Chronic dorsalgia of vertebrogenic origin. Dorsalgia

Patients often hear from an orthopedist-traumatologist the diagnosis of “dorsalgia.” What is this? What danger does this unknown phenomenon pose to the body? Dorsalgia is a pain syndrome in the back. Negative sensations vary in degree of intensity, localization, and the reasons against which the discomfort developed.

The Latin root "algia" means pain in the words lumbodynia, thoracalgia, cervicalgia, sacralgia. Why does pain occur? Is it possible to quickly get rid of painful manifestations? The answers are in the article.

Reasons for the development of pathologists

According to the observations of doctors, most often pain in the back area appears against the background. With a severe degree of pathology, noticeable destruction of the vertebrae, the patient feels discomfort even at rest.

The vertebral bones are separated by a nucleus pulposus filled with fluid. With age-related changes, under high loads, cracks appear in the shell, some of the liquid leaks out, and the “lining” that prevents abrasion of the bone tissue decreases. With osteochondrosis, protrusions of the affected nucleus (hernia) are often noted, a nerve is often pinched, and painful sensations occur.

Other causes of pain:

severe;
microtraumas, cracks, fractures of vertebral bodies;
tuberculosis, tumors in various parts of the spinal column, provoking the formation of bone growths - thorns, causing pain.

Destruction of bone tissue, decreased elasticity of cartilage pads, lack of nutrients, poor blood circulation in the problem area are a consequence of negative factors.

Often, patients do not attach importance to mild pain, their lifestyle remains the same, and there is no talk of changing their occupation. After a certain time, problems in various areas of the back become more pronounced.

It is important to know what factors accelerate damage to the vertebral bodies and intervertebral discs. It's time to listen to negative feelings in the following cases:

presence of extra pounds;
high physical activity;
heavy work associated with lifting and moving heavy objects;
pathologies of internal organs;
uncomfortable posture during the working day, causing excessive stress on the back muscles and spinal column;
depression, psycho-emotional overload for a long period;
drafts, frequent hypothermia;
hormonal imbalances during pregnancy and menopause;
lack of sufficient range of motion, working at a computer;
injuries;
harmful production factors;
lack of microelements, especially calcium, in foods that appear on the table every day.

Characteristic symptoms

Localization of pain syndrome:

sacralgia – coccyx area;
– lumbar region;
Thoracalgia – pain in the thoracic region;
Cervicalgia – discomfort in the neck area.

Negative signs depend on the nature of the pain. The classification is based on the causes of the development of pain.

Doctors distinguish two types of back pain:

reflex. The main reason is degenerative processes in the intervertebral disc. The destruction of the shell of an important element is provoked by chemical processes to protect other tissues of the spinal column. Against the background of certain reactions, muscle tissue becomes tense and a dull, aching pain appears. The muscles are dense, spasmodic, the pain syndrome does not depend on the nature of the movements;
compression Negative symptoms occur when nerves and blood vessels are compressed. Often the pain radiates to the leg or arm; on the compression side, the limb gradually becomes thinner due to loss of muscle mass. Characteristic symptoms of compression of sensitive tissues: a feeling of “pins and needles” in the arm or leg, tingling, numbness of the limbs, limited mobility of the arm or leg on the affected side.

Important! Vertebrogenic pain is associated with pathological changes in the spine. Dorsalgia of a nonvertebrogenic nature develops against the background of the action of psychogenic factors, with somatic diseases, fibromyalgia.

Symptoms of dorsalgia in the cervical region

It’s time to contact a traumatologist-orthopedic surgeon if the following signs appear:

pain occurs when the body is in an uncomfortable position, discomfort spreads along the back of the neck;
discomfort disappears when changing position or stopping activities that caused pain;
unpleasant sensations have a short duration;
Often the “shots” radiate to the neck or arms, the problem areas are heavy and “cotton-like”.

Pain syndrome in the thoracic region

Characteristic signs will help to suspect damage to cartilage and bone tissue in the spinal column:

with ossification of the joints between the vertebrae, the elasticity of the spinal column decreases, movements are more limited;
in the thoracic region, the ribs connect to the vertebrae; as bone formations grow, the affected areas thicken. Any careless movement or higher load provokes pain;
discomfort often occurs during sleep when a person stretches;
a characteristic sign of dorsalgia in the thoracic region is that the strength of the pain changes with movement;
the pain syndrome manifests itself more clearly with a deep breath;
with intercostal neuralgia, lumbago on the side of the ribs is very painful, after the painful sensations subside, an unpleasant feeling of burning tissue in the lumbago area remains;
When the shoulder blades are brought together, a crunching sound is often heard, and a feeling of heaviness remains for a long time;
Dorsalgia of the thoracic region is often confused with an attack of angina.

Signs of tissue damage in the lumbosacral region

Peculiarities:

The risk group is men aged 40 years and older, engaged in hard work (age-related changes in the vertebrae and cartilage tissue are affected). Pain syndrome often occurs at an earlier age with high loads on the limbs and spine;
At the peak of the load, a characteristic sign was noted - lumbar lumbago. Painful symptoms limit the patient’s mobility: the person is afraid to move so as not to provoke a new attack of pain;
discomfort often manifests itself on one side: aching pain occurs when a nerve root is pinched;
When a shooting occurs, the body tries to ease the acute symptoms, and the lower back muscles automatically relax. For this reason, the patient is in a half-bent position;
pain often spreads to the groin, buttocks, and lower extremities. With dorsalgia of the lumbosacral region, slight lameness develops.

General rules and effective treatment methods

It is possible to eliminate pain, prevent relapses, and reduce the negative impact on the body only after establishing the exact cause of the pain and the factors that increase the risk of developing dorsalgia. During diagnosis, the patient is examined by an orthopedic traumatologist, has an X-ray of the spine, MRI and CT scan. The help of a neurologist, therapist, or endocrinologist is often required. Depending on the identified diseases, the patient often visits two or three specialists during the treatment period.

Therapy goals:

determine the cause of pain and negative factors;
stop the destruction of cartilage tissue and vertebral bodies;
reduce pain syndrome;
eliminate compression of nerves and blood vessels, reduce the risk of necrosis of the affected areas;
remove or reduce the strength of neurological symptoms (“goosebumps”, decreased sensitivity, numbness of the arms and legs);
restore the speed of metabolic processes, normalize the supply of oxygen and nutrients to the affected intervertebral discs;
restore functionality to problem areas of the spinal column. Compliance with this point restores the patients’ ability to work.

application of European standards for the treatment of nonspecific pain in the back;
short courses of group drugs. In severe stages, the duration of use of NSAIDs reaches three months. Diclofenac, Ortofen, Indomethacin, Nise, Ibuprofen, Voltaren Emulgel, Ketoprofen;
medications that reduce muscle spasms. Central muscle relaxants are effective: Mydocalm, Sirdalud;
injections of B vitamins. The combination of vitamins B12 and B1 improves neurohumoral regulation, prevents seizures, which often accompany the use of potent drugs;
painkillers. The most commonly used drugs are paracetamol-based. For acute pain, to relieve attacks (painful shooting), paravertebral blockades with hormonal agents and anesthetics, the drug Ketanov (up to five days), are allowed.

