Antibiotics in the treatment of chronic back pain, is it possible?

Damage to the skeletal muscles of inflammatory origin is called myositis. The body signals with local pain, indicating the location of the pathology. Painful sensations occur soon after injuries or infections, as a result of hypothermia or prolonged work in an uncomfortable position. If pain in muscle tissue increases, this indicates the progression of inflammation. How to treat myositis depending on the characteristics of its course, we will tell you in this article.

Types of myositis and causes

The appearance of muscle pain with compaction in the affected area, a feeling of spasms, swelling, general malaise, and increasing pain with movement indicate the development of myositis. The disease is classified according to its cause.

1. Traumatic myositis. The occurrence is provoked by trauma. Muscle fibers are affected by excessive physical activity or injury. As a result, internal tissue ruptures, hemorrhage occurs, and local inflammation progresses. Pathology is indicated by redness, swelling, local pain, and muscle weakness.
2. Parasitic. This form is caused by parasitic larvae. The disease is easily confused with other types of degenerative and inflammatory diseases. Muscles in any part of the body can be affected: diaphragm, tongue, eye muscles, buttocks, calves.
3. Infectious. The impetus for development is a previous infection. The disease can develop against the background of acute respiratory viral infections, influenza, and other viral diseases. The pain affects one muscle group or several.
4. Rheumatic. A disease of an infectious-allergic nature that develops against the background of infectious intoxication in the presence of immune disorders. The cause is often streptococcus.
5. Ossifying. It means the gradual ossification of muscle tissue. This is a rare genetic disease.
6. Dermatomyositis. A progressive disease of a systemic nature with an unknown etiology. Affects smooth, skeletal muscles and connective tissues. Causes damage to the skin. Accompanied by impaired motor functions.
7. Polymyositis. Refers to a chronic type of muscle inflammation. The reasons lie in autoimmune disorders. May occur as a result of a viral infection.

The disease is also classified according to the nature of its course. The chronic form means that after treatment the disease subsides, but the problem is not completely eliminated. There is a sluggish manifestation of symptoms. As a result of an unfavorable combination of circumstances, for example, severe hypothermia, the disease worsens again. Traumatic and infectious myositis occurs in acute form. It is characterized by the sudden onset of pain, which is most often local in nature.

The main causes of myositis include:

• infectious diseases;
• soft tissue injuries;
• physical stress;
• hypothermia of the body;
• muscle infection by parasites;
• regularly performing work in an awkward position.

Causes of the disease

Common ways you can develop inflammation are working in drafty areas, or having a viral disease in someone you are in close contact with. But being constantly surrounded by people and visiting public transport cannot guarantee your safety from myositis of the back muscles. Symptoms that do not appear immediately play a cruel joke on us. The process of treating a disease directly depends on its cause. It could be:

• infection that is transmitted by airborne droplets;
• heavy physical activity on any part of the body;
• sudden change in body temperature;
• frequent injuries at work and at home.

Symptoms of myositis

The main symptom of myositis is local pain. The pain increases with movement and pressure on the muscle. Tension and spasm are felt at the site of pain. The pain is often accompanied by redness and swelling. Manifestations of myositis also depend on the location of the lesion.

Treatment of myositis in the Solnechny sanatorium

Good treatment results are achieved through an integrated approach and a developed therapy program. All conditions for high-quality diagnosis and treatment of myositis have been created in the Solnechny sanatorium in the Republic of Belarus. This is a specialized medical institution specializing in diseases of the musculoskeletal system. A powerful therapeutic base includes a variety of techniques, including hydrotherapy, mud therapy, physiotherapy, physical therapy, ultrasound and laser effects on the body. A variety of treatment and rehabilitation programs are carried out using the latest equipment. Clients are offered a balanced diet. All this, coupled with a healing climate, gives excellent healing results.

Treatment of myositis

If the development of myositis is associated with an infectious component, then first of all it is recommended to pay attention to lifestyle. You should give up bad habits to avoid additional intoxication of the body and quickly stop the inflammatory process. Hypothermia must be avoided. If you are forced to work in an uncomfortable position, change your body position more often and take breaks. Exercise in moderation. Timely treatment of myositis under the supervision of doctors will avoid complications.

