Anatomy of the spine and peripheral nervous system

What causes lower back pain?

Most often, a pinched lower back takes you by surprise: it becomes painful to move, and the person panicsly tries to figure out what to do. This condition can be avoided by knowing in advance what reasons lead to an unpleasant ending. Here are some of the most common factors:

1. Inadequate physical activity. For example, lifting heavy weights, especially in people with little training.
2. Displacement of the lumbar vertebrae, dislocation, and other dangerous back injuries.
3. Hypothermia, prolonged exposure to low temperatures (for example, in water).
4. Neoplasms of various types.
5. Osteochondrosis. Calcification of bone tissue and thinning of the cartilage of the intervertebral discs lead to a reduction in the distance between the vertebral bodies. Because of this, the nerve roots coming out of the spinal cord are pinched.
6. Protrusion of an intervertebral disc into the spinal canal (protrusion) or outward, with a herniated intervertebral disc. Even if the integrity of the cartilaginous ring is preserved, mobility is greatly affected.
7. Overweight. Additional kilograms increase the load on the spinal column. The process develops in a similar way when carrying a child, when additional kilograms and a shift of weight forward, onto the stomach, can lead to compression of the nerves.
8. Lack of vitamins and minerals. It occurs due to poor nutrition and leads to degenerative changes in the bones, including the development of osteoporosis.
9. Incorrect posture, scoliosis, stoop.
10. Sedentary work, lack of mobility. An uncomfortable sleeping place, leading to an unnatural posture in which the spine cannot fully straighten.

Signs of a pinched nerve in the lower back occur with pathological changes in the spine and intervertebral discs. The condition can be provoked by infectious diseases, degenerative changes in bone and cartilage tissue. Tolerating the sensations and hoping that it will go away on its own, or to self-medicate, is dangerous. It is necessary to find out why the disease occurred. Therefore, you need to contact doctors who specialize in treating the spine and joints. They recognize the problem in time and find a way to keep the patient healthy.

Osteochondrosis: pinched nerve endings

A pinched nerve is a condition in which the nerve roots become compressed. They are connected to the spinal cord, so on their way they may encounter obstacles in the form of a hernia, protrusion, or spasmodic muscles. diseased spine

constantly reminds of itself with severe discomfort, unpleasant sensations in various areas.

Osteochondrosis can be located in any part (rarely in the chest). Most often the sciatic, cervical nerve is pinched. The back begins to hurt in a certain place. It may become numb and less sensitive. In advanced cases, dysfunction of individual internal organs is observed. This is all due to the fact that the nerve root is compressed. By the way, there are 3 types of nerves:

1. Sensitive;
2. Vegetative;
3. Motor.

If the first one is pinched, the person will definitely feel unbearable pain and will try to eliminate the interfering symptom in a timely manner. If compression of the other two nerves occurs, the patient may not experience obvious discomfort. But this only aggravates the situation, because complications develop.

Symptoms

The clinical picture depends on the extent of the affected area, the presence of inflammation, the degree and cause of pinched nerve root.

There are 8 nerves in the cervical region. If at least one of them is compressed, a person feels pain, numbness, tingling in the innervation zone. The shoulder hurts and goes numb, the muscle fibers weaken – the nerve in the area of ​​the C5 vertebra is deformed. A similar picture in C6 provokes numbness and pain in the hands. If we are talking about the C7 vertebra, discomfort is also felt in the middle finger, tingling is possible. In the case of C8, the person cannot move their arms normally.

In the chest area, due to its low mobility, nerves are pinched quite rarely. If this happens, it hurts very much near the heart. Breathing problems begin, and chest tightness appears. If the situation is neglected, the pain reaches the stomach. Take an antispasmodic to rule out gastritis, ulcers and other gastrointestinal diseases. If it helped, the reason is these diseases.