Helpful Tips:

During the treatment of dorsalgia, it is important to maintain physical activity: bed rest is not the best way to eliminate pain;
only in severe cases, during an attack it would not hurt to reduce the load on the back and limbs;
You cannot lie in bed for a long time: muscles weaken, blood circulation worsens, the risk of thrombosis increases, there is insufficient nutrition and oxygen supply to tissues;
Lack of reasonable exercise slows down metabolism, and the healing process is delayed.

To eliminate problems in the thoracic, cervical and lumbosacral spine, other methods of therapy are used: in this article.

optimal loads on the spine and limbs: the health of bone and cartilage tissue is at risk, both with hard work and with low mobility;
You cannot stand in one place for a long time; it is harmful to sit for several hours without a break;
you need to eat right, focus on foods that support the quality of the tissues of the musculoskeletal system;
morning exercises are the easiest way to keep your muscles toned. Flexibility of the spine, good health, prevention of joint diseases and vertebrogenic pathologies, improved metabolism are not all the “advantages” of regular exercise;

The most common manifestation of serious problems with the spine is vertebrogenic dorsalgia - back pain caused by various factors that are traumatic, degenerative, neoplastic and inflammatory in nature.

Causes of vertebrogenic dorsalgia

The reasons why the disease occurs are quite numerous. They can be associated either directly with spinal problems or appear as a result of various diseases that have arisen in the human body. However, there are several main factors that contribute to the onset of the disease:

Frequent and prolonged stay in an uncomfortable position
Various injuries
Diseases of the joints and internal organs
Heavy physical activity
Hypothermia
Osteochondrosis
Spondyloarthrosis and other diseases of the spine

Symptoms of vertebrogenic dorsalgia

Often the disease manifests itself gradually, and symptoms may not be noticeable until after 2 weeks. Among the main signs that may signal the onset of the disease:

Discomfort and pain in the spine
Worsening pain with movement, coughing, sneezing, or deep breathing
The occurrence of pain after physical activity, due to careless or sudden movement

Treatment methods

The clinic’s specialists provide high-quality and successful treatment for this disease. Vertebrogenic dorsalgia will be effectively and quickly defeated with the help of centuries-tested methods of oriental medicine, including:

Acupuncture is an effective method that helps quickly eliminate pain and muscle spasms, as well as relieve swelling.
Acupressure is a method that achieves complete relaxation and nutrition of muscle tissue, activates the recovery of the body as a whole and improves blood circulation.
Pharmacopuncture is a method of oriental medicine that promotes a speedy recovery of the patient.
Manual therapy is an effective method that helps improve the flow and outflow of blood to the spine, releasing pinched nerves and blood vessels.
PRP therapy is the latest method of stimulating recovery processes. It is used to restore the functions of various organs after diseases and injuries, including to restore the function of the musculoskeletal system.

Treatment of vertebrogenic dorsalgia at the Paramita clinic

The clinic’s doctors use proven oriental methods for treating vertebrogenic dorsalgia. They are the safest and most gentle, do not cause pain and give good results.

The main focus of the course is a combination of progressive therapy techniques with effective Eastern methods. For each patient, a special course of treatment is drawn up in accordance with the degree of development of the disease and the general condition of the body.

“You have thought about your own health and contacted us - with this step you trusted us with their lives. We highly appreciate your choice, and on behalf of the Paramita clinic team, I want to assure you that we will do everything possible to justify it.”

Dorsalgia is a combined concept, literally translated from Latin as back pain. Includes all diseases of the spinal column, the main symptom of which is pain in any part of the back and spine. This condition is found everywhere and affects people of any age group.

Causes

There are a number of predisposing factors that increase the risk and lead to the development of dorsalgia:

Spinal diseases characterized by dorsalgia:

Malignant tumors of the spine;
Tuberculosis, bone form;
Vertebral osteomyelitis;
Congenital developmental anomalies;

Classification

By location of pain There are 4 types of dorsalgia:

Cervicalgia – back pain at the level of the cervical spine;
Thoracalgia (intercostal neuralgia) - back pain at the level of the thoracic spine;
Lumbodynia - back pain at the level of the lumbar spine;
Combined dorsalgia is back pain at the level of two or three parts of the spine.

By origin There are two types of dorsalgia:

Vertebrogenic dorsalgia - back pain caused by diseases of the spine. Some experts distinguish subspecies:

traumatic – caused by spinal injuries;
inflammatory – caused by inflammatory processes in the spine;
degenerative – caused by degenerative processes in the spine;
neoplastic – caused by tumor growth in the spine and its structures.

Nonvertebrogenic dorsalgia is back pain not associated with spinal pathology. Its subspecies:

myofascial – caused by changes in the muscular framework of the back (sprains, bruises, inflammation, etc.);
psychogenic – without physical reasons, caused by mental and psychological factors;
other reasons.

Symptoms of dorsalgia

The symptoms of dorsalgia are quite varied:

Pain in the back, in the spine. Localization - cervical, thoracic or lumbosacral spine, from localized to widespread. Intensity – from mild to intense, disrupting performance. Character – aching, sharp, pulsating, constant or periodic, pulling, occurs at rest or after exercise, shooting, blocking, etc.;
Gait disturbance;
Numbness of the skin of the back;
Discomfort in the legs;
Weakness in the body;
Increased body temperature.

Diagnostics

For a complete examination and diagnosis of dorsalgia, an integrated approach is applied to each patient:

Survey (collection of complaints and anamnesis of life and illness). Helps to establish complaints at the time of contacting a doctor, the chronology of their occurrence, the mechanism of development of the underlying disease and its complications, causes;
Inspection. Allows you to identify forced body positions, visible deformations of the spine, violations of active and passive movements in the affected part of the spine, etc.;
Palpation. Feeling the spine reveals tension in the muscular frame of the back, pain in the spine, any deformation, etc.;
Neurological examination. Checking for sensitivity of the skin and muscle fibers (pain, temperature, tactile sensations), preservation of physiological reflexes, paresis or paralysis, the presence of pathological reflexes;
X-ray of the spine in two projections (antero-posterior and lateral). Allows you to detect deformations of the spinal column, the condition of the spinal canal, fractures, dislocations and other changes in bone tissue;
CT (computed tomography). Layer-by-layer X-ray images make it possible to determine the pathological area with great accuracy, detecting a violation of the integrity of not only the spine, but also the spinal cord, etc.;
MRI (magnetic resonance imaging). The most accurate visual method. Determines any violations of the structure of the spine, spinal cord, soft tissues, blood vessels and nerves;
Spinal tap. Allows you to detect hemorrhage in the spinal cord, the presence of tumor cells in the cerebrospinal fluid, purulent and inflammatory processes, etc.;
Myelography. A contrast X-ray determines the condition of the spinal cord.

Treatment of dorsalgia

Treatment of dorsalgia of any location and origin can be divided into conservative and surgical.