Drug treatment

Medicines are prescribed by the attending physician after receiving the diagnostic results. The purpose of taking them is to stop the inflammatory process, eliminate the causes of myositis, and alleviate symptoms. For the treatment of myositis, medications belonging to different pharmacological groups are prescribed:

• non-steroidal anti-inflammatory drugs (NSAIDs) to relieve inflammation;
• analgesics for pain relief;
• combined means for external use (ointments) to eliminate spasms, distract, analgesic effects, for reflex expansion of capillaries.

Nonsteroidal anti-inflammatory drugs are prescribed in tablets and injections. Injections are given for acute disease and unbearable pain. Intramuscular administration provides a rapid therapeutic effect. Medicines with snake and bee venom are often prescribed as antispasmodics.

Depending on the causative agent of the infectious disease, antibacterial and antiparasitic drugs may also be prescribed. When the body has an autoimmune reaction, immune suppressants are used.

To strengthen the body and normalize the conduction of nerve impulses in muscle tissue, the therapy program includes B vitamins, as well as vitamin and mineral complexes.

A relatively new method of treating myositis is pharmacopuncture. Medicinal substances are injected subcutaneously into biologically active points on the human body. Such injections with homeopathic compounds, vitamins, and biostimulants combine the advantages of reflexology, homeopathy and traditional medicine. The undeniable advantages of this method include:

• therapeutic effect directly on sore muscles and ligaments;
• minimizing the risk of allergic reactions;
• almost instant effect from the procedure;
• the minimum dose of the drug eliminates the risk of side effects;
• injections are given only 1-3 times a week.

Physiotherapy

Physiotherapeutic methods are used in the complex treatment of myositis. They give excellent results at any stage of the disease. In mild cases, sometimes only physiotherapeutic treatment is sufficient, without the use of medications.

The following physiotherapy procedures are prescribed:

• electrophoresis;
• magnetic therapy;
• laser therapy;
• amplipulse therapy.

During electrophoresis, soft tissue is exposed to a constant electric current. Thanks to this, pain is reduced, the intensity of the inflammatory process is reduced, increased muscle tone is eliminated, and the body’s defenses are activated. The medicine is first applied to the pad, but in a smaller volume compared to internal use. Active substances penetrate the skin and intercellular spaces and act locally on the problem area. The therapeutic effect occurs faster.

During magnetic therapy, the body is exposed to a static or alternating magnetic field. As a result, the physicochemical properties of the water systems present in the body change. Muscle weakness, swelling, inflammation are eliminated. Pain is reduced. Blood circulation in tissues improves, metabolism stabilizes.

Laser therapy provides good therapeutic results. The light flux, consisting of rays of a fixed length, affects muscle tissue. As a result, the patient receives an anti-inflammatory, immunocorrective, analgesic, and restorative effect.

Amplipulse therapy involves influencing the body with low-power currents. The earlier the stage of myositis, the more effective the treatment is. The technique is allowed to be used even in childhood. In the tissues involved in the pathology, spasms are eliminated, blood circulation is improved, drainage of fluids is enhanced, and the occurrence of edema is prevented.

Exercise therapy

Therapeutic exercise refers to rehabilitation therapy. A set of physical exercises, performed under the supervision of an instructor, stimulates the restoration of functions, improves joint mobility, and prevents the development of complications. After exercise therapy, swelling decreases, blood supply to tissues is activated, and the sensation of pain decreases. Exercise therapy is beneficial for a person’s physiological and psychological health.

Musculoskeletal back pain

Ph.D. Podchufarova E.V.

MMA named after I.M. Sechenov

Back pain remains the leading reason for seeking medical help and occupies a leading position among diseases leading to temporary disability. Up to 84% of the adult population experiences at least one episode of low back pain during their lifetime , and 40-70% experience neck pain [8]. The share of musculoskeletal pain among chronic pain syndromes is about 23%, while up to 50% of patients experience pain in more than 5 areas, including the lumbar and sacral spine, lower leg, shoulder girdle and neck [15].

Risk factors for musculoskeletal pain syndromes include age; engaging in heavy physical labor, especially accompanied by prolonged static loads, heavy lifting, body rotation and vibration; psychosocial aspects (monotonous work, dissatisfaction with working conditions); depression, obesity, smoking, drug addiction, severe scoliosis, history of headaches. It is also believed that the risk of back pain depends on anthropometric status (height, build), difference in leg length, changes in posture in the form of increased kyphosis, lordosis, moderate scoliosis, gender (women get sick more often), however, the role of these factors has not been proven [ 8].

