles of evidence-based medicine, boils down to several provisions: informing the patient; exclusion from bed rest; the appointment proved effective treatment; correction of treatment tactics with its inefficiency in the period of 4-12 weeks.

Rational information about the nature of the disease, its prognosis and treatment methods allows to correct misconceptions of the patient about back pain and to strengthen his active participation in rehabilitation programs. This aspect has been given more attention only in the last few years. It is shown that the “educational booklet” reduces the number of repeated calls to the general practitioner for back pain, and a 15-minute clarification by trained average medical personnel, accompanied by a demonstration of a booklet about pain and a subsequent phone call, leads to greater patient satisfaction with treatment. At the same time, the diagnosis of any specific pathology of the spine (“disc hernia”, “radiculopathy”) in the absence of clinical symptoms of compression of the lumbosacral roots or signs of serious pathology, conflicting opinions and advice of doctors increase psychological distress and misconceptions about the prognosis of the disease, leading to an increase painful behavior, the degree of disability and the deterioration of the prognosis for recovery. Informing the patient is based on a moderate level of evidence. The volume of information is usually limited to 3-5 key positions (good prognosis, absence of the need for radiography in the absence of serious pathology, connection of pain with muscles, ligaments, disc and joints, the need to maintain activity). It is desirable to provide a patient with a brief memo containing these statements.

To maintain the level of daily activity is the most frequent position of clinical recommendations from around the world in managing patients with acute back pain. With acute musculoskeletal pain, there is no need to comply with bed rest, even in the first days of the disease, wearing fixation belts, as well as using a pedestal when moving (walking stick or crutch). Currently, 6 systematic reviews and 10 randomized controlled trials are available on the effects of bed rest on acute pain in the lumbosacral region. With a high degree of evidence, bed rest should be excluded from the management of this group of patients. However, given that in a number of cases, high pain intensity can significantly limit the amount of daily activity, individual clinical recommendations (for example, from the UK) indicate that the patient can comply with bed rest, but he should be informed that the restriction of activity in this case is his own response to pain, not a method of treatment.

If there is a need for anesthesia, the patient should be prescribed medication at regular intervals (not on demand), with paracetamol and NSAIDs being the drugs of choice. All NSAIDs can be conventionally divided into groups, based on the primary effect on cyclooxygenase (COX) isoforms: COX1 and COX2. Most standard NSAIDs (diclofenac, ketoprofen, indomethacin, etc.) are classified as nonselective inhibitors of COX. The predominantly selective inhibitors of COX2 include nimesulide and meloxicam, with highly selective coxibes. The selectivity of drugs for COX2 provides a higher degree of safety in relation to the gastrointestinal tract (GI tract). The incidence of gastrointestinal side effects with non-selective COX inhibitors is about 10%, and the risk of serious adverse events increases significantly in the elderly. The least frequent side effects from the gastrointestinal tract in the treatment of nonselective NSAIDs are noted with the use of diclofenac and ibuprofen, which may be due to the more frequent administration of low doses of these drugs. In general, the advantage of any one NSAID before others in the treatment of acute pain in the back is not shown. Therefore, when choosing NSAIDs it is necessary to take into account the presence and nature of risk factors for adverse events, the presence of co-morbidities, the nature of interaction with other drugs and the cost. The maximum recommended time for the use of oral NSAIDs is 10-14 days.

Regarding paracetamol, there are currently two systematic reviews showing that it has no advantages with respect to the analgesic effect before NSAIDs. At the same time, the spectrum of side effects of this drug is well studied, and the risk of their development is relatively low. Therefore, in most clinical recommendations, it is referred to as a drug for the relief of back pain along with NSAIDs. When paracetamol is ineffective, the use of NSAIDs is recommended.

The efficacy of muscle relaxants in acute back pain is shown. According to modern clinical recommendations, muscle relaxants should be prescribed as a short course in the form of monotherapy or in addition to paracetamol and NSAIDs with insufficient effectiveness of the latter.

Concerning non-medicinal methods of treatment of acute pain in the back, it can be noted that manual therapy is recommended for patients who have not returned to the normal level of daily activity. At the same time, the majority of clinical recommendations, including the latest European ones, do not indicate the optimal timing of manual therapy. It is noted that this method of treatment is more effective than placebo, however, it has no advantages over other types of treatment (physiotherapy exercises, “school pain in the back”, taking analgesics). In general, spinal manipulations in patients with back pain musculoskeletal performed by qualified specialists are a safe method of treatment (the risk of development of the horse tail compression syndrome is less than 1 per million).

Modern clinical recommendations point out the inexpediency of prescribing special exercises for acute pain in the lumbosacral region. Multidisciplinary treatment programs are useful in working patients with subacute pain in the back and restriction of activity for more than 4-8 weeks. They usually include an educational program (“back pain school”), physical therapy, studying and, if possible, changing working conditions, behavioral psychotherapy. However, the contribution of each of these methods of influence can not be studied.

With acute pain in the back, ineffective traction of the spine, percutaneous electrical neurostimulation is proved. Due to the lack of evidence base in the treatment program for a patient with acute pain in the lumbar region, it is not advisable to include physiotherapy, wearing a warming belt, the use of psychotherapy, visiting a “school of back pain”, the appointment of a massage. There is a weak evidence of the effectiveness of acupuncture in acute pain in the lumbosacral region.

Thus, in the overwhelming majority of cases, acute back pain is a benign self-limiting condition, and most patients do not need additional instrumental examinations. Optimal is considered an active approach to treatment. If necessary, drug therapy, the drugs of choice are NSAIDs and paracetamol.

Patients who do not show improvement within 4 weeks of treatment need to be screened again for markers of clinically significant pathology, as well as identification of signs of psychosocial distress and correction of therapy taking into account the revealed violations.

Chronic pain in the back. A major problem is the treatment of patients with chronic (persisting for more than 3 months) pain syndrome. Within their framework, both radicular (eg, neurogenic intermittent claudication) and skeletal-muscular and psychogenic pain syndromes are noted. In all cases of chronic pain syndromes, it is necessary to try to reveal as much as possible the source of painful impulse using data from both a neurological and a neurological examination using diagnostic blockades. Proceeding from the different specific weight of the role of psychological factors and objective violations in each individual case of chronic pain syndrome, treatment of patients should be aimed at correction of both peripheral sources of pain and accompanying psychological disorders.