In case of exacerbation of dorsalgia, in the case of severe pain, bed rest is recommended. To speed up the healing process and its maximum effect, the bed should have an orthopedic mattress and pillow, the patient should be comfortable and comfortable. It is necessary to receive complex of medicines:

NSAIDs. They are basic in the treatment of dorsalgia. They are prescribed both in the form of tablets or capsules (for mild to moderate pain) and by injection (for intense pain). It is recommended to combine with local products from the same group (cream, gel, ointment). Representatives: Diclofenac, Nimid, Analgin, Indomethacin, Baralgin, Pentalgin, etc. The frequency of oral administration is 1-4 times a day, injections are 1-2 times a day.
Muscle relaxants. Relaxes the back muscles and smooth muscle fibers in the walls of blood vessels, reduces pain, restores posture and mobility of the spinal column. Representatives: Mydocalm, Tizalud, Tizanil, Baclofen, etc. The frequency of administration is 1-2 times a day.
Chondroprotectors. Accelerate the restoration of affected cartilage tissue and prevent further development of the disease. The course of treatment with these drugs is long, at least several months. Representatives: Mucosat, Chondroitin sulfate, Artron Complex, Artra, etc.
Angioprotectors. They restore patency in blood vessels, normalize and accelerate gas exchange and metabolism between blood and tissues, improve the condition of the vascular walls, and reduce tissue swelling. Representatives: Pentoxifylline, Detralex, Troxevasin, Ascorutin, etc.
Biological stimulants. Stimulate and accelerate metabolic processes and natural mechanisms of fighting the disease, increase the rate of tissue restoration, restore blood flow and conduction of nerve impulses. Representatives: Aloe, Plazmol, FiBS, etc.
Vitamins. They accelerate metabolism, blood supply to tissues, nerve conduction, improve tissue restoration processes, and reduce the development of the disease. Representatives: Milgamma, B vitamins (B1, B2, B6 and B12).
Metabolic agents. They accelerate metabolic processes, restore blood flow and gas exchange in tissues, and activate natural mechanisms to combat the disease. Representatives: Mildronate, Trimetazidine, etc.

The human spine, like most other parts of the skeleton, plays an important role in human life.

It performs different functions, but the main one is support, helping to maintain balance. But under certain circumstances, pain may occur in the thoracic spine area.

- a common phenomenon. Almost every person has encountered it at least once in their life. Although he might not have realized that this was precisely dorsalgia.

It is generally accepted that this phenomenon generally refers to any manifestation of pain in a given part of the spine. However, many doctors disagree with this. The disease occurs due to degenerative-dystrophic deformities of the vertebrae.

In this article you can learn more about this disease, its causes, diagnosis and treatment.

Dorsalgia of the thoracic spine

Osteochondrosis or dorsalgia of the thoracic spine is an inflammatory process occurring in the thoracic region. Among the many types of osteochondrosis, this disease is much less common and mainly affects people who lead a sedentary lifestyle.

With this type of disease, intervertebral discs are destroyed. But, despite the complexity of the disease, symptoms appear much less frequently than in cases with damage to other parts of the spine. This is due to the fact that the thoracic spine is a sedentary part of the human skeleton, so the symptoms are less pronounced.

This situation leads to the fact that patients seek help even when the disease is in an advanced and often chronic state. People who spend a long time in front of monitors, professional drivers, and those who have suffered from various types of scoliosis should regularly undergo medical examinations regarding the possible occurrence of the disease.

Classification

In real medical practice, the following classification is used:

vertebrogenic dorsalgia;
myofascial dorsalgia.

Relatively speaking, chronic dorsalgia of the first type develops due to diseases of the spine. And pain of the second type is caused exclusively by muscle tension. Sometimes, when dorsalgia is diagnosed, nonspecific back pain appears due to diseases of the internal organs (kidneys, gastrointestinal tract, pelvic organs, lungs).

The development of vertebrogenic dorsalgia occurs after pinching of the spinal nerve roots. Pinching is usually followed by inflammation and radiculitis develops. Radiculitis can be located between the vertebrae or at the site of a bulging disc. Pain usually occurs only after a degenerative change in the tissue of the intervertebral discs, which is called osteochondrosis.

Spasms of muscle tissue lead to vascular spasms, which impairs the nutrition of disc tissue. As a result, the intervertebral discs simply dry out. The space between the vertebrae becomes smaller, and this is followed by pinching of the nerve endings and pain attacks, which are stimulated by reflex pinching of the muscles.

Sometimes the nerve endings are pinched by the spasmed muscles themselves, causing the pain to become even more acute and difficult to bear. In the myofascial scenario, the cause of the development of pain is also muscle spasm. Tight muscles form pain points - triggers. It is in these areas that pain manifests itself. Based on the location of pain, the following are distinguished:

dorsalgia of the lumbosacral spine;
dorsalgia of the thoracic spine;
dorsalgia of the cervical spine.

Vertebrogenic dorsalgia

The main cause of pain, which can be called dorsalgia, is osteochondrosis. But the main prerequisites are degenerative, neoplastic, traumatic or inflammatory lesions of the spinal structure.

Osteochondrosis belongs to the group that is commonly called degenerative changes, but in addition to osteochondrosis, the causes of pain can be spondylitis, spondylosis, ankylosing spondylosis or a reflection of pain from the sacral region, vertebral fractures, which are very often not diagnosed.

A separate group includes neoplastic changes such as tumors and oncology, infectious and inflammatory effects (tuberculosis, brucellosis, etc.), as well as deforming scoliosis.

Dorsalgia of the thoracic spine

In the thoracic region, osteochondrosis is least pronounced. The development of the disease implies degenerative changes in the intervertebral discs. Thoracic osteochondrosis is widespread, but is rarely diagnosed, because this disease often resembles a heart attack, angina pectoris, or a disease of the gastrointestinal tract.

If you have pain when inhaling and exhaling, intercostal pain, difficulty bending your body, pain when raising your arm, you should turn your attention to the thoracic spine.

Dorsalgia of the cervical spine

Usually the cause of neck pain is an exacerbation of cervical osteochondrosis. Such dorsalgia can be accompanied by pain in the arm, in the shoulder area, and headaches.

Cervical dorsalgia occurs or worsens when staying in an uncomfortable position for a long time, during physical exertion, sudden bending and awkward movements of the neck. There is also a rarer case of the disease - osteochondrosis, in which the back hurts between the shoulder blades.

Causes and symptoms of dorsalgia of the thoracic spine

Based on the cause of the syndrome, it can manifest itself in different ways. Unpleasant sensations can be sharp and accompanied by numbness of the limbs and limited mobility.

A person may feel a pressing, aching pain. When walking, inhaling or bending, the symptom often intensifies. The causes of dorsalgia in 90% of cases are pathologies of the spine. Among them are:

herniated intervertebral discs;
protrusion;
osteoporosis;
spondylosis;
osteochondrosis;
traumatic lesions.

Often, vertebrogenic dorsalgia (that which is associated with diseases of the spine) occurs due to congenital diseases. This may be kyphosis, scoliosis, Sheirman-Mau disease.

Nonvertebrogenic dorsalgia of the spine appears due to pathologies not related to the spinal column. Its most common causes are:

infectious and inflammatory diseases;
immune system disorders;
disruptions in metabolic processes in the body.

Dorsalgia is often caused by pathological changes in internal organs. These could be diseases of the stomach, intestines, kidneys or liver.

Why is thoracic osteochondrosis dangerous?