Depending on the sources of back pain, vertebrogenic (pathogenetically associated with changes in the spine) and non-vertebrogenic musculoskeletal pain syndromes . Pain syndrome associated with vertebrogenic disorders occurs with spondylolisthesis and instability, arthropathic syndrome with degenerative lesions of the facet and costotransverse joints. In addition to the relatively common indicated dystrophic changes in the spine, vertebrogenic sources of back pain include relatively rarely detected (less than 0.2% of cases) tumor, traumatic, infectious lesions, as well as compression fractures of the vertebral bodies due to osteoporosis. Examples of non-vertebral pain syndromes include diseases of internal organs and psychogenic pain syndromes. Myogenic pain can develop both under the influence of vertebrogenic and non-vertebrogenic changes. Of great importance for differential diagnosis is the identification of local, reflected and irradiating.

Local pain can be associated with any pathological process that affects pain receptors. Local pain is often constant, but can change in intensity depending on changes in body position or movement. The pain can be sharp or aching (dull), and although it is often diffuse, it is always felt in or near the affected part of the back. This type of pain arises from irritation of nociceptors in the skin, muscles, tendons, ligaments, joints and bones and is carried out by the posterior branches of the spinal nerves and sinuvertebral nerves. It is now generally accepted that localized back pain is most often caused by damage to muscles, ligaments and degenerative changes in the spine.

A feature of the spinal column is the absence of long tendons, but there is a very close interaction between muscles, paraspinal ligaments and fascia. These structures form the primary defense in case of injury. Currently, muscular-tonic and myofascial pain syndromes (MFPS) are considered to be the most common sources of back pain .

Often, intense physical activity (for example, lifting weights) leads to increased tension in the paravertebral muscles and the formation of tears at the muscle attachment points, in the muscle fibers and in their connective tissue sheaths. At the same time, the involvement of untrained muscles in a long-term load (exposure to cold, reflex tension due to pathology of an internal organ, spine, suboptimal motor stereotype) also leads to the formation of pain and tonic muscle contraction (spasm), mainly due to an increase in metabolic activity and the release of biologically active substances that stimulate free nerve endings. Often, it is the spasmed muscles that become a secondary source of pain, which, in turn, triggers a vicious circle of “pain - muscle spasm - pain” that persists for a long time.

There are several hypotheses for the formation of local muscle hypertonicity. Thus, the triggering point of a muscle spasm can be static (isometric) work of minimal intensity for a long time (exposure to cold, reflex muscle tension due to pathology of an internal organ, spine, defective motor stereotype), as a result of which, at the initial stage, a regrouping of the contractile substrate occurs - the most The stronger part of the muscle stretches the weaker part. With a short pause in work, residual tension remains ~ spatial deformation of the weaker part of the muscle. Under conditions of constant distorted afferentation, first of all, inhibitory processes are weakened, which ultimately leads to an increase in the tone of the entire muscle. In addition to local and spinal segmental mechanisms, suprasegmental structures are involved in the pathogenesis of hypertonicity, including efferent descending pathways: reticulospinal, rubrospinal and pyramidal [2]. There are other theories of the formation of muscle spasms. The possibility of its development through the mechanism of the so-called “viscerosomatic reflex” with the participation of the sympathetic part of the autonomic nervous system has been shown [12].

Referred pain is of two types: pain that spreads from the spine to areas lying within the lumbar and upper sacral dermatomes, and pain that is projected into these areas from internal organs, for example, with diseases of the pancreas, aortic aneurysm, gastrointestinal pathology tract, retroperitoneal space, gynecological diseases (Zakharyin-Ged phenomenon). The intensity of pain resulting from damage to internal organs usually does not change with movements in the spine. There is still no comprehensive explanation of the mechanisms of referred pain. One of the hypotheses is the possibility of its formation due to the convergence (direct or indirect) of somatic and visceral afferent axons on the same groups of neurons in the central nervous system (at the level of the dorsal horn, in the thalamus or sensory cortex) [12].

One of the main forms of referred pain is myofascial pain syndrome (MPPS). Its pathognomonic sign is the formation of trigger points (TT) - areas in the muscle, upon palpation of which pain occurs in a distant but strictly defined area. There are active TTs, characterized by the presence of spontaneous referred pain, and passive ones, in which pain is determined only by palpation. TT corresponds to the zone of local muscle compaction. Although with MFPS in the absence of symptoms of nerve compression, focal neurological symptoms are not detected, patients may complain of a feeling of “numbness”, as well as paresthesia (“crawling”, tingling) in the area of ​​pain irradiation.