In the treatment of MFBS, an integrated approach is used. It includes the impact on all levels involved in the formation of a vicious circle of pain. This includes the effect on the muscle concerned and TK: its stretching, massage, exposure to heat or cold, percutaneous neurostimulation, electrostimulation and injections of botulinum toxin type A, the appointment of analgesics, antidepressants, muscle relaxants. The most effective are injections of local anesthetics in TK. Usually inject 0.5-1 ml of a 0.5% solution of novocaine. After injection, passive stretching of the muscle is performed. To relax the remaining tension of muscle fibers above the muscle and the area of ​​reflected pain, it is advisable to spray the refrigerant (chloroethyl). Irrigation is carried out at a speed of about 10 cm / s, the direction of the jet is 30 ° to the surface of the skin. Other local methods of treatment include ischemic compression (strong and prolonged compression of the trigger point with your fingertips for 1 minute with a gradual increase in the pressure force to 10-13 kg, leading to its inactivation), massage, ultrasound application (in continuous or pulsed mode with intensity 0 , 2-0.5 W / cm2 around the TK). An important place is occupied by applications on painful areas of the skin of gels, ointments – both anti-inflammatory and irritating. It is justified to use dimexide applications in combination with corticosteroids, lidocaine, procaine. In addition, the relaxation of spasmodic muscles is achieved by post-isometric relaxation (IRP). PIR is reduced to muscle relaxation after their volitional stress without changing the distance between the attachment points of the muscle (i.e., after isometric tension). If the effectiveness of treatment is inadequate, botulinum toxin injections are expedient, followed by IRP. At МФСС receptions of a soft-tissue manual therapy (techniques of a myofascial relaxation, muscular-energetic techniques, etc.) are effective. Correcting the asymmetry of the body, the motor stereotype, avoiding provoking loads and poses is beneficial.

In the cases of dysfunction of the arched, rib-transverse joints, rib-chest and sacroiliac joints, blockades with local anesthetics and corticosteroids are shown and manual therapy is performed. With prolonged maintenance of pain syndrome and short-term effect from drug blockades in cases of dysfunction of arched joints and sacroiliac joints, it is necessary to consider the use of their radiofrequency denervation (RFD), which leads to a reduction in the severity of pain by at least 60% in 80% of patients.

Drug therapy for exacerbations of chronic musculoskeletal pain syndromes includes the administration of NSAIDs in conventional doses of 5-7 days, muscle relaxants and antidepressants. Amitriptyline (50-100 mg per day) is effective in 50-60% of patients with chronic back pain. Selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline), devoid of the side effects of tricyclic antidepressants, are used to correct concomitant chronic pain of depression, anxiety and sleep disorders, but the antinociceptive effect is much less pronounced. A group of selective serotonin and noradrenaline reuptake inhibitors, including venlafaxine (75 mg per day) and duloxetine (60 mg per day), is promising for the treatment of patients with chronic pain. Selective serotonin and noradrenaline reuptake inhibitors are included in the latest (2006) European clinical guidelines as an effective treatment for chronic pain in the lumbosacral region.

If depression often accompanies chronic pain, then at the stage of subacute pain (with a duration of pain of 6 to 12 weeks), anxiety disorders are often brought to the fore, related to the patient’s presentation of uncertainty or a negative prognosis for a full quick recovery. Behavioral and cognitive behavioral psychotherapy helps to correct incorrect, impeding the patient’s convalescence about the nature of his illness, change the social reinforcement of painful behavior, reduce dependence on analgesic therapy and increase the level of daily activity.

Behavioral psychotherapy based on the principle of reinforcement, includes several aspects: gradual activation of patients, changing social reinforcement of pain behavior, reducing dependence on analgesic therapy, teaching patients self-control skills.

Gradual activation of patients should begin with the explanation that small physical activity is not harmful, but useful. For this purpose, it is advisable first to ask the patient to keep a diary of daily activity and then together to analyze how much time during the day he spends lying because of pain in his back. For example, if the daily normal activity of the patient is only 4 hours, the initial goal of treatment may be to recommend actively 20 minutes per hour. Gradually, the duration of motor activity increases, for example, up to 5-10 minutes rest after 1.5 hours of stay in an upright position, and achievements are recorded by the patient in a diary. It is advisable to combine the activation with exercise physiotherapy exercises with gradually increasing loads, while aerobic exercises (walking, swimming) are preferable.

The pains in the lower abdomen in women can have many different causes, connected both with female physiology and anatomical structure, as well as due to diseases, dysfunctions and pathologies that do not depend on the sex of the patient.

Most of the pain in the lower abdomen occurs with violations of the functions of the gastrointestinal tract, urinary system, reproductive organs, but can also occur as a result of a violation of the innervation of the nerves due to infringement in the lumbar spine, systemic disease (eg Crohn’s disease), overstrain of the peritoneum muscles , increased gas formation or sensitivity in ovulation and menstrual periods. How to determine the cause of pain in the abdomen?

Abdominal pain: organic causes

The pains at the bottom of the peritoneal region, with a clear and diffuse localization (right, left, at the bottom, covering the entire lower abdomen) can arise as a consequence of organic causes and physiological processes in women. The pain syndrome can also accompany physiological processes, for example, painful sensations when the intestine is opened with gases formed during digestion, or pain when adapting the musculoskeletal system to the growing volume of the uterus during the period of gestation.

The pains in the lower abdomen with organic disorders are caused by various diseases and can occur in the following cases:

• with diseases of the organs of the reproductive system (endometritis, endometriosis, ovarian apoplexy and cystic formations in this organ, andeksitah, uterine myoma, etc.);
• with diseases and pathologies of the urinary system, digestive tract, acute surgical pathologies (appendicitis, cholecystitis, pyelonephritis, bladder inflammation, intestinal infections, etc.);
• the presence of a foreign body in the uterine cavity (intrauterine device, especially if the rules of use are not observed, the timing of replacement, spiral growth in the endometrium);
• pathology of the gestation period: ectopic pregnancy, developing miscarriage, the process of premature detachment of the placenta, the consequences of medical abortion and other surgical interventions.

Pain sensations are determined by the nature of the disease or pathology and can be characterized as sharp, pulling, grasping, aching, spilling, stitching, sharp, blunt, etc.

Pain in the lower abdomen as a symptom of appendicitis

Inflammation of the appendix or appendicitis, contrary to popular belief, may be accompanied not only by pain in the iliac region to the right. The classical picture of appendicitis starts with pain in the epigastric region, most often shifts to the right, but the pain can spread to other parts of the abdominal cavity and irradiate to the lower back. Expression and a variety of sensations can be replaced from acute, cutting pains to stupid and aching depending on the severity of the inflammatory process. Appendicitis is also accompanied by an increase in body temperature, symptoms of general malaise (nausea, vomiting, chills).

Pain in intestinal infections

With the development of the intestinal infection, the pain begins with a dull, non-localized pain that covers most of the peritoneum, later concentrating in the lower abdomen with a return to the lumbar region.

Pain in infections of the urinary system

Most often, with cystitis, pyelonephritis, the abdomen is hurting in women, male patients with urinary tract diseases note a different symptom due to the different anatomical structure of the body.

Pain in infectious diseases of this type is accompanied by frequent urge to urinate, possibly the presence of bloody inclusions in the urine. In pyelonephritis, pain in the lumbar region is also noted, often – body hyperthermia, signs of general intoxication (decreased appetite, nausea, headaches, etc.).