Without timely and proper treatment, thoracic osteochondrosis can cause the following diseases:

protrusion and hernia of the thoracic spine;
spinal cord compression;
problems with the heart, intestines, liver, kidneys and pancreas;
disturbances in the duodenum, intestinal motility, gallbladder dyskinesia;
intercostal neuralgia - compression or irritation of the intercostal nerves.

What can be confused with osteochondrosis of the chest?

Symptoms of osteochondrosis of the thoracic spine are varied; it can easily be confused with the following diseases:

angina pectoris, heart attack. Difference: after taking heart medications, the chest pain does not go away, the patient’s cardiogram is normal;
appendicitis, cholecystitis, renal colic;
gastritis, ulcer, colitis;
pathology of the mammary glands;
pneumonia. Pneumonia is distinguished from osteochondrosis by cough, shortness of breath and fever.

It is impossible to make a correct diagnosis on your own. Only a specialist can determine osteochondrosis of the thoracic spine.

What diseases cause dorsalgia?

Pain in the back can be caused by both pathology of the anatomical formations of this area and diseases of the internal organs. To establish the cause of any illness, you need to undergo an examination. This article discusses dorsalgia, which develops with diseases of the spine, and we will dwell on its causes in more detail.

Spinal diseases are divided into several large groups:

Degenerative diseases (osteochondrosis, disc herniation, spondylosis, spondylolisthesis and others);
Deformations (scoliosis, kyphosis, lordosis);
Consequences of injuries (fractures, sprains, dislocations);
Rheumatic diseases (Bechterew's disease);
Oncological pathology (osteoma, osteoclastoblastoma, osteosarcoma);
Infectious diseases (osteomyelitis, tuberculosis).

Clinical picture

As mentioned above, dorsalgia is a pain syndrome; it is a manifestation of the disease, not a diagnosis. This syndrome is characterized by two main symptoms - back pain and stiffness or limitation in movement. The clinical picture mainly depends on the disease in which we have dorsalgia.

Osteochondrosis

Over time, cracks form in the annulus fibrosus. A disc with an altered nucleus and fibrous ring can prolapse into the lumen of the spinal canal (disc prolapse), and masses of the nucleus pulposus penetrate through the cracks of the fibrous ring, forming disc herniations.

The described processes in one spinal segment lead to reactive changes in adjacent vertebrae and intervertebral joints, resulting in disruption of the kinematics of the entire spinal column.

In addition, the process may involve the ligamentum flavum, which becomes denser over time and puts pressure on the root or membranes of the spinal cord. Over the years, stabilization is possible due to disc fibrosis, but a reverse change is never observed.

The development of spinal osteochondrosis and its progression are caused by congenital bone anomalies, excessive physical activity and other reasons that contribute to the wear and tear of cartilage tissue.

Osteochondrosis is perhaps the most common disease, often occurring in people of working age. It is believed that degenerative processes that start in the cartilage tissue of the spine after 22-25 years are a normal phenomenon. All fabrics are prone to wear and tear and natural aging.

Osteochondrosis begins the development of more severe conditions such as spondylosis and disc herniation. In this case, neurological symptoms (paresthesia - changes in sensitivity and damage to internal organs) join the symptoms of dorsalgia.

Pain with osteochondrosis can be permanently dull, or it can be acute, paroxysmal, intensifying with movement.

Disc herniation

Intervertebral hernia often occurs in the lumbar region. Many of us have seen what a hernia on the anterior abdominal wall looks like when the internal organs protrude into the pathological cavity (hernial sac) through an opening in the peritoneum. So, approximately the same picture is observed in the spine. A defect appears in the lining of the intervertebral disc, through which the nucleus pulposus protrudes into the spinal canal.

As the protrusion grows, the hernia begins to compress the nerve fibers and irritate the spinal cord. With a small hernia, symptoms may be completely absent. Pain appears only when muscles, ligaments and nerve fibers are involved in the pathological process, when inflammation develops when the roots of the spinal nerves are pinched.

The pain can be either constant or in the form of an acute attack (lumbago - lumbar pain). With dorsalgia in the thoracic spine, the pain often radiates to the cervical spine.

Spondylosis and spondylolisthesis

This pathology most often affects older people. Spondylosis is manifested by deformation of the vertebrae due to bone growths (osteophytes) formed against the background of degenerative processes in the bone and cartilaginous structures of the spine. The pain in this disease is constant, can be very intense, and is difficult to treat.

Spondylolisthesis occurs in the lumbar region and, in addition to varying pain intensity, is characterized by changes in the functions of the pelvic cavity organs.

Spinal deformities

The spine has natural curves (cervical lordosis, thoracic kyphosis, lumbar lordosis and sacral kyphosis), deviation from which should be considered a deformity (curvature). Such deformations include pathological lordosis, pathological kyphosis, as well as scoliosis, which is a lateral curvature.

At the same time, the center of gravity shifts, and the tone of the back muscles also changes. The back is under constant tension, so pain in these conditions will be moderately chronic.

I prick my finger - it hurts, but here my back is intact!

After any injury, residual effects can be a concern. So, even after sprains, dislocations and fractures of the spine, sluggish pathological processes in the tissues persist, which can periodically manifest as pain after prolonged stress or overexertion.

And again the infection

Microbes enter the spinal tissue mainly through the hematogenous (blood) and lymphogenous (lymph) routes. Of all infectious diseases, the most common are osteomyelitis and spinal tuberculosis.

In the first case, a nonspecific process takes place (can be caused by any pathogenic microbe), in the second - a specific process (caused by a microbe of one type). The painful attack is accompanied by symptoms of intoxication (fever, chills, muscle weakness).

Oncological pathology

There are two types of tumors in the spine: those growing from bone and those growing from cartilage. Both types can be malignant or benign.

In addition, according to their origin, formations are distinguished between primary and secondary or metastatic. The main symptom of a mass formation in the spine is pain, the intensity of which depends on the type of tumor and its size.

Mechanism of development of dorsalgia

Depending on which structures of the spinal column are involved in the process in each specific case, either compression or reflex syndromes predominate in the clinical picture.

Compression syndromes develop if altered structures of the spine deform or compress the roots, blood vessels or spinal cord. Reflex vertebrogenic syndromes arise as a result of irritation of various structures of the spine, which has powerful sensory innervation. It is believed that only the bone tissue of the vertebral bodies and the epidural vessels do not contain nociceptive receptors.

Based on localization, vertebrogenic syndromes are distinguished at the cervical, thoracic and lumbosacral levels.
Cervical syndromes.

Clinical syndromes of cervical localization are largely determined by the structural features of the cervical spine: there is no disc between CI and CII, CII has a tooth, which in pathological conditions can cause compression of spinal structures. The vertebral artery passes through the transverse processes of the cervical vertebrae.

Below the CIII vertebrae are connected using uncovertebral joints, the structures of which can be deformed and serve as a source of compression.

Compression syndromes of the cervical localization. At the cervical level, not only roots and vessels, but also the spinal cord can be subjected to compression. Compression of blood vessels and/or the spinal cord is manifested by a clinical syndrome of complete or, more often, partial transverse lesion of the spinal cord with mixed paresis of the arms and lower spastic paraparesis.