The following criteria for diagnosing MFPS have been identified: “major” criteria (all must be present):

1. complaints of regional pain;
2. palpable “tight” cord in the muscle;
3. area of ​​increased sensitivity within the “tight” cord;
4. a characteristic pattern of referred pain or sensory disturbances (paresthesia);
5. limitation of range of motion.

“Minor” criteria (must have 1 of 3) include:

1. reproducibility of pain or sensory disturbances upon stimulation (palpation) of the TT;
2. local contraction upon palpation of the TT of the interested muscle or upon injection into the TT;
3. reduction of pain when stretching a muscle or during a therapeutic blockade, or injection with a “dry” needle.

The reasons for the development of MFPS are postural tension with prolonged forced stay in an antiphysiological position; individual constitutional inconsistencies in the form of a significant (>1.5 cm) difference in leg length, asymmetry of the pelvic bones, flat feet, relative elongation of the second metatarsal bone; long-term immobilization; compression of muscles by uncomfortable clothing, corset or bandage, straps of a bag or backpack; stressful state; hypothermia; sprains, overloads of untrained muscles, their bruises, as well as pathology of internal organs. The pathogenesis of MFPS formation remains not fully understood. The "ischemic muscle spasm" theory proposes that the initial stimulus, often physical trauma, such as direct injury or chronic strain, results in a persistent release of intracellular calcium and prolonged and abnormal muscle contraction of a particular part of the muscle. This spasm can cause pain and damage by releasing serotonin, prostaglandins and other inflammatory mediators, which in turn may lead to a subsequent reflex spasm of the muscle. There is also an opinion that reflex muscle spasm can occur in response to pain afferent impulses and is aimed at additional activation of muscle proprioceptors, which blocks according to the principle of “gate pain control”. Other theories for the formation of MFPS include hyperactivity of muscle spindles and motor end plates [1].

Irradiating (radicular) pain is characterized by greater intensity, spread to the corresponding dermatomes and the conditions that cause it. The mechanism of this pain is irritation or compression of the root (spinal nerve). The spread of pain almost always occurs in the direction from the spine to some part of the limb. Compression radiculopathy is also manifested by characteristic motor, sensory and reflex disorders. Coughing, sneezing or physical activity are common factors that increase pain.

Sometimes back pain can be one of the symptoms of common chronic pain syndromes (in particular, fibromyalgia).

Diagnostic criteria for fibromyalgia are:

1. the presence of generalized pain in the left or right half of the body, above or below the waist, or axial pain (in the neck, anterior chest wall, back), lasting at least 3 months;
2. pain in 11 of 18 points located bilaterally, upon palpation with a pressure of approximately 4 kg: on the back of the head in the area of ​​the suboccipital muscles; in the area of ​​intertransverse spaces C5-C7; in the middle of the upper edge of the trapezius muscle; above the scapular spine at the medial edge of the scapula; at the II sternocostal joint; 2 cm distal to the lateral epicondyle of the humerus; at the top of the superolateral quadrant of the buttocks; behind the greater trochanter; on the medial surface of the knee joint proximal to the joint space.

The most common complaints with fibromyalgia are aching pain in the neck, shoulder girdle, back, headaches, a feeling of fatigue, poor sleep, stiffness in the muscles and joints in the morning, a feeling of swelling of the joints (and objective swelling of the joints may not be noted), meteosensitivity (increased pain in the cold season), deterioration of the condition with light exertion, panic attacks. Currently, the etiology of fibromyalgia remains unknown, and the pathomorphological, biochemical and mental changes present in patients have served as the basis for many hypotheses about the genesis of the disease.

Psychogenic back pain is very difficult to diagnose and can be observed in the structure of depressive disorders, in hypochondriacal and somatoform pain disorders, as well as in delusional disorders.

The most common pathophysiological basis of musculoskeletal pain is the formation of nociceptive pain syndrome. The pain in this case is usually well localized, corresponds to the degree of tissue damage and the duration of action of the damaging factors, intensifies with movement and weakens at rest. In most cases, its occurrence is associated with the activation of nociceptive C-fibers (primary nociceptors), which are the peripheral terminals of sensory neurons whose bodies are located in the dorsal root ganglion. Another component of pain in this case is hyperalgesia - increased perception of mechanical, chemical, or temperature pain stimuli. It is localized in the area of ​​tissue damage and occurs as a result of sensitization (increased excitability) of nociceptors. The latter occurs when exposed to biologically active substances released or synthesized at the site of injury (substance P, kinins, prostaglandins, leukotrienes, cytokines, nitric oxide, tumor necrosis factor, etc.). Long-term nociceptive impulses can lead to sensitization of nociceptive neurons and the formation of “secondary hyperalgesia,” which contributes to the chronicization of the pathological process [3,10].