Endometriosis

Endometriosis, the proliferation of endometrial cells, characteristic of the uterine cavity, in the intrauterine space and beyond, is most often expressed as pulling pains that build up in the premenstrual and menstrual periods. Painful sensations differ depending on the stage of the disease and localization: the abdomen in the middle region hurts during the growth of the endometrium in the uterine cavity, with the retrocervical form of endometriosis and the proliferation of tissues in the appendages may hurt below the abdomen, in the inguinal or pubic region.

Pain as a symptom of ovarian apoplexy

Apoplexy of the ovary develops due to rupture of the ripened follicle in the ovulatory period. The condition is accompanied by damage to the ovarian vessels, a hemorrhage into the cavity of the peritoneum. To provoking factors include intense physical activity, sexual intercourse, etc.

A sharp pain on the right or left (depending on the location of the damaged ovary) in a woman during ovulation, accompanied by a drop in blood pressure, a syncope, a pallor of the skin – an occasion for an urgent call of a specialist. Apoplexy of the ovary is a condition that threatens life and requires emergency surgery.

Pain in uterine myoma

Myoma of the uterus is accompanied by pain in the lower abdomen with a formed formation of considerable size, exerting pressure on surrounding tissues and neighboring organs (aching, drawing pain), and also in the derivation of the formation: the rejecting myomatous node is accompanied by cramping pains, bleeding from the vagina. Treatment is exclusively surgical.

Ovarian cysts: pain in torsion of the legs

Ovarian cyst is a formation consisting of a body and a “leg” containing blood vessels. With physical effort, falling, abrupt movements of the trunk, gymnastic exercises, the leg of cystic education is prone to twisting due to displacement of the body’s position of the cyst. At partial twisting disturbed the outflow of venous blood from the body of the cyst, which is accompanied by drawing, aching pains from the side of the affected ovary.

Full torsion of the foot stops the flow of arterial blood, causing tissue necrosis. This process is accompanied by a clinical picture of the “acute abdomen”: strong, cramping pains in the lower abdomen on the right or left, hyperthermia, signs of poisoning the body. Urgent surgical intervention is required.

Inflammation of the appendages, uterine cavity

Antexitis, salpingoophoritis, endometritis, inflammation of the uterus and its appendages of various etiologies, depending on the form of the disease, can be accompanied by both aching, pulling pains in the lower abdomen and inguinal region, and by pronounced painful sensations accruing upon palpation of the inflamed organ.

Pain in ectopic pregnancy

Implantation of the egg after fertilization outside the uterine cavity (most often in one of the fallopian tubes, less often inside the ovary, in the peritoneum) is accompanied by a pain in the lower abdomen with a pulling, aching character, with irradiation into the lumbar region.

With the growth of the embryo, increased pressure on surrounding tissues begins, with tubal pregnancy without surgery, accompanied by rupture of the fallopian tube, severe, severe pain, internal hemorrhage. Treatment emergency, operative.

Why does the abdomen hurt in women during pregnancy?

The first trimester of the gestation period is often accompanied by painful sensations in the abdomen. Rooting lower abdomen, in the groin area may, in threatened abortion in the first months, ectopic pregnancy, accompanying bearing and sharpening his background diseases.

However, most of these nagging, aching pain are called “the tone of the uterus” and represent the physiological process of the muscle tissue and ligaments adapt to changes in the reproductive organ. In the absence of additional symptoms, such painful sensations do not require therapy or anesthesia. In some cases, drugs-antispasmodics (Papaverin, No-Shpa) can be prescribed.

Match abdomen below the second and third trimester may also because of the rising load on the ligaments, accompanied by softening ligament tissue, calcium deficiency, the pressure on the cervix. Normally, physiological pains do not need treatment and pass during relaxation, change in body position, moderate physical activity.
Sharp, severe pain in the abdomen with the localization of the low location of the placenta may be a sign of its premature detachment and require urgent medical attention. Cramping, periodic uterine voltage can be both a sign of the beginning of “training bouts” Braxton-Hicks contractions, physiologically normal and symptom of threatened miscarriage. When any new painful sensations appear, a specialist consultation is necessary.

Algodismenorea

This diagnosis is most common in the age of puberty and the formation of organs of the reproductive system. Algodismenorea is accompanied by pains before menstruation. It requires differentiation from premenstrual syndrome, endometritis, endometriosis, stagnant phenomena associated with the bending of the uterus, intrauterine inflammatory diseases, etc.

Why does the abdomen ache in the middle of the menstrual cycle?

Pain during the period of ovulation occurs in about 10% of women of reproductive age. They are usually characterized as stitching, localized from one of the ovaries (lower right or left), or pulling, accompanied by a feeling of “dense lump” in the lower abdomen.

As a rule, such feelings last no more than 24-48 hours, ending with the release of the ovum from the ovary. If you pay attention to the vaginal discharge, then on this day they will be more mucous, dense, “vitreous,” small bloody inclusions are possible.

Such pain, not accompanied by additional symptoms, does not require treatment. It is possible to take single-dose antispasmodics or pain medications as prescribed by a doctor.

Pain after sex

Most often, the pain after the end of the sexual intercourse, not accompanied by orgasmic contractions, is associated with swelling of the tissues, the flow of blood to the organs in the process of excitation. There are also painful sensations associated with traumatizing the tissues with an excessively intense sexual intercourse, and pain as a symptom of pelvic organs: adhesions, endometriosis, endometritis or undexitis in chronic form, cervicitis, tumoral neoplasms of the genital organs.

Pain is most often a sign of disorders, dysfunctions, painful processes in organs and tissues. The physiological causes of the painful sensations of the female reproductive system are limited by the menstrual cycle, ovulation, the gestation period and are manifested, as a rule, by drawing, aching pain, limited in time and arising on certain days and periods.

All other manifestations should become an occasion for examination by a specialist and a course of treatment.

In its variety of headaches, there is no equal. It can be long and aching, or sharp and unbearable, it can cover the entire head or be felt only in the temples.

Causes of headache

Headache is one of the most frequent complaints with a therapist or neurologist. At the same time, the headache is considered something not very serious: with episodic pain, most prefer to drink an analgesic tablet and consider the problem resolved. We prefer to go to the doctor only if there is very severe pain, or if there are more seizures.

The causes of the headache are a great many: changes in blood pressure; inflammation, trauma and brain tumor; neuralgia; autonomic dysfunction; solar and thermal shocks; intoxication and much more. In some diseases, for example, with migraine, an intense headache is the main manifestation of the disease.

In its variety of headaches, there is no equal. It can be long and aching, or sharp and unbearable, it can cover the entire head or be felt only in the temples. So, under what conditions does the headache occur, and what is it?

Aching bilateral headache and its causes

A aching bilateral headache often accompanies arterial hypotension. Usually such a headache appears after sleep in the morning and is felt in the temporal areas. There is a headache with physical exertion, drinking beverages containing caffeine – for example, tea or coffee.