Root compression can be clinically divided into:

root C3 - pain in the corresponding half of the neck;
root C4 - pain in the area of the shoulder girdle, collarbone. Atrophy of the trapezius, splenius and longissimus muscles of the head and neck; possible cardialgia;
root C5 - pain in the neck, shoulder girdle, lateral surface of the shoulder, weakness and atrophy of the deltoid muscle;
root C6 - pain in the neck, scapula, shoulder girdle, radiating along the radial edge of the hand to the thumb, weakness and hypotrophy of the biceps brachii muscle, decreased reflex from the tendon of this muscle;
root C7 - pain in the neck and scapula, spreading along the outer surface of the forearm to the II and III fingers, weakness and atrophy of the triceps brachii muscle, decreased reflex from its tendon;
root C8 - pain from the neck spreads along the inner edge of the forearm to the fifth finger of the hand, decreased carporadial reflex.

Cervical reflex syndromes. Clinically manifested by lumbago or chronic pain in the neck area with irradiation to the back of the head and shoulder girdle. On palpation, pain is detected in the area of the facet joints on the affected side. Sensitivity disorders, as a rule, do not occur.

It should be noted that the cause of pain in the neck, shoulder girdle, and scapula can be a combination of several factors, for example, reflex pain syndrome due to spinal osteochondrosis in combination with microtraumas of the tissues of the joints, tendons and other structures of the musculoskeletal system.

Thus, with glenohumeral periarthrosis, many researchers note in such patients damage to the C5-C6 discs, as well as injury to the shoulder joint, or myocardial infarction, or other diseases that play the role of triggers. Clinically, with glenohumeral periarthritis, pain in the periarticular tissues of the shoulder joint and limitation of movements in it are noted.

Only pendulum-like movements of the shoulder in the sagittal plane are possible (frozen shoulder syndrome). The adductor muscles of the shoulder and periarticular tissues are painful on palpation, especially in the area of the coracoid process and the subacromial zone. “Sensory” disorders are not determined, tendon reflexes are preserved, sometimes somewhat animated.

Reflex cervical syndromes include the syndrome of the anterior scalene muscle, which connects the transverse processes of the middle and lower cervical vertebrae with the first rib. When this muscle is involved in the process, pain occurs along the anterior outer surface of the neck, radiating along the ulnar edge of the forearm and hand.

When palpating the anterior scalene muscle (at the level of the middle of the sternocleidomastoid muscle, somewhat laterally), its tension is determined, and in the presence of muscle trigger points, pain distribution zones are reproduced in it - shoulder, chest, scapula, hand.

Vertebrogenic neurological complications in the thoracic spine with osteochondrosis are rare, since the bone frame of the chest limits displacement and compression. Pain in the thoracic region more often occurs in inflammatory (including specific) and inflammatory-degenerative diseases (ankylosing spondylitis, spondylitis, etc.).

In medical practice, the first place in terms of treatment is taken by lesions of the lumbar and lumbosacral spine.

Lumbar compression syndromes. Upper lumbar compression syndromes are relatively rare. Compression of the LII root (LI-LII disc) is manifested by pain and loss of sensitivity along the inner and anterior surfaces of the thigh, and decreased knee reflexes.

Compression of the LIV root (LII-LIV disc) is manifested by pain along the anterior inner surface of the thigh, decreased strength, followed by atrophy of the quadriceps femoris muscle, and loss of the knee reflex. Compression of the LV root (LIV-LV disc) is a common location.

It manifests itself as pain in the lower back with irradiation along the outer surface of the thigh, the anterior surface of the leg, the inner surface of the foot and big toe. Hypotonia and wasting of the tibialis muscle and decreased strength of the dorsal flexors of the thumb are noted.

Compression of the SI root (LV-SI disc) is the most common location. It manifests itself as pain in the buttock, radiating along the outer edge of the thigh, lower leg and foot. The strength of the triceps surae muscle decreases, sensitivity in the areas of pain irradiation is impaired, and the Achilles reflex fades.

Lumbar reflex syndromes. Lumbago - acute pain in the lower back (lumbago). Develops after physical activity. Manifests itself with sharp pain in the lumbar region. The antalgic posture and tension of the lumbar muscles are objectively determined. Neurological symptoms of loss of function of the roots or nerves of the lumbosacral region, as a rule, are not detected.

Lumbodynia is chronic lower back pain. It manifests itself as dull aching pain in the lower back. Palpation determines the pain of the spinous processes and interspinous ligaments and facet joints (at a distance of 2-2.5 cm from the midline) in the lumbar region, in which movements are limited. Sensory disorders are not defined.

Piriformis syndrome. The piriformis muscle begins at the anterior edge of the upper sacrum and attaches to the inner surface of the greater trochanter of the femur. Its main function is hip abduction. The sciatic nerve passes between the piriformis muscle and the sacrospinous ligament.

Therefore, when the piriformis muscle is tense, compression of the nerve is possible, which occurs in some cases with lumbar osteochondrosis. The clinical picture of piriformis muscle syndrome is characterized by sharp pain in the subgluteal region radiating along the posterior surface of the lower limb.

Adduction of the hip causes pain (Bonnet test), the Achilles reflex is reduced. The pain syndrome is accompanied by regional autonomic and vasomotor disorders, the severity of which depends on the position of the body - pain and autonomic disorders decrease in the supine position and intensify when walking.

Symptoms

The exacerbation period will last 2-3 weeks. At the same time, the pain gradually increases. Mild pain appears in the affected part of the spine. As a rule, pain manifests itself especially actively when breathing deeply and bending forward, backward, or to the sides.

The specific symptoms of dorsalgia will directly depend on the disease and its stage. For example, in the case of an intervertebral hernia, the pain can be quite acute at first, but at the final stage it can hardly be felt. This will be associated with atrophy of the pinched nerve.

When diagnosed with dorsalgia, the symptoms can be so different that the severity of the disease is not always related to the intensity of the pain. There is a widespread, but completely erroneous opinion that if it doesn’t hurt too much, then nothing bad is happening.

The price to pay for such a mistake may be disability, the need for urgent surgical intervention, and the inability to live a full life. If your back hurts, you should urgently go to the doctor and get examined.

The nature of pain during dorsalgia can be very different. The pain can be pulling, burning, aching, cutting, and can radiate to the leg, arm, buttock, or shoulder blade. The location of the pain is no less varied. They can appear below, above, in the middle, on the right, on the left, between the shoulder blades. But, despite such diversity, all pain can be divided into sudden and chronic.

Sudden pain

A sharp, sudden pain, similar to a lumbago, is called dorsago. The cause of pain in the chest area will most often be thoracic osteochondrosis. Sometimes the pain is so strong that the person has difficulty breathing or freezes in a forced position. A lumbago in the lumbar region is called lumbago.

The most likely cause of such pain is lumbar osteochondrosis. If you immediately contact a specialist, it will be quite easy to relieve sudden pain. If the problems are not big, then one or several massage sessions will be enough for the pain to go away. Sometimes acupuncture and manual therapy are also used to quickly relieve pain.

Chronic pain

Chronic pain does not appear immediately. They usually develop gradually. At first, the pain occurs briefly when inhaling, exhaling and bending over. Gradually they become more and more frequent guests. The cause of chronic dorsalgia is dystrophic changes in the intervertebral discs. A possible cause is also inflammation of the intervertebral joints. This disease is called ankylosing spondylitis. In addition to these reasons, there are a dozen others.