In the vast majority of cases, back pain is a benign condition , and most patients with acute back pain do not require additional instrumental examinations. However, it should be noted that in order to exclude “serious” causes of back pain, all patients must undergo an examination aimed at identifying the so-called signs of “serious pathology”. Thus, the presence of weakness in the leg muscles, decreased sensitivity in the anogenital area (“saddle anesthesia”), pelvic disorders indicate the presence of compression of the roots of the cauda equina and require immediate magnetic resonance imaging (MRI) or computed tomography (CT) followed by urgent consultation with a neurosurgeon . You should pay attention to the characteristics of the pain syndrome, data from the anamnesis and somatic examination of the patient. The absence of a connection between pain and movement, its persistence at night, a history of malignant neoplasms, HIV infection, the use of immunosuppressants, IV infusions, causeless weight loss, fever and nocturnal hyperhidrosis require additional research methods already at the patient’s first visit for exclusion, first of all, of infectious and tumor lesions of the spine. The age of patients over 55 and under 20 years of age is also a risk factor for detecting “serious pathology” in back pain. In all of these cases, radiography of the lumbosacral region in direct and lateral projection, a general blood and urine test, and if osteomyelitis, epidural abscess and damage to the cauda equina roots are suspected, additional MRI of the lumbosacral spine is necessary. If it is necessary to clarify the condition of bone structures, bone scintigraphy is indicated, and if the presence of a malignant neoplasm is suspected, a study of the level of prostate-specific antigen (PSA) is indicated.

Patients with a recent history of trauma (fall from a height, traffic accidents, etc.) should undergo radiography of the lumbosacral spine, and if this information is insufficient and the pain persists for more than 10 days, a scintigraphic study should be performed [9]. In the absence of signs of “serious pathology,” the patient should be informed about the benign nature of this condition, explain that, based on the clinical examination, he has no signs of a “dangerous disease” of the spine, and at present there is no need for additional examination. It is not advisable to recommend bed rest even in the first days of the disease, wearing belts, or using support when moving (sticks or crutches). It is necessary to convince the patient that a little physical activity is not dangerous, advise him to maintain daily activity, and if the pain syndrome resolves, begin work as soon as possible.

Considering that the leading mechanism for the formation of pain syndrome associated with musculoskeletal disorders is the effect of algogenic substances - products of arachidonic acid metabolism on nociceptors with the formation of nociceptive pain, it is most advisable in cases of musculoskeletal pain syndromes to use non-steroidal anti-inflammatory drugs (NSAIDs) , the mechanism whose action is to inhibit cyclooxygenase (COX), a key enzyme that regulates the biotransformation of arachidonic acid into prostaglandins (PG), prostacyclin and thromboxane [4].

According to the characteristics of pharmacokinetics and analgesic activity, all NSAIDs can be divided into 4 large groups:

1. with relatively low analgesic activity and short half-life;
2. with high analgesic activity and short half-life;
3. with moderate analgesic activity and an average half-life;
4. with high analgesic activity and a long half-life [16].

A classic representative of the first group of NSAIDs is the phenylpropionic acid derivative ibuprofen. This group also includes salicylates and mefenamic acid. All of these drugs are used to relieve episodic nociceptive pain of low intensity. Drugs of the second group belong to the classic drugs for the relief of rheumatic (arthritic) pain. The most widely used drug is diclofenac. The disadvantages of the drug are the slow absorption of the active ingredient due to the presence of an acid-resistant capsule in traditional tablet forms, as well as significant metabolization during the first pass through the liver, which reduces its bioavailability by up to 50%. Other drugs in the second group include indomethacin, lornoxicam (Xefocam) and ketoprofen. They are characterized by good bioavailability and high analgesic activity. The drugs of the third group include a derivative of phenylpropionic acid - naproxen. characterized by moderate analgesic activity. Its ulcerogenic effect is comparable to diclofenac. The fourth group consists of oxicams: meloxicam, piroxicam and tenoxicam. The long half-life (days) of drugs in this group limits their use as first-line drugs for the treatment of acute short-term pain syndromes. Selective COX-2 inhibitors (celecoxib and rofecoxib) are characterized by slow absorption and a relatively long half-life. The advantage of the drugs is their safety in relation to the gastrointestinal tract.