Contrary to popular belief, hypertension rarely causes a headache if the pressure is increased continuously. But if it jumped dramatically, most people feel headache and tinnitus, combined with the flashing of flies before their eyes, a feeling of tightness in the back of the head, a thud in the temples and dizziness. To such a state should be taken seriously, it can become a sign of a developing hypertensive crisis. A crisis, in turn, can lead to complications: stroke and myocardial infarction.

Psychogenic headache

Widespread and so-called psychogenic headache. Under this name, the headache is combined from mental or physical stress, as well as pain in anxiety and depression. With such conditions it can be difficult to describe the nature of pain – it can be either aching, now pressing, then concentrated in the occipital, temporal or frontal areas, then spread throughout the head. Diagnosis and treatment of headaches are individual for each patient and often require the involvement of specialists in medical psychology and psychoneurology.

Migraine headache

Headache is the main and often the only manifestation of migraine – a disease associated with a violation of the tone of the cerebral vessels. Migraine often affects women: the first bouts begin at the age of 10 to 30 years. When a classic migraine first appears aura in the form of blurred vision, obscuring objects, etc. Then a one-sided pulsating headache builds up, which can give into the eye and is accompanied by nausea, vomiting, sound and photophobia.

There are many other forms of migraine. With them, the pain can begin without an aura, be accompanied by neurological disorders, appear in the face, be sudden, short-term and intense (“thundering”). Sometimes seizures may follow one after another for several days, accompanied by nausea and vomiting. This condition is called a migraine status.

Horton’s (histamine) headache

It manifests as periodic short (15 minutes – 2 hours) seizures. Usually, such headaches occur late at night or early in the morning. The pain is extremely strong, burning, drilling, piercing; appears suddenly and is usually concentrated on one side in the orbit. During the attack the patient can not lie or sit, but walks around the room (unlike the patients with migraine who try to find a dark, quiet place and fall asleep). Typically, seizures occur daily for several weeks or even months, after which they disappear for years. Most often, the Hortonian headache affects men over 20 years old.

Headache from meningitis

If a severe headache occurs simultaneously with fever, it can signal the onset of meningitis – inflammation of the meninges. With meningitis, the headache is severe, it can be pressing on the eyes, accompanied by nausea and vomiting. At the same time, there are other manifestations of meningitis – for example, it is impossible to touch the chin to the chest, there may be disturbances in consciousness. On the other hand, high temperature itself causes a headache, which, however, occurs after taking aspirin or paracetamol.

Sudden severe headache

A sudden severe headache (often with loss of consciousness or a sensitivity disorder in any area of ​​the body) occurs with a hemorrhage in the brain (hemorrhagic stroke). As a rule, it occurs with an increase in blood pressure and atherosclerosis of cerebral vessels. The headache in stroke is often described very emotionally: “this is the most terrible headache I’ve ever experienced,” “something seemed to burst in my head.” This formidable condition often ends pitifully: subsequent persistent disruption of movements and sensitivity, or even death. The prognosis largely depends on timely and qualified medical care, so in such cases, “first aid” should be called forth immediately.

Headache as a symptom of a brain tumor

If the headache episodes began for no apparent reason and quickly became regular and intense, you should not postpone the visit to the neurologist – this pain is often the first manifestation of a brain tumor. Often the pain is accompanied by nausea, dizziness, double vision. Similar pain can also be observed with a hematoma (blood clump) under the cerebral membrane or with an abscess (suppuration) of the brain.

Headache as a symptom of diseases of the spine

Quite often, the cause of the headache lies outside the cranial cavity. For example, cervical osteochondrosis, spondyloarthritis, radiculitis and other diseases of this part of the spine are often accompanied by a headache. The cause of pain in the frontal and temporal areas can be inflammation of the paranasal sinuses – for example, sinusitis or frontalitis. When otitis headaches capture the parotid space, can be very strong and sharp (“shoots in the ear”). Strengthening the headache against otitis media or spreading it to other parts of the head, along with the occurrence of nausea and vomiting, may be a sign of the spread of infection and requires immediate medical attention. Headache and impaired sensation of the face become a manifestation of neuralgia of the trigeminal or facial nerves. “Masked” headache may also be the disease of the joints of the lower jaw.

Toxic headache

Another type of headache is toxic. It occurs when poisoning with various chemicals or as a side effect of taking medications. For example, headache is often caused by drugs that lower blood pressure, nitrates, psychotropic drugs and many other substances. A special case of toxic headache is the popularly known hangover; with it the head hurts because of the action of acetic aldehyde – a toxic product of the decomposition of ethyl alcohol.

Spilled headache

A diffuse headache may occur in a perfectly healthy person in a stuffy room (due to a banal lack of oxygen for the brain). It can cause carbon monoxide, car exhausts, evaporation from drying paint and just sharp smells, even pleasant ones. A severe headache accompanies sun and heat strokes.

As you can see, the causes and manifestations of the headache are many. And it is not surprising, because pain is a signal that the body gives us in case of danger. These signals are especially alarming when it comes to such a complex and sensitive organ as the brain and adjacent tissues.

Well, in order not to wait for a headache, it is necessary to train the vessels with moderate physical exertion, to be more often outdoors, not to drink without measure and not to abuse medicines. And if your head aches, visit your doctor or neurologist and follow his recommendations carefully and accurately.

In the meantime, headaches can turn into chronic and substantially impair your life. What kind of headache indicates a serious illness? And what is the disease itself? Let’s try to figure out how to distinguish headaches and how to treat them.

Tension pains

This is the most common type of headache in the world – each of us experienced it at least once in life. They are not repeated often, the chronic form is acquired in 3% of cases.

Symptoms. It feels like pressure or tightness around the circumference of the upper part of the head. It may seem that the muscles of the forehead and orbits are too tense, but you can not relax them. The duration of such pain varies from half an hour to a week, the intensity usually increases by the evening.

Possible reasons. Tension pain can be associated with excessive stress or trauma to the muscles of the head and neck. However, in diagnosis, the source of pain, as a rule, remains “uncertain.”

How to treat. Because the pain rarely gets regular, the best remedy for them is simple painkillers, like ibuprofen or paracetamol. If the pain does not pass more than a week, you can try to do light physical exercises, regularly stretch the shoulders and neck, more to be in the air to level out stress. Chronic tense pains are treated medically with the doctor’s prescription.

Migraine

Symptoms. Migraine is called repetitive pain on one side of the head, lasting about 4 hours and longer. As a rule, episodes of migraine are repeated and can lead to dizziness, nausea and photophobia (photophobia). Sometimes before the onset of an attack, patients experience visual anomalies – see bright colored rings and bands – or feel a slight tingling all over the body.