Chronic pain is excellently eliminated by various methods of reflexology and physiotherapy. Of course, you will need patience to complete a full course of treatment, but with regular procedures you can achieve a powerful therapeutic effect, achieve increased blood supply and accelerate metabolic processes in the area of the intervertebral discs, joints, vertebrae, and muscles that surround the spine.

With sufficient persistence, you can not only stop degenerative processes, but also reverse them. With a competent approach to treatment, intervertebral discs can completely recover, and pain can completely go away.

Diagnosis of the syndrome

The causes that can cause pain in the back and spinal regions have a huge range, so it is impossible to make a specific diagnosis based on pain symptoms alone.

In order to make the most effective diagnosis and identify the processes that occur in the spine, it is necessary to use innovative imaging methods, such as MRI or tomography, as well as conventional x-rays in several projections.

The use of MRI is justified by the fact that X-ray imaging is not able to detect the presence of malignant and other tumors and myoplasia, which are detected using magnetic resonance imaging or ultrasound.

To identify and treat the disease in a clinic, you need to contact a neurologist, but when contacting more specialized specialized institutions, it is best to undergo diagnosis and treatment from a vertebrologist. Correct and timely diagnosis is a good prerequisite for effective treatment of the disease.

Treatment of dorsalgia

Treatment of dorsalgia of any location and origin can be divided into conservative and surgical. In case of exacerbation of dorsalgia, in the case of severe pain, bed rest is recommended.

To speed up the healing process and its maximum effect, the bed should have an orthopedic mattress and pillow, the patient should be comfortable and comfortable. It is necessary to receive a set of medications:

NSAIDs. They are basic in the treatment of dorsalgia. They are prescribed both in the form of tablets or capsules (for mild to moderate pain) and by injection (for intense pain). It is recommended to combine with local products from the same group (cream, gel, ointment). Representatives: Diclofenac, Nimid, Analgin, Indomethacin, Baralgin, Pentalgin, etc. The frequency of oral administration is 1-4 times a day, injections are 1-2 times a day.
Muscle relaxants. Relaxes the back muscles and smooth muscle fibers in the walls of blood vessels, reduces pain, restores posture and mobility of the spinal column. Representatives: Mydocalm, Tizalud, Tizanil, Baclofen, etc. Frequency of administration - 1-2 times a day.
Chondroprotectors. Accelerate the restoration of affected cartilage tissue and prevent further development of the disease. The course of treatment with these drugs is long, at least several months. Representatives: Mucosat, Chondroitin sulfate, Artron Complex, Arthra, etc.
Angioprotectors. They restore patency in blood vessels, normalize and accelerate gas exchange and metabolism between blood and tissues, improve the condition of the vascular walls, and reduce tissue swelling. Representatives: Pentoxifylline, Detralex, Troxevasin, Ascorutin, etc.
Biological stimulants. Stimulate and accelerate metabolic processes and natural mechanisms of fighting the disease, increase the rate of tissue restoration, restore blood flow and conduction of nerve impulses. Representatives: Aloe, Plazmol, FiBS, etc.
Vitamins. They accelerate metabolism, blood supply to tissues, nerve conduction, improve tissue restoration processes, and reduce the development of the disease. Representatives: Milgamma, B vitamins (B1, B2, B6 and B12).
Metabolic agents. They accelerate metabolic processes, restore blood flow and gas exchange in tissues, and activate natural mechanisms to combat the disease. Representatives: Mildronate, Trimetazidine, etc.
Glucocorticosteroids. They are used in cases of pronounced clinical manifestations, when other means do not have the required effect. They enhance the effects of drugs, especially NSAIDs, reduce the severity of pain, reduce swelling, and restore physiological processes. These are Prednisolone, Prednisone, Dexamethasone, etc.

After the acute manifestations of dorsalgia have subsided, when the pain syndrome is less pronounced, physiotherapy is recommended:

Acupuncture;
Traction of the spine;
Laser therapy;
Magnetotherapy;
Osteopathy;
Electrophoresis;
Massage;
Apitherapy;
Mud therapy;
Swimming;
Manual therapy.

Surgical treatment of dorsalgia is practically not used. The exception is those cases when conservative treatment is not effective, or severe complications develop.

Complications

With a long course of dorsalgia and the absence of timely and correct treatment, complications of the underlying disease develop:

Pain that cannot be treated;
Cerebrovascular accident (including stroke);
Paresis or paralysis of the arms, legs, and entire body;
Dysfunction of the pelvic organs (impaired urination, defecation, sexual dysfunction).

Preventive actions

There are no specialized methods of prevention. Taking into account the number of preconditions that can cause pain in the spine, it is possible to give only very general and joint recommendations for the prevention of pain conditions and lesions of the spine.

The main thing that can have a positive effect is a careful attitude towards yourself, the use of normal and proportional loads. Gymnastics classes, exercises in the morning.

A balanced diet and timely consultation with doctors is the key to ensuring that dorsalgia never manifests itself. At the same time, it is very important to prevent recurrent manifestations of those diseases that are already occurring. To do this, you must adhere to the recommendations given by the doctor.

As it was found out, dorsalgia is a cumulative manifestation of pain, which is caused by various reasons and can be effectively treated with various methods.

The main thing that everyone who has read this article needs to remember is that the body is a very “smart” creation that always responds with pain to various malfunctions in the functioning of internal organs or systems.

Therefore, if any signals arise, you must immediately contact a specialist for examination; excellent health also encourages periodic independent visits to the clinic for medical examinations.

Dorsalgia — back pain is a clinical syndrome caused by many causes. The most common cause of dorsalgia is dystrophic lesions of the spine: osteochondrosis with damage to the intervertebral discs and adjacent surfaces of the vertebral bodies; spondylosis, manifested by arthrosis of the facet and/or facet joints; spondylitis

Along with vertebrogenic causes of back pain, there may be other causes not directly related to the spine.

Vertebrogenic pain in the back and limbs is caused by the following reasons.

Disc herniation.
Spondylosis.
Osteophytes.
Sacralization or lumbalization.
Arthrosis of the intervertebral (facet) joints.
Ankylosing spondylitis.
Spinal stenosis.
Instability of the spinal segment with spondylolisthesis.
Vertebral fractures.
Osteoporosis.
Vertebral tumors.
Ankylosing spondylitis.
Functional disorders of the spine.

Nonvertebrogenic back pain occurs due to the following reasons.

Myofascial pain syndrome.
Psychogenic pain.
Referred pain in diseases of internal organs.
Intra- and extramedullary tumors.
Metastatic lesions.
Syringomyelia.
Retroperitoneal tumors.

Osteochondrosis of the spine is one of the causes of vertebrogenic dorsalgia. The process is primarily localized in the nucleus pulposus of the intervertebral disc, which becomes less elastic due to loss of moisture. Under the influence of mechanical stress, the nucleus pulposus can sequester and protrude towards the annulus fibrosus of the disc. Over time, cracks form in the annulus fibrosus. A disc with an altered nucleus and fibrous ring can prolapse into the lumen of the spinal canal (disc prolapse), and masses of the nucleus pulposus penetrate through the cracks of the fibrous ring, forming disc herniations. The described processes in one spinal segment lead to reactive changes in adjacent vertebrae and intervertebral joints, resulting in disruption of the kinematics of the entire spinal column. In addition, the process may involve the ligamentum flavum, which becomes denser over time and puts pressure on the root or membranes of the spinal cord. Over the years, stabilization is possible due to disc fibrosis, but a reverse change is never observed.