For the treatment of acute musculoskeletal pain syndromes, special attention is drawn to drugs of the second group, characterized by high analgesic activity and a short half-life. The use of Xefocam (lornoxicam) , a drug belonging to the oxicam class, for the treatment of acute pain syndromes has been shown to Its analgesic properties are associated with a powerful inhibition of COX-2, as well as inhibition of the formation of interleukin-6 and the synthesis of inducible nitric oxide. In addition, Xefocam stimulates the production of endogenous dynorphin and endorphin, which contributes to the physiological activation of the antinociceptive system [5]. Xefocam is prescribed in doses from 2 to 16 mg twice a day. It is quickly and completely absorbed after oral or intramuscular administration and actively (more than 99%) binds to plasma proteins. The elimination period is approximately 4 hours, which may provide the opportunity to restore the levels of prostaglandins necessary to protect the gastric mucosa and maintain normal blood flow to the kidneys. The drug practically does not induce liver enzymes and does not accumulate in the body in doses recommended for clinical use. Excretion of Xefocam occurs in approximately equal proportions with urine and feces. For mild to moderate degrees of hepatic and renal failure, no dose adjustment is required. The pharmacokinetics of Xefocam are not significantly different in elderly, mature and young people. The effectiveness of oral administration of the drug according to the following regimen: day 1 - 16 mg in the morning and 8 mg in the evening, days 2-4 - 8 mg 2 times a day, day 5 - 8 mg/day. for acute pain in the lumbar region was significantly higher than the placebo effect (p <0.015) and equivalent to the effectiveness of diclofenac at a dose of 150 mg/day. The analgesic effect with oral, intramuscular or intravenous administration of Xefocam for acute back pain at a dose of 2 to 16 mg 1-2 times a day significantly exceeds the effect of placebo, and the analgesic effect of 4 and 8 mg of the drug is equivalent to 500 mg of naproxen [ 6].

has also been shown to have good (comparable to morphine) effectiveness in relieving pain after microdiscectomy surgery at the lumbosacral level [14]. In patients who have undergone surgery for cardiac pathology, the analgesic effect is 24 mg/day. Xefocam was equivalent to 150 mg/day. diclofenac sodium [7]. The drug has been shown to be highly effective in the treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

In cases where the pain syndrome has not regressed during the first two weeks of treatment, a re-examination is necessary to identify signs of “serious pathology”. In their absence, it is necessary to reassure the patient that a good prognosis for recovery is maintained and to supplement treatment with non-drug therapy: thermal physiotherapy, manual therapy (including post-isometric relaxation (PIR)), vacuum and manual massage. For arthropathic disorders, blockades of the facet joints and sacroiliac joints with local anesthetics are effective. When treating MFPS, treatment can be supplemented with injections of anesthetics into the TT, applications of gels and ointments (both NSAIDs and irritants) to painful areas of the skin. In the absence of a clear positive effect from treatment within a month, patients, along with repeated screening for signs of “serious pathology,” need to undergo an additional examination, including a general blood and urine test, radiography of the lumbosacral region with functional tests, and if its information content is insufficient, scintigraphy .

In cases of exacerbation of chronic pain syndromes of the lumbosacral localization, a course (7-14 days) use of Xefocam in combination with non-drug treatment methods and antidepressants is indicated in the presence of clinical symptoms of psychological disorders (fear, irritability, fatigue and sleep disturbances, decreased libido and appetite) or concomitant depressive disorders [11,13].

In 2005, a prolonged form of Xefocam, Xefocam Rapid, . The pharmacokinetics of Xefocam Rapid when administered orally is similar to the intramuscular route of administration of a non-narcotic anesthetic drug. The drug has a special structure, consisting of different contents of its constituent granules. Some Xefocam Rapid granules contain sodium bicarbonate, others contain the active ingredient. In comparative studies with ibuprofen and diclofenac potassium, Xefocam Rapid was 3 times faster and 8.5 times more effective than both compared drugs, which demonstrated approximately the same activity. The drug has demonstrated particular effectiveness in relieving acute musculoskeletal pain.

Thus, Xefocam and its rapidly absorbed form (Xefocam Rapid) can be used as an effective monotherapy for acute musculoskeletal pain syndromes in the first weeks of the disease, as well as combination therapy for exacerbation of chronic back pain.