Possible reasons. The mechanism of the appearance of migraines has long been the subject of controversy in the scientific community. Now doctors are sure – this is a disease with no exact psychic properties. It is related to the violation of brain functions, but with what, it is for certain unknown. It is noted that in the process of the appearance of pain the blood vessels of the head greatly expand, and abnormal electrical activity appears on the cerebral cortex.

How to treat. Approximately 20% of migraine sufferers have pain after a certain external impact – a sharp smell, loud monotonous sound, cigarette smoke, etc. Such sick doctors are simply advised to avoid “risk factors”, the rest remains to drink medicine for the intended purpose (the greatest effectiveness is given triptans, but they act almost like a drug – the more you drink, the worse it cures). Unfortunately, you can not completely cure migraines, but you will not help them with simple painkillers.

Cluster pains

These pains affect approximately 1% of the total population of the planet, and in 80% of cases it is men.

Symptoms. It is an intense throbbing pain on one side of the head, usually in the anterior part, near the eye. It lasts from 15 minutes to an hour and is accompanied by reddening of the eyes, tearing, a runny nose, a rush of blood to the head. It usually appears at the same time of day with uniform time intervals – once a week, a month, two, and so on. Sometimes achieves such an acuteness that a person can not but what normally functions – even move and talk.

Possible reasons. Unknown.

How to treat. This kind of pain is difficult to treat, because they occur sporadically and can disappear as unpredictably as they appeared. When prolonged attacks, oxygen therapy is used (the patient breathes through the mask) and medicinal injections according to the doctor’s prescription.

Hangover

Symptoms. Obvious.

Possible reasons. Guess how much alcohol contributes to the onset of a headache, a lot. One of them says that alcohol dilates the vessels of the brain and disrupts the work of the neurotransmitter serotonin – a substance through which electrical signals are transmitted from one nerve cell to another. Both of these symptoms are also observed with migraine pain. In addition, alcohol dries the body, and dehydration is also known as a provoker of migraine attacks.

How to treat. The best remedy is a paracetamol tablet and a good sleep. But to treat with a joke to a hangover still not worth it. If the head hurts even after a small dose of alcohol, you may be suffering from migraine, and alcohol simply pushes seizures.

Brain tumor

Hypochondriacs and simply anxious patients often link the headache to brain cancer. We hasten to reassure: in fact, only 4% of tumor formations manifest themselves in this way.

Symptoms. If pain is still associated with the tumor, they usually appear in the morning and are accompanied by vomiting. Episodes are repeated periodically and eventually become worse and worse. If against this background there is a sharp weight loss, personality changes and convulsive seizures, this is an occasion to undergo a brain examination.

Possible reasons. When the tumor grows to a certain size, an increase in brain volume leads to an increase in intracranial pressure. Hence the initial symptoms.

How to treat. Depends on the location, size and type of education.

Intracranial bleeding

Having suffered an injury to the head vessels, a person may not understand this immediately. Sometimes a bleeding occurs a few hours after the rupture of the vessel, but potentially very dangerous.

Symptoms. Sudden, growing pain in any part of the head. It is accompanied by visual impairments, speech skills, coordination, personality disorders, nausea. Symptoms appear in turn and deteriorate over time. In the end, a person can lose consciousness.

Perhaps the reasons. A rupture of the vessel can occur as a result of a trauma (strong impact) or because of excessive thinning of its walls.

How to treat. First of all, the doctor will need to remove the accumulated blood from the cranium, because the hematoma will press on the brain, damaging it. Then it is extremely important to find out the cause of the hemorrhage: if it was not preceded by a clear trauma, the gaps may recur. Such patients need a cerebral vascular examination.

Temporal arteritis

The disease, as a rule, occurs in people 50 and older and without treatment can lead to complete blindness.

Symptoms. Strong headaches occur against the background of weight loss, insomnia, depression, sometimes high fever and redness of the scalp. The shoulder and neck can also hurt.

Possible reasons. Many different factors can push the disease, including viral infections. A strong attack on the immune system causes it to malfunction and makes the immune system attack the walls of blood vessels. Among other “provokers” of arteritis – uncontrolled intake of drugs, intense exposure to sunlight, alcoholism, hypothermia and various injuries.

How to treat. The most commonly used steroid drugs that stop the inflammation of blood vessels. If there are accompanying problems with eyesight (for example, clouding of the lens), the treatment should be handled by an ophthalmologist.

Sad statistics show that about half of the adult population suffers from back pain, but only one in five calls for qualified help from a doctor. Negligent attitude to one’s health is fraught with involvement in the pathological process of not only many muscles, but also some internal organs. The result of the defeat of the cervical spine are severe headaches, buzzing in the ears, blurred vision, dizziness. If the thoracic area is affected, the work of the heart and lungs is disrupted. Diseases of the lumbar spine affect the functioning of the digestive organs and kidneys, men lose libido.

With regular attempts to lift heavy objects, and also because of jumps and falls, microtraumas of intervertebral discs occur. The systemic nature of the negative effect helps to lose the elasticity of the intervertebral discs – they flatten, the distance between the vertebrae decreases. Accordingly, the nerve roots from the spinal cord are clamped. The result is discomfort and pain. At the same time, in the region of the clamping of the unequal-vascular bundle, puffiness is formed, because of which the patient experiences even more pain. The destruction of the intervertebral disc leads to the fact that it stops damping and traumatizes even more.

The prognosis of doctors is based on the age at which the patient first encountered the disease. The most dangerous situation develops, if the symptoms appeared in 16-18 years – this means an early onset of the disease. By 21-23 years, protrusions with a high probability of protrusions, to 32-34 years – intervertebral hernias. In the elderly, hernias are often aggravated, vegetative dysfunction, neuralgia, vascular disease develops. If the pain in the back is localized in the lumbar region and first touched the patient, when he has reached the age of 55-65 years, doctors give a positive prognosis.

Examination of the spine is necessary if the pain does not go away during movement, intensifies at night, has a high intensity and appeared for the first time. In addition, the need to urgently visit the clinic says incontinence of feces and urine, recent injuries, an oncological anamnesis. If the pain lasts longer than two weeks, the disease with a high degree of probability will take a chronic form, which is difficult to treat.

SYMPTOMS

In the vast majority of cases, the culprit of pain is osteochondrosis. The intervertebral hernia manifests itself as painful sensations when lifting heavy objects and with simultaneous turning of the trunk in an inclined position. After this, the patient feels weakness and pain in the leg – right or left. Discomfort is worse with body movements, sneezing, coughing. Radiculitis is easy to recognize by the sharp pain in the lower back. If the patient experiences continuous unpleasant sensations in the occipital part and shoulders when trying to turn his head, it signals a chronic spinal disease – cervical spondylosis, which provokes growth and subsequent deformation of the vertebrae. Among other things, those suffering from back pain often complain about the inability to breathe deeply and the lack of mobility of the chest. In some cases, the cause is trauma – sprain or bruise. Proper treatment allows you to recover completely, the absence of treatment contributes to the occurrence of serious complications that can lead to a noticeable curvature of the spine.