Three main pathophysiological mechanisms for the development of dorsalgia have been studied.

Peripheral sensitization of pain receptors associated with their injury or other pathological effects. In osteochondrosis, these receptors are located in the fibrous ring of the intervertebral disc, the posterior longitudinal ligament, facet and facet joints, spinal roots and paravertebral muscles. Sensitization of these receptors occurs due to trauma to the musculoskeletal tissues of the back, causing the release of pro-inflammatory and algogenic substances (prostaglandins, bradykinin), including mechanisms of peripheral sensitization.
Damage to nerve structures (nerve, root, intervertebral ganglion) due to various pathological processes (trauma, inflammation, vascular insufficiency). As a result, neuropathic pain develops.
Central sensitization, which in the first stages is a protective mechanism, and with long-term pain contributes to its intensification.

The processes described above are shown schematically in the figure.

Depending on which structures of the spinal column are involved in the process in each specific case, either compression or reflex syndromes predominate in the clinical picture.

Based on localization, vertebrogenic syndromes are distinguished at the cervical, thoracic and lumbosacral levels.

Cervical syndromes. Clinical syndromes of cervical localization are largely determined by the structural features of the cervical spine: there is no disc between CI and CII, CII has a tooth, which in pathological conditions can cause compression of spinal structures. The vertebral artery passes through the transverse processes of the cervical vertebrae. Below the CIII vertebrae are connected using uncovertebral joints, the structures of which can be deformed and serve as a source of compression.

Compression syndromes of the cervical localization. At the cervical level, not only roots and vessels, but also the spinal cord can be subjected to compression. Compression of blood vessels and/or the spinal cord is manifested by a clinical syndrome of complete or, more often, partial transverse lesion of the spinal cord with mixed paresis of the arms and lower spastic paraparesis. Root compression can be clinically divided into:

root C3 - pain in the corresponding half of the neck;
root C4 - pain in the area of the shoulder girdle, collarbone. Atrophy of the trapezius, splenius and longissimus muscles of the head and neck; possible cardialgia;
root C5 - pain in the neck, shoulder girdle, lateral surface of the shoulder, weakness and atrophy of the deltoid muscle;
root C6 - pain in the neck, scapula, shoulder girdle, radiating along the radial edge of the arm to the thumb, weakness and hypotrophy of the biceps brachii muscle, decreased reflex from the tendon of this muscle;
root C7 - pain in the neck and scapula, spreading along the outer surface of the forearm to the II and III fingers, weakness and atrophy of the triceps brachii muscle, decreased reflex from its tendon;
root C8 - pain from the neck spreads along the inner edge of the forearm to the fifth finger of the hand, decreased carporadial reflex.

Cervical reflex syndromes. Clinically manifested by lumbago or chronic pain in the neck area with irradiation to the back of the head and shoulder girdle. On palpation, pain is detected in the area of the facet joints on the affected side. Sensitivity disorders, as a rule, do not occur. It should be noted that the cause of pain in the neck, shoulder girdle, and scapula can be a combination of several factors, for example, reflex pain syndrome due to spinal osteochondrosis in combination with microtraumas of the tissues of the joints, tendons and other structures of the musculoskeletal system. Thus, with glenohumeral periarthrosis, many researchers note in such patients damage to the C5-C6 discs, as well as injury to the shoulder joint, or myocardial infarction, or other diseases that play the role of triggers. Clinically, with glenohumeral periarthritis, pain in the periarticular tissues of the shoulder joint and limitation of movements in it are noted. Only pendulum-like movements of the shoulder in the sagittal plane are possible (frozen shoulder syndrome). The adductor muscles of the shoulder and periarticular tissues are painful on palpation, especially in the area of the coracoid process and the subacromial zone. “Sensory” disorders are not determined, tendon reflexes are preserved, sometimes somewhat animated.

Reflex cervical syndromes include the syndrome of the anterior scalene muscle, which connects the transverse processes of the middle and lower cervical vertebrae with the first rib. When this muscle is involved in the process, pain occurs along the anterior outer surface of the neck, radiating along the ulnar edge of the forearm and hand. When palpating the anterior scalene muscle (at the level of the middle of the sternocleidomastoid muscle, somewhat laterally), its tension is determined, and in the presence of muscle trigger points, pain distribution zones are reproduced in it - shoulder, chest, scapula, hand.

In medical practice, the first place in terms of treatment is taken by lesions of the lumbar and lumbosacral spine.

Lumbar compression syndromes. Upper lumbar compression syndromes are relatively rare. Compression of the LII root (LI-LII disc) is manifested by pain and loss of sensitivity along the inner and anterior surfaces of the thigh, and decreased knee reflexes. Compression of the LIV root (LII-LIV disc) is manifested by pain along the anterior inner surface of the thigh, decreased strength, followed by atrophy of the quadriceps femoris muscle, and loss of the knee reflex. Compression of the LV root (LIV-LV disc) is a common location. It manifests itself as pain in the lower back with irradiation along the outer surface of the thigh, the anterior surface of the leg, the inner surface of the foot and big toe. Hypotonia and wasting of the tibialis muscle and decreased strength of the dorsal flexors of the thumb are noted. Compression of the SI root (LV-SI disc) is the most common location. It manifests itself as pain in the buttock, radiating along the outer edge of the thigh, lower leg and foot. The strength of the triceps surae muscle decreases, sensitivity in the areas of pain irradiation is impaired, and the Achilles reflex fades.

Lumbar reflex syndromes. Lumbago - acute pain in the lower back (lumbago). Develops after physical activity. Manifests itself with sharp pain in the lumbar region. The antalgic posture and tension of the lumbar muscles are objectively determined. Neurological symptoms of loss of function of the roots or nerves of the lumbosacral region, as a rule, are not detected. Lumbodynia is chronic lower back pain. It manifests itself as dull aching pain in the lower back. Palpation determines the pain of the spinous processes and interspinous ligaments and facet joints (at a distance of 2-2.5 cm from the midline) in the lumbar region, in which movements are limited. Sensory disorders are not defined.

Piriformis syndrome. The piriformis muscle begins at the anterior edge of the upper sacrum and attaches to the inner surface of the greater trochanter of the femur. Its main function is hip abduction. The sciatic nerve passes between the piriformis muscle and the sacrospinous ligament. Therefore, when the piriformis muscle is tense, compression of the nerve is possible, which occurs in some cases with lumbar osteochondrosis. The clinical picture of piriformis muscle syndrome is characterized by sharp pain in the subgluteal region radiating along the posterior surface of the lower limb. Adduction of the hip causes pain (Bonnet test), the Achilles reflex is reduced. The pain syndrome is accompanied by regional autonomic and vasomotor disorders, the severity of which depends on the position of the body - pain and autonomic disorders decrease in the supine position and intensify when walking.

Differential diagnosis of compression and reflex vertebrogenic syndromes. Vertebrogenic compression syndromes are characterized by the following features.