The sciatic nerve is compressed in the lumbar region. The roots are too sensitive. Proteins contained in the disc also increase irritability. Pinching is characterized by pain, although it can be asymptomatic. A burning sensation similar to an electric shock can reach the toes. The lower extremities become numb.

Problems in the lumbosacral region lead to the development of radiculitis. This part of the spinal column bears the heaviest load, especially if a person is overweight.

Issues

The nerve gets pinched for several reasons:

1. Muscle hypertonicity, exacerbation of osteochondrosis. The distance between the vertebrae decreases, as a result of which they compress the nerves;
2. Spasm of muscle fibers. Not only the nerve endings are pinched, but also the blood vessels. The tissues do not relax, and with prolonged tension, necrosis begins;
3. Hernia, disc protrusion;
4. Degenerative changes due to age;
5. Vegetovascular dystonia. Autonomic nerves suffer;
6. The tissues surrounding the spine are inflamed;
7. Vertebral displacement;
8. Osteochondrosis, especially with injuries, infections, chronic diseases, obesity, poor posture and blood clots, during pregnancy.

Therapy

If a vertebra is displaced, contact a massage therapist or chiropractor. In case of protrusion, the correct position of the disc is restored. If there is another disease, it is eliminated first. If a hernia is diagnosed, surgery is performed.

In all cases, doctors prescribe medications.
To get rid of pain and inflammation, take non-steroidal anti-inflammatory drugs. For severe pain, powerful analgesics are indicated. Muscle relaxants will help eliminate muscle spasms. Corticosteroids are rarely prescribed. Sometimes surgery is needed. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Types and symptoms of the disease

In addition to intense pain that can radiate to the legs or arms, there are many indirect signs of lumbar disease. When determining whether a nerve is pinched in the lower back, one should focus both on the intensity of the pain syndrome and on other signs that have arisen in areas of the body remote from the epicenter:

• lower back pulls and burns;
• the leg (or both legs) is numb, and the sensation does not go away for several days;
• a certain muscle group moves poorly;
• the gait became uncertain, constrained, shaky;
• state of general weakness, rapid fatigue;
• the pain intensifies not only with movement, but also with coughing, sneezing, even laughing;
• if the nerve branch that goes to the internal organs is pinched, the heart, intestines, and stomach can hurt.

The pain is always present. The intensity depends on how much the nerves responsible for pain sensitivity are involved. Typically, a whole bundle of nerves is subjected to pressure, causing several symptoms at once.

Principles of treatment

The lumbar region consists of five vertebrae. Depending on the location of the problem, the types of disease and methods of treating the consequences of a pinched spinal nerve differ. Doctors differentiate sciatica, lumbago, and lumboischialgia. Sciatica is characterized by pain in the areas of the sacrum and gluteal muscles. The legs usually shoot in the posterior projection. The sensations are intense; between attacks, the patient experiences fear of a new attack, which leads to constant stress and chronic fatigue.

Lumbago is determined by throbbing pain in the lower back. It often occurs during a sharp turn or tilt. With lumboischialgia, pain varies in intensity, is transmitted to the leg and back of the thigh, movements become constrained. Sciatica or inflammation of the sciatic nerve occurs against the background of a hernia, infectious diseases, and diabetes.

When deciding what to do if a nerve is pinched in your back, you need to remember: see a doctor. Pinched nerve cells do not receive nutrition, they can begin to die, which will lead to serious consequences, including paralysis.

When deciding how to relieve a patient from the consequences of a pinched nerve in the lower back, doctors recommend complex treatment, which consists of providing competent first aid, specific studies, drug and non-drug therapy and mandatory rehabilitation:

1. To alleviate the condition, before the doctor arrives, it is necessary to remove all loads, protect the patient from drafts and cold, lay him on a flat mattress, bandage his back with a scarf or handkerchief, and, if necessary, give an analgesic.
2. At the doctor's discretion, a number of studies are carried out: medical history, x-rays, CT, MRI, and other hardware methods. This is necessary to make an