CAUSES

Examination of the spine helps to identify the reason for the patient’s backache. Only understanding what is the catalyst for the ailment makes it possible to choose a suitable treatment regimen. The back is the most extensive anatomical region, which includes the lower back and the sacrum, neck, scapula and spine. It is on the back is the projection of dozens of important anatomical structures. This is due to a variety of causes that can cause malaise. Usually these factors are pathology of the musculoskeletal system and various diseases:

• Osteoporosis.
• Violation of the spinal circulation.
• Osteochondrosis.
• Radiculitis.
• Spondylarthrosis.
• Herniated disc.
• Scoliosis

Nevertheless, it is important to understand that the illness is not always due to diseases of the musculoskeletal system. Often the pain is a consequence of the defeat of internal organs:

• Kidney disease.
• Diseases of the gallbladder and liver.
• Problems with the intestines.
• Interruptions in the work of the heart.
• Numerous lung diseases.

In a situation where the pain is caused by diseases of the internal organs, the pain does not disappear, whatever the patient does. He can lie, sit, walk, but the intensity of sensations does not get lower. At the same time, the doctors of EUROMEDPRESTIGE do not rule out the reverse situation, when the osteochondrosis of the thoracic section makes itself felt by the pains in the heart area mistaken for angina pectoris.

It is not at all a fact that the projection of the internal organs will coincide with the localization of pain in the back. The pain itself can also be of a different nature. Dull and aching pain between the shoulder blades is clearly indicative of cardiac pathology. Sharp pain, affecting the back and significantly increasing with a change of posture, means lumbosacral radiculitis, disc hernia or sciatica. The pain that throws into the thigh and the groin area is a typical symptom of renal colic.

DIAGNOSTICS

Only a careful examination of the patient will help to find out the exact cause of the disease. Diagnosis involves drawing up a clinical picture of the disease, consulting a neurologist, as well as a number of special methods:

• Magnetic resonance tomography (gives a good effect if necessary to visualize the spinal cord).
• X-ray of the spine immediately in two or three projections.
• Ultrasonography.
• Inspection of the chiropractor.
• Comprehensive analysis of blood, including biochemical.
• CT scan.
• Densitometry.
• Somatic examination.

In the process of collecting anamnesis, the doctor finds out the emotional state of the patient and possible stresses, localization of pain in the back and irradiation. He also asks about the injuries and diseases, fixes the relationship between pain in the spine and body movements.

Diagnosis of the spine is aimed at studying the neurological status, muscle tone and signs of tension. In addition, it is important to determine the level of difficulty in movement due to painful sensations when trying to lift a leg. Sensitivity diagnostics are of primary importance, since it can decrease or, conversely, increase.

The goal of a physical examination is the detection of any infections, tumors, somatic diseases that can be expressed through diseases of the back. Only clinical data give grounds to speak about compression and reflex complications of osteochondrosis. However, one must understand that not all problems with the spine signal about osteochondrosis, a disease that affects most adults and people over fifty years of age. Pain syndrome can be a manifestation of a much more serious ailment, so it is very important to conduct the most thorough examination and find the real cause of the ailment. Only in this case the treatment will be really effective.

TREATMENT OF PAIN IN SPIN

Treatment of back pain is always appointed based on the cause of the ailment, which can be different in each case. Basic methods include:

• Surgical intervention in emergency cases.
• Manual therapy.
• Therapeutic physical training (LFK).
• Reception of medicines.
• Physiotherapeutic measures.
• Extension of the spine.
• Postisomerization relaxation.
• Organization of interstitial and paravertebral blockades.
• Various massages.

Treatment, consisting in taking medications, allows you to remove pain and inflammation, significantly improve metabolic processes in the body. Painkillers are divided into two categories – not narcotic and narcotic. Typical analgesics are non-steroidal anti-inflammatory drugs. To improve immunity, immunomodulators and a complex of vitamins B and C are used. Narcotic pain medications are used only in extreme cases, when pain is almost impossible to tolerate, and other drugs have no noticeable effect. Drugs are injected with injections in a situation where the back does not ache due to a slight muscle strain, but because of a malignant tumor or a dangerous injury.

Currently, the modern highly effective and safe method of treating problems of the spine, joints, ligaments – shock wave therapy, which is a hardware method of therapeutic influence on tissues by means of impact acoustic waves of a certain frequency, is gaining popularity.

It is impossible to overestimate the benefits of physiotherapeutic procedures, which significantly strengthen the spinal muscles, stabilize the spine and positively influence the metabolic processes. The most effective in this sense is electrophoresis with calcium, as well as paraffin treatment, electrostimulation. If financial possibilities allow, the patient is obliged to visit mud resorts – their positive effect on the way to recovery is scientifically proven.

LFK and massages are also aimed at strengthening the muscles and stabilizing the spine. They significantly reduce the intensity of pain, and sometimes can completely rid of unpleasant sensations. Nevertheless, therapeutic exercise and massage are shown only after the aggravation of pain has been relieved, otherwise the patient’s well-being and the overall clinical picture of the disease will deteriorate noticeably. Therapeutic exercises should be conducted under the supervision of a doctor, any serious stresses are excluded. At the first lessons, most often no movements are made, all you need is to lie quietly on an even, soft surface. At subsequent meetings, the doctor forces the patient to perform small movements in amplitude and strength – first to lift his legs from the prone position, then using special shells. The most basic exercise for strengthening the spine, which causes associations with sipping a cat is the deflection in a position where the patient is on all fours. If pain intensifies during exercise, you should immediately stop exercising.

Surgical intervention to remove the hernia of the disc is indicated only in specific cases, when the spinal cord and the roots of the horse tail are strongly compressed. Without it, also not to do, if the patient is diagnosed with discogenic radiculopathy, accompanied by obvious paresis. The absence of any effect after conservative treatment for three to four months and a large disc herniation leave no choice but to contact the surgeon.

If the main methods of treating pain in the back do not give a tangible result, doctors turn to alternatives, among which:

• Osteopathic effect
• Acupuncture
• Vacuum Therapy

In the East, acupuncture has proven itself hundreds of years ago as a unique remedy for many diseases, including back pain. In the clinic “EVROMEDPRESTIZH” acupuncture is not just the introduction of needles in key points, but also the simultaneous introduction of drugs. In addition, they are irradiated with a laser and are affected by magnetic waves.

In the process of manual therapy the doctor actively kneads the spine with his hands. The goal is to release the nerves, move the incorrectly erect vertebrae and return them to their original position, and also eliminate pain. Despite the similarity of techniques, osteopathy is different: it has no definite contraindications and is often performed even against the background of aggravation of pain.