The pain is localized in the spine, radiating to the limb, right up to the fingers or toes.
The pain intensifies with movement in the spine, coughing, sneezing, and straining.
Regional autonomic-vascular disorders, often dependent on body position.
Symptoms of loss of function of compressed roots are determined: impaired sensitivity, muscle wasting, decreased tendon reflexes.

The following are characteristic of reflex vertebrogenic syndromes:

The pain is local, dull, deep, without radiating.
The pain intensifies with load on the spasmed muscle, its deep palpation or stretching.
There are no symptoms of loss.

Regional autonomic-vascular disorders are not typical.

Treatment of vertebrogenic pain syndromes. In the acute period of the disease, when the pain syndrome is severe, the main task of the doctor is to relieve pain. To successfully complete this task, certain conditions must be met.

The spine should be kept at rest. To do this, place a shield under the mattress or place the patient on a special orthopedic mattress. For 5-7 days, the motor mode is limited, and the patient is allowed to stand only in an immobilizing belt or corset and only for physiological necessity. The rest of the time, bed rest is indicated. The expansion of the motor regime is carried out carefully; the recommended movements should not cause pain.
Drug treatment should be structured taking into account all links in the pathogenesis of pain. The source of pain in compression syndromes is pathologically altered structures of the spinal column, which either irritate tissue nociceptors or compress the spinal roots. In reflex syndromes, the source of pain can be both the spine itself and reflexively spasmed muscles that form tunnel syndromes. In addition, with chronic (lasting more than 3 months) or recurrent pain, depressive, anxiety, hypochondriacal and other affective disorders develop. The presence of such disorders must be actively identified and treated, since they have an extremely negative impact on the course of the disease.
Non-drug treatment is recommended. Physiotherapy, manual therapy, kinesitherapy, etc. are widely used in the treatment of vertebrogenic pain syndromes.
Surgical intervention is used when conservative treatment is ineffective within 4 months or there are signs of spinal cord compression with dysfunction of the pelvic organs, sensory conduction disorders or damage to the central motor neuron (in the presence of pyramidal signs).

Drug treatment

Analgesics, anti-inflammatory non-steroidal drugs, anesthetics. To relieve pain, the use of analgesics metamizole sodium (Analgin), paracetamol, tramadol (Tramal) and nonsteroidal anti-inflammatory drugs (NSAIDs) enterally and parenterally is indicated. The use of NSAIDs is pathogenetically justified because, in addition to the analgesic effect, they have an anti-inflammatory effect (due to their effect on cyclooxygenase (COX-1 and COX-2), they inhibit the synthesis of prostaglandins, which prevents the sensitization of peripheral nociceptors and the development of neurogenic inflammation).

Among the well-proven drugs in this group, we note diclofenac, which is available in the form of tablets of 50 and 100 mg, rectal suppositories and solutions for parenteral administration. The drug ketorolac (Ketolac) has a powerful analgesic effect, which is recommended to be administered for severe pain syndromes at 30 mg IM for 3-5 days, and then switch to tablet forms, prescribing 10 mg 3 times a day after meals for more than 5 days. In addition to those listed above, you can use other drugs in this group: meloxicam (Movalis), lornoxicam (Xefocam), ketoprofen (Ketonal), etc. But it should be remembered that most NSAIDs are contraindicated for peptic ulcers of the stomach and duodenum, with a tendency to bleeding. If the patient is diagnosed with the above diseases, even in remission, the listed NSAIDs are contraindicated. In such cases, the drugs of choice are selective COX-2 inhibitors, which do not have such a significant effect on the gastrointestinal tract, in particular celecoxib (Celebrex), a selective COX-2 inhibitor. It should be prescribed at a dose of 200 mg 3 times a day after meals for 7-10 days.

To reduce pain, paravertebral blockades can be performed with an anesthetic (Procaine, Lidocaine, etc.) in combination with corticosteroids (50 mg Hydrocortisone, 4 mg Dexamethasone, etc.). Blockades using anesthetics and corticosteroids are recommended to be carried out once every 3 days. In most cases, 3-4 blockades are sufficient for a course of treatment (elimination of acute pain).

Vascular agents. Considering the mandatory participation of the vasomotor component in the pathogenesis of vertebrogenic syndromes, especially those of a compression nature, it is necessary to introduce vasoactive drugs into the treatment complex. The choice of drug depends on the presence of concomitant vascular disease and the severity of vasomotor disorders. In mild cases, oral administration of vasodilators (nicotinic acid preparations or their analogues) is sufficient. If the patient is diagnosed with severe compression radiculopathy, parenteral administration of drugs (Trental) that normalizes both arterial inflow and venous outflow is necessary.

Psychotropic drugs. Patients with chronic pain need correction of affective disorders. To carry out adequate correction of psychoaffective disorders, their diagnosis is necessary (consultation with a psychotherapist or psychodiagnostic testing). In case of predominance of anxiety-depressive and depressive disorders, the prescription of antidepressants is indicated. Preference is given to drugs that have, along with an antidepressant, anxiolytic effect: amitriptyline - from 25 to 75 mg / day for 2-3 months, tianeptine (Coaxil), mianserin (Lerivon), etc. If the patient has predominant hypochondriacal disorders, tricyclic antidepressants should be combined with antipsychotics that do not cause extrapyramidal disorders - tifidazine (Sonapax) - 25-50 mg/day, sulpiride (Eglonil) - 25-50 mg/day.

Non-drug treatment of vertebrogenic pain syndromes. Physiotherapy plays an important role in the treatment of pain syndromes. In the acute period of the disease, preference is given to the use of physical factors that reduce pain, improve regional hemodynamics, especially the outflow of blood from the area of compression, and relieve muscle spasm. At the first stage, diadynamic currents, microwave fields, magnetic therapy, UV irradiation, and acupuncture are used. As the pain subsides, physiotherapy is prescribed to improve tissue trophism and increase range of motion (laser magnetic therapy, massage, phototherapy, kinesitherapy). During the recovery period, it is recommended to actively involve the patient in the treatment process: expand the motor mode, strengthen the muscle corset, etc.

It should be remembered that complete comprehensive treatment of patients with vertebrogenic lesions of the nervous system allows one to achieve complete and long-term remission. During the period of absence of pain, it is necessary to recommend an active lifestyle, physical exercise (without significant vertical and “twisting” loads on the spine), and recreational swimming.

Literature

Belova A. N., Shepetova O. N. Guidelines for the rehabilitation of patients with movement disorders. M., 1998. P. 221.
Kukushkin M. L. Pathophysiological mechanisms of pain syndromes. Pain. 2003. No. 1. P. 5-13.
Podchufarova E.V., Yakhno N.N., Alekseev V.V. et al. Chronic pain syndromes of lumbosacral localization: the significance of structural musculoskeletal disorders and psychological factors // Pain. 2003. No. 1. P. 34-38.
Shmyrev V.I. Treatment and rehabilitation program for patients with dorsalgia: method. recommendations. M., 1999. 28 p.
Yakhno N. N., Shtulman D. R. Diseases of the nervous system. T. 1. 2001.

L. G. Turbina, Doctor of Medical Sciences, Professor
MONIKI, Moscow