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Source: Russian Medical Journal, No. 12, 2005

Treatment depending on location

Myositis affects any muscle group. The set of therapeutic measures depends on the location of the pathology.

Pain concentrated in the cervical spine indicates myositis of the neck. A sample list of assignments would look like this:

• anti-inflammatory drugs for internal use;
• local application of creams and ointments with a warming, antispasmodic, analgesic effect;
• massage to eliminate spasms, restore blood circulation, improve neck mobility;
• physiotherapeutic procedures to speed up recovery.

The inflammatory process in the muscles of the back and lumbar region most often occurs as a result of a cold, hypothermia, or after high physical activity. Myositis is differentiated from kidney diseases, spinal osteochondrosis, and then treatment is prescribed. The therapy program stipulates bed rest and restriction of movements for the duration of acute pain. Analgesics are prescribed in the form of injection blockades and for internal use, NSAIDs, hardware muscle traction, and reflexology.

Myositis of the chest is often accompanied by an increase in body temperature. Under these conditions, the patient is prescribed bed rest. The main task is to stop the cause of inflammation. To alleviate the condition, painkillers and anti-inflammatory drugs are prescribed. If there is a bacterial component, antibiotic treatment is carried out. For autoimmune pathology, the treatment program includes immunosuppressants and glucocorticosteroids. Electrophoresis of the thoracic region is prescribed as maintenance therapy during recovery. Acupuncture and hirudotherapy have a good effect.

For myositis of the extremities, muscle rest is provided at the initial stage of treatment. It is necessary to exclude any stress on muscles and joints. Injections and external agents are used for pain relief. To relieve the inflammatory process, NSAIDs are prescribed. Thermal procedures are indicated in the absence of swelling and redness. After stopping the acute process, massage procedures, exercise therapy, and reflexology are allowed.

Shoulder myositis is also treated comprehensively: anti-inflammatory therapy, anesthetics, and physiotherapy are used. Additionally, kinesiotherapy can be prescribed - a rehabilitation technique, a type of physical therapy, the purpose of which is to reduce muscle tension, reduce inflammation, and increase mobility. Kinesiotherapy also includes various types of therapeutic massage. The technique is effective for severe pain and functional disorders of the limbs and spine. If the shoulder joint is affected at the same time as the muscle tissue, chondroprotectors and massage products are used for external use.

Physical rehabilitation

For muscle pain in the back, rehabilitation specialists at the Yusupov Hospital widely use physical therapy, kinesio taping, and various types of massage. These methods are used in the treatment of muscle pain that occurs due to diseases of the spine and back muscles. They are a good means of rehabilitation after injuries.

Independent choice of physical exercises and their incorrect implementation can greatly harm the patient. Rehabilitologists prescribe similar treatment. Physical therapy classes are conducted under the guidance of a senior instructor-methodologist of exercise therapy.

Treatment of infectious myositis

According to its clinical course, infectious myositis is classified as acute. The main symptoms are severe discomfort and pain in the area of ​​the affected tissues, high temperature, muscle tightness, and general weakness of the patient. This is a dangerous type of disease that can only be treated under the supervision of doctors.

The drug therapy program includes antibiotics, anesthetics, and antipyretics. In the purulent form, surgical intervention is often required. The surgeon opens the abscesses, excises necrotic tissue, and installs drainage. Enzyme therapy is performed to cleanse dead cells and stimulate the production of collagen fibers.

Antibiotic drugs are prescribed depending on the infectious pathogen. Antibiotic agents can be combined with bactericidal agents. In severe cases of infectious myositis, steroids are prescribed.

When the acute infectious process can be stopped, the recovery stage begins. At this stage, exercise therapy, balneological procedures, massage, and physiotherapy are recommended.

How does the disease manifest?

Pain in the back, chest or other part of the body where there are muscles are the first signs of the disease, which are not immediately felt. It can be triggered by various irritants, which lead to back myositis, but the symptoms and treatment are very similar. However, there are also advanced cases when the disease can develop into purulent muscle myositis, and surgical intervention cannot be avoided. There are two types of disease that differ from ordinary inflammation, in such cases a complete diagnosis is needed:

1. Dermatomyositis is a female disease caused by age-related infection in the body or constant stress. Leads to the appearance of red spots on the body, swelling of the limbs and increased temperature.
2. Polymyositis - affects several muscles in the body at once after suffering a serious illness: influenza, bronchitis, inflammation. May lead to muscle atrophy.