Vacuum therapy on the principle of use resembles the banks that our grandmothers put to children and grandchildren. In order to relieve the pain, a rarefied pressure, that is, a vacuum, is organized. Due to this, the blood begins to circulate more actively in the affected area, multiplying the metabolic processes many times. At the same time, the doctor moves the cans, thus making a vacuum massage. Vacuum therapy is considered one of the most effective means of getting rid of pain.

If you completely refuse to move it does not work, you need to put on a corset around your neck or on your lower back, and also use special ointments. In addition, compresses, hydrocortisone and novocaine blockades should be made. In the case of pain relief, it is important to begin to strengthen the back, slowly increasing physical activity.

The chronic course of radiculopathies and reflex symptoms requires physical therapy, reflexotherapy, the taking of inflammatory drugs, manual therapy and visits to special spas.

Regardless of the treatment plan developed, each patient must strictly follow the orthopedic correct regimen.

COMPLICATIONS OF NOT CURE SPINE DISEASES

Doctors of the medical center “EVROMEDPRESTIZH” insist on the timely treatment of diseases of the back, as a negligent attitude towards one’s own health can lead to serious consequences.

Instability in the vertebral motor segment, accompanied by excessive mobility between the two vertebrae, is formed as a negative consequence of injuries. It is caused by overgrowing of the ligaments or a sudden restriction of the mobility of a particular vertebra. Instability in osteochondrosis develops against the background of a decrease in the height and volume of the discs. As a result, the ligaments located between the vertebrae lengthen and lose the ability to maintain their position relative to each other. Such instability is always manifested by pain, which becomes stronger in the evening and at times when the patient takes certain poses. Often the patient is confronted with instability in the cervical region – this is fraught with constant headaches and dizziness during head movements.

It is important to give an account of the fact that excessive mobility of the cervical vertebrae in children under five is not a cause for panic, provided there are no birth injuries, any violations in the development of the baby and headaches. However, in any case, only a specialist’s consultation on stabilizing the vertebrae can remove all fears and clarify the situation.

Statistics, conducted by doctors, clearly illustrates the common complications of osteochondrosis – protrusion and disc herniation. Clinically, they do not have special differences, but with hernia the symptoms are much more pronounced, because the hernia is called the contents of the nucleus that fell through the crack of the fibrous ring of the intervertebral disc. The protrusion is a protrusion, in which the disk remains whole outside. In any case, the location of the hernia or protrusion in the posterior half of the disc entails not only pain, but also irradiation of them in the limb. Even with chronic osteochondrosis, with which the patient lives for years, protrusions and hernias only arise as a result of disproportionate axial loads, that is, lifting weights, jumping from height, twisting of the trunk, stresses. Accordingly, avoiding complications will help a way of life in which the patient avoids risk factors.

PREVENTION

Doctors of the clinic “EUROMEDPRESTIGE” are strongly advised to adhere to the following recommendations:

• If you work in the office, make sure that the chair or armchair is comfortable and well supported back.
• Correct any curvature of the spine and posture disorders in a child in childhood.
• Try to keep your back straight, as proper posture removes the load from the spine.
• Fight with excess weight – fullness negatively affects the spine, because it is in tension most of the time.
• Make sure that the ration necessarily included products with a high content of vitamins, magnesium and calcium (beans, fish dishes, fresh milk, spinach, bread, nuts, peas).
• Do not bend unnecessarily.
• If you are forced to carry weights, distribute them evenly, choose a backpack between the backpack and the bag. Lifting the weights from the floor, lean on the legs, the spine should be relaxed. In doing so, bend your knees and keep your back straight.
• Pay attention to physical activity. Only regular exercise helps to create a muscular corset. It is not enough to just sit straight and stand near the wall – muscles must remember the posture, even when you forget about it.
• Grab something from the top shelves, use a chair or a ladder, do not drag.

Only a serious attitude towards one’s own health and adherence to all the recommendations will avoid the occurrence of serious problems with the spine in the future.

Pain in the stomach is one of the symptoms of a variety of diseases. And often it is not directly related to this digestive organ and indicates problems with others. What can the pain in the stomach say, how to find out its cause and what makes sense to take to relieve the pain?

Causes of pain in the stomach

The first question the doctor will ask you will be the nature of the pain in the stomach. It is the answer that can tell a lot about the disease that caused the appearance of pain.

• Acute stomach pain, which occurs suddenly, often indicates pancreatitis, cholecystitis and duodenal ulcer.
• A sudden, sudden pain can be caused by a chemical burn of mucous membranes or poisoning.
• A very severe sharp pain, which patients describe as “a knife stuck”, is often the result of perforation of the ulcer.
• A burning sensation is characteristic of an ulcer or gastritis, and dull aching pain in the stomach is a sign of the same diseases in a chronic or initial form. With gastritis, there is a clear connection with food intake: the pain manifests either immediately after eating, or when the person is fairly hungry.
• Spasmodic, cramping pain is often a sign of an ulcer or inflammation of the duodenum. Such pain is often disturbed at night or a few hours after the last meal.
• Acute, but brief (a few seconds) “shooting” pain, which occurs when inhaling or abruptly changing the position of the body, is typical for spasms of the diaphragm, arising from inflammation or circulatory disorders.
• Constant weak aching pain in the stomach often accompanies malignant neoplasms, as well as polyps of the stomach. When cancer spreads to the pancreas, the pain becomes shrouded.
• Strong cramping pain is most characteristic of gastrointestinal infections.
• Intensive pain in the upper abdomen, which in a couple of days weakens, but remains constant – a fairly characteristic symptom of the pathologies of the large intestine, in particular, colitis.
• Severe pain in the navel, which for several hours moves to the right upper abdomen, can talk about appendicitis.

This is not all causes of pain in the stomach.Sometimes such a symptom is accompanied by other diseases – irritable bowel syndrome, intestinal thrombosis, abdominal aortic dissection, intestinal obstruction, stomach trauma, ischemic heart disease, certain nervous diseases, allergic reactions, etc.

Most of the diseases accompanied by this symptom are very serious and require immediate medical intervention. And in some cases, the word “immediate” has a literal meaning – with appendicitis, perforation of ulcers and severe poisoning, the count can go on for hours, and even a small delay can become fatal.

What to do if there is pain in the stomach

Whatever caused the pain in the stomach, it can not be treated independently. Even an experienced doctor with many years of practice can not with full certainty make a diagnosis only on the basis of external signs. And a man without medical education is all the more powerless.

The number of first aid measures that can be provided with pain in the stomach is very small. The most that you can do before the doctor’s arrival is to take an antispasmodic or analgesic. When heartburn is taken antacids – drugs that reduce acidity, or antisecretory drugs that inhibit the production of acid. However, heartburn is not always associated with increased acidity, so taking such drugs can not only be useless, but also worsen the condition.

With medicines in general, you should exercise special care: the effects of medications can distort the symptoms and create difficulties in diagnosing. It is important to understand that modern painkillers are very effective and can completely eliminate the pain in the stomach for a long time. This creates a false impression of recovery. However, the disease does not disappear anywhere. Relieving pain in the stomach with pills, you only lose valuable time: heal the effect, forgetting the reason.

