Found that in different life periods, back pain occurs in 80% of the population. Among adults, more than half suffer from prolonged chronic symptoms. This prevalence includes the disease in a group of social problems.
The most susceptible and prone to clinical manifestations are:
- people without sufficient physical activity;
- engaged in enhanced training or heavy physical labor;
- addicted to alcoholic beverages;
Dorsalgia is not all pain. For its detection requires accurate diagnosis.
What is the Dorsal Classification of the International Classification?
Dorsalgia is defined in ICD-10 as a group of diseases exhibiting such a common clinical symptom as back pain. Coded M54, is included in the block "Dorsopathy", a subgroup "Other dorsopathies", the class "Diseases of the musculoskeletal system."
It is important that the dorsalgia does not apply:
- osteochondrosis of the spine;
- any lesions of the intervertebral disc;
- is an inflammation of the sciatic nerve.
It is interesting that in the ICD there are no such diagnoses as "spondyloarthrosis" or "facet syndrome".According to many scientists, they most fully reflect the nature of pathological changes. However, they are forced to "cover" the term "Another spondylosis" with code M47.8.
What is hidden under the term "others"?
"Other" can be considered all unspecified pain syndromes in the back area with an unclear origin of an inflammatory or unknown nature.
With this diagnosis, the patient can undergo examination and treatment until the cause and type of changes in the muscles, spine or before the detection of reflected back pain are diagnosed in internal organs( most often duodenal ulcer, duodenitis, pancreatitis).
For a thinking doctor such "diagnoses" are impossible.
Differences in the localization of
Depending on the localization of the lesions, dorsalgia is distinguished:
- of the entire vertebra, beginning with the cervical region;
- cervicalgia - defeat only in the neck;
- pain in the thoracic region;
- lesion of the lumbar spine in the form of sciatica;
- lumbosacral radiculitis( type lumbago + sciatica);
- pains in the lower back;
- radiculopathy - when the radicular syndrome predominates;
- , unspecified other species.
Clinical forms of
Neurologists distinguish between two forms of dorsalgia:
- acute - occurs suddenly and lasts up to three months, in 1/5 of patients it becomes chronic;
- chronic - lasts more than three months.
One-sided "long" pain speaks in favor of the root cause of
One of the founders of the national neurology of the spine Ya. Yu. Popelyansky identified a more accurate temporal characteristic of pain:
- chronic recurrent with rare exacerbations;
- chronic recurrent with frequent or prolonged exacerbations;
- gradual or continuous( permanent type of flow).
Studies using diagnostic blockade have established that the main cause of chronic pain is spondyloarthrosis( facet syndrome):
- with cervical localization - up to 60% of cases;
- at a thoracic level of lesion - up to 48%;
- for pain in the lower back - from 30 to 60%.
Most patients are elderly.
Transition to a chronic form is promoted by hereditary predisposition, stresses, mental illnesses with disturbed perception, with pathological sensitivity.
For the clinical characteristics of the disease, there are 4 etiological varieties of back pain:
- nonspecific pains - are associated with lesions of the intervertebral joints, sacroiliac joint( facet);
- muscular - from overstrain or injury to muscles, ligaments, fasciae;
- radicular - squeezing of nerve roots leaving the spinal canal;
- specific - the so-called pain caused by the disintegration of the tumor, vertebral fractures, tuberculosis, infectious agents, systemic lesions in rheumatoid polyarthritis, psoriasis, and lupus erythematosus.
Depending on the cause, dorsalgia is divided into 2 types:
- vertebrogenic dorsalgia - includes all connections with the spine pathology, changes in the spinal column are more often associated with degenerative-dystrophic processes or unfavorable static and dynamic loads;
- is non-embryonic - includes muscle, psychogenic, depending on various diseases.
Clinical manifestations of
Symptoms of dorsalgia depend on the prevailing mechanism in pathology.
For radiculopathy are characterized by:
- unilateral leg pain with changes in the lumbar region, or in the arm, the shoulder in the thoracic part of the back, stronger in intensity than in the back;
- on irradiation is regarded as "long" - from the waist to the fingertips;
- numbness in certain areas;
- weakness of the muscles that are innervated by the affected roots;
- marked tension symptoms( Lassega);
- increased pain during coughing, sneezing;
- in the supine position of pain is reduced, the scoliosis is equalized, caused by spastic contraction of muscles.
The most susceptible to traumatization of the intervertebral joint is the lumbar region, especially with sharp twists toward the
An additional negative factor is the weakness of the muscles of the abdominal wall, allowing the shape of the spinal column to change in the lower part.
For the facet syndrome are typical:
- every aggravation changes the nature of the pain;
- pain in the lumbar region of the aching, compressive or pressing character;
- reinforcement when extending, turning to the side, rising;
- stiffness in the mornings and evenings with maximum severity of pain;
- localization in the near-vertebral zone, one- or two-sided;
- in the lumbosacral lesion irradiates into the gluteal region, on the back of the thigh to the coccyx, in the groin, does not "descend" below the knee;
- from the upper lumbar region pain radiates on both sides of the abdomen, into the chest;
- from the cervical vertebrae - extends into the foreleg, scapula, rarely below;
- , unlike radiculopathy, is not accompanied by a disturbed sensitivity.
Diagnosis of vertebrogenic dorsalgia is based on the experience of a neurologist. When examined, soreness is detected in certain areas of innervation. Checking the reflexes, sensitivity, symptoms of stretching allows you to suspect the nature of the lesion.
To exclude osteochondrosis of the spine, prolapse of the intervertebral disc:
- radiographs in different projections;
- magnetic resonance tomography;
- computed tomography.
The only standard way to prove the pathology of the facet joints is to monitor the disappearance of pain after blockade of the spinal nerve under the control of computed tomography. The technique is used only in specialized clinics.
It should be noted that the patient may have manifestations of both vertebral and muscular symptoms. It is impossible to distinguish them.
In the treatment of dorsalgia, doctors use the standards of the European recommendations for the therapy of nonspecific back pain. They are universal, do not depend on the source, are calculated taking into account the maximum level of evidence.
- non-steroidal anti-inflammatory drugs in short courses or up to three months;
- group of muscle relaxants to combat muscle spasm;
- analgesics( preparations based on Paracetamol).
With persistent pain, paravertebral blockades with hormonal agents and anesthetics are used.
Before taking 1 packet dissolve in half a glass of water, the dosage is convenient for adolescents and elderly people.
The use of chondroprotectors for treatment is justified by the damage to the cartilaginous tissue. But serious studies of their effectiveness in dorsalgia have not yet been carried out.
It is strongly suggested not to put the patient in bed, but to keep the motor activity, to engage in physiotherapy exercises. This is even considered as an additional risk factor for chronic pain.
Negative effects of non-steroidal agents are exacerbations of diseases of the stomach and intestines. The most effective and safe at the present time is Nimesulide( Naise) in combination with Ketorol.
Most physicians approve the use of physiotherapy:
- phonophoresis with hydrocortisone;
Methods of surgical treatment are used for persistent pain. They are associated with blockade transmission of pain impulses through the nerve roots. This is achieved by radiofrequency ablation. The method can be performed on an outpatient basis under local anesthesia.
Prevention of exacerbations
The information component of the treatment plan is to explain the patient the nature of the disease, in dealing with stress. It is proved that the prognosis for treatment is much better if the patient himself participates in rehabilitation.
For prevention are recommended:
- exercises, strengthening the muscular frame of the spine;
- swimming lessons;
- repeated massage courses;
- application of orthopedic pillows, mattress, cervical collar;
- reception of vitamins.
In case of long back pain, there are ways to help, so do not suffer and suffer. Self-treatment with different compresses and warming can lead to the opposite result.
- What is related to dorsalgia
- What is hidden under the term "other"
- Locality differences
- Clinical forms
- Clinical manifestations
- Preventative exacerbations