Treatment of chronic myositis

The acute form of myositis that is not completely cured becomes chronic. Chronic muscle inflammation is also characteristic of spinal diseases such as osteochondrosis, arthrosis, and vertebral hernia. Therapeutic measures are usually carried out at the time of exacerbations. The medications used are the same as for acute myositis. The main emphasis is on means that eliminate the cause of the development of pathology. These are mainly drugs to combat inflammation and autoimmune disorders.

For chronic forms of the disease, it is recommended to keep a set of medicinal plasters in stock. The patches are effective for pain and inflammatory processes in the tissues of the musculoskeletal system. They release biologically active substances to the body within 12 hours, providing a warming, analgesic effect, increasing blood circulation, and preventing the further development of inflammation.

Drug therapy is supplemented with physiotherapeutic procedures, physical exercises, and massage. Patients are prescribed a special diet. For effective rehabilitation and prevention of relapses, sanatorium treatment is encouraged.

Injections

For acute muscle pain, doctors at the Yusupov Hospital prescribe intramuscular, intravenous, and injections of painkillers performed as blockades. Neurologists at the Yusupov Hospital are fluent in blockade techniques. Novocaine and lidocaine injections are made into trigger points. They help relax and restore the tone of the back muscles. When performing a paravertebral blockade, the drug is injected along the lower edge of the rib to points located near the spine.

Painkillers are administered through a catheter into the intervertebral space. All types of injections for back pain are performed with high quality by specialists from the rehabilitation clinic. By calling the Yusupov Hospital, you can get treatment for back muscle pain at an affordable price. You will be offered a special rehabilitation program, thanks to which you can get all the necessary procedures and save money.

Features of therapy in pregnant women

Myositis develops during pregnancy for two reasons: against the background of an infectious disease and due to increased load on the back muscles as a result of weight gain.

The difficulty of treatment is the fact that a limited list of medications can be used during pregnancy. Most analgesics and anti-inflammatory drugs have a wide range of side effects and contraindications. The active substances from their composition can penetrate the placenta to the fetus and cause harm and have a negative impact on development. The doctor must take into account the duration of pregnancy, the peculiarities of its course in the patient, and correlate the risks of taking medications with the effect of treatment.

To relieve inflammation and reduce fever, medications containing paracetamol are mainly prescribed. Creams and ointments based on herbal ingredients are suitable for local anesthesia and relief of muscle spasms. It is prohibited to use ointments containing animal and insect poisons.

To relieve pain, dry heat and light massage procedures are suitable. For preventive purposes, it is recommended to avoid sudden weight gain, use a bandage in the third trimester, and perform special exercises for pregnant women.

Nutrition for myositis

The diet should consist of nutritious but easily digestible dishes. Foods high in vitamins A, B, C, D, E, PP help fight inflammation. The daily menu should include:

• fresh vegetables and herbs;
• sweet and sour fruits - oranges, apples, plums, kiwi;
• foods rich in salicylates - honey, vegetable oils, legumes, nuts, black and green tea, peppers;
• boiled and stewed beets, carrots, potatoes;
• decoctions of beneficial herbs;
• sea ​​fish.

In addition to clean water, it is recommended to consume more vitamin drinks: juices, fruit drinks, homemade compotes. The total volume of liquid should reach 2 liters.

For spasmodic pain, it is recommended to include foods rich in calcium, magnesium, and zinc in the diet. These elements are found in cereals, dairy products, green crops, liver, pumpkin, and chicken eggs.

Prevention of myositis

You can exclude recurrent manifestations of myositis if you pay attention to prevention:

• harden the body, often walk in the fresh air, regularly ventilate the room, conduct contrasting douches with cool and warm water;
• sunbathing, swimming in natural reservoirs in the warm season;
• avoid drafts, protect the body from hypothermia, dress according to the weather;
• exercise in moderation, avoid unnecessary stress on the muscles, start with warm-up exercises;
• when working in an uncomfortable position, take short breaks, perform warm-up exercises for stiff and tired muscles;
• Regularly use the services of a massage room, do a general preventive massage for all muscle groups, massage the back or collar area.

The myositis treatment program includes drug treatment, exercise therapy, physiotherapy, and dietary nutrition. Following the doctor’s recommendations and giving up bad habits speeds up recovery and serves as a preventive measure against relapses.