Important!

Do not use a heating pad to relieve pain in the stomach. In some states, heat can actually help and alleviate the pain, but in others (in particular, in purulent inflammatory processes and bleeding) it significantly accelerates the development of the disease and worsens the condition. You can help the doctor diagnose. To do this, you will need to provide him with as much information as possible about his condition. Therefore, before going to the clinic try.

You can help the doctor diagnose. To do this, you will need to provide him with as much information as possible about his condition. Therefore, before taking the clinic, try to remember as much as possible and formulate:

• the circumstances of the occurrence of pain (before, after or during meals, day or night) and its character (sudden or gradually increasing, sharp, aching, sharp, burning, cramping). Try to remember if the source of pain was moving, and if so, how.
• diet in the last days before the appearance of pain: what, when and in what quantities did you eat (food and drinks).
• list of medications that you take (including dietary supplements and vitamin complexes).
• all additional symptoms. It is important for the doctor to know if you have had nausea and vomiting, bitter taste in the mouth, diarrhea or constipation, belching and bloating, whether blood or mucus was noticed in the stool, rash, fever, shortness of breath, rapid heartbeat and dizziness, any other pain head, muscle, articular).
• recent changes in health status. These include both natural (pregnancy, childbirth, lactation, menopause), and pathological. Remember all the diseases, recently transferred, nervous shocks, episodes of severe overwork. Significant may be factors such as a sharp weight gain or causeless weight loss, the development of anxiety and depression, changes in lifestyle.

Systematization of this information is the best help you can provide yourself. But the diagnosis and treatment should be carried out by a qualified specialist.

Diagnostics

Diagnosis of diseases that cause stomach pain begins with a patient’s interview (here the information above is very useful) and an external examination, including palpation of the abdomen, listening to the heart rhythm and working the lungs.

Then the doctor will necessarily send you for the delivery of biomaterial for laboratory tests. Usually this list includes urine and feces analysis, general and biochemical blood analysis, as well as analysis of gastric juice.

For an accurate diagnosis, instrumental studies are also needed – ultrasound of the abdominal cavity organs, less often – a radiograph with contrast, CT or MRI.

In the vast majority of cases, the diagnosis becomes clear after these basic studies. Significantly less serious diagnostic measures, such as laparoscopy, are required, in which a microchamber on a flexible probe is inserted through a small incision into the hollow organs, which allows the physician to assess their condition visually.

Treatment of diseases and conditions that provoke pain syndrome

The scheme of treatment of pain in the stomach depends entirely on the causes that caused these unpleasant sensations. Consider the principles of therapy for the most common causes of stomach pain.

Elimination of heartburn

Heartburn is a burning sensation behind the sternum, in the upper part of the abdomen. The reason is the ingestion of stomach contents into the esophagus. Most often it manifests itself in half an hour after a meal. Heartburn is not an independent disease, but a symptom of such diseases as gastritis, duodenitis, ulcers of the stomach or intestines, cholecystitis and others. Heartburn is often confused with manifestations of certain heart diseases – angina and hypertension, in which there is a similar sensation, in any way, not related to the gastrointestinal tract. However, most often heartburn is the result of gastritis or peptic ulcer of the stomach.

Measures to eliminate heartburn are the treatment of the underlying disease that caused it. In addition, recommended a special diet: for all types of heartburn, you need often (5-6 times a day), but gradually, completely eliminating fatty foods, spices, smoked foods and pickles, carbonated drinks and alcohol, beans and vegetables with high content cellulose (they can cause flatulence and worsen the condition). If heartburn is associated with high acidity, antacids and antisecretory drugs are prescribed.

Treatment of gastritis

Gastritis is called inflammation of the gastric mucosa. Its development can provoke frequent long-term stresses, the presence of pathological microflora, metabolic disorders, chronic infectious diseases, excessive consumption of alcoholic beverages, autoimmune diseases, long-term use of certain types of medications (most often non-steroidal anti-inflammatory drugs) and some other reasons.

When treating stomach pain caused by gastritis, do not use drugs based on acetylsalicylic acid and ibuprofen – these are effective pain killers, but they irritate the gastric mucosa. Usually appoint absorbents and funds that envelop the stomach from the inside. If gastritis is caused by a bacterial lesion, a course of antibiotics is needed. Diet for gastritis involves the rejection of acute, fatty and salty, as well as from foods rich in fiber, and dishes that can cause fermentation processes (primarily milk and bakery products, as well as some fruits such as grapes).

Treatment of gastric ulcer

Without proper treatment, gastritis can lead to the development of peptic ulcer. Gastric ulcer most often develops due to the activity of the bacterium Helicobacter pylori or regular intake of large doses of preparations of acetylsalicylic acid. Stress, as was thought for a long time, does not cause a ulcer by itself, but it significantly accelerates the development of the disease. With peptic ulcer, a burning and rather severe pain in the stomach manifests itself approximately 4 hours after eating, is localized in the middle of the abdomen and is often accompanied by a belching, a feeling of heaviness, vomiting or nausea.

Gastric ulcer is a dangerous disease that can lead to complications such as bleeding and peritonitis. Therefore, treatment must begin immediately. Usually prescribe antibiotics for the destruction of hostile bacteria, anti-inflammatory drugs, antacids to reduce acidity. There are also preparations of complex influence: they simultaneously kill the bacteria Helicobacter pylori, and protect the gastric mucosa from aggressive action.

Diet with peptic ulcer should consist of light lean food: take the products in a grinded form (mousse, puree), as the chewing process itself stimulates the production of gastric juice.

Pain in the stomach can not be tolerated!

It must be remembered that pain in the stomach can not be tolerated, suppressed with pills and treated with folk remedies. Many diseases and pathologies that cause stomach pain are characterized by rapid development, so the sooner you seek qualified help, the higher the chances of recovery.

For example, appendicitis is one of the most common diseases that physicians of emergency surgery departments have to deal with – it is easily amenable to drug treatment at the earliest stages. Yes, and a timely operation to remove the appendix is ​​considered relatively simple, and the forecast after its implementation is favorable. However, up to now, about 0.75% of patients who have consulted a doctor only a day after the onset of the first pain die from this disease. The reason – in the very rapid development of the disease (from the first signs to the origin of foci of gangrene is only three days) and the implicit severity of symptoms. About a fifth of patients with necrotic changes in the appendix feel only minor pain and ignore it until it’s too late.

Delay with pain in the stomach is also extremely dangerous in cases of poisoning, ulcers and infections – the consequences can be not only sad, but also tragic.

So, unpleasant sensations in the area of ​​the stomach can testify both to minor malfunctions in the work of the organism, and about extremely serious pathologies. In any case, ignoring the pain is unacceptable. Correctly selected medications and procedures in most cases can eliminate not only pain, but also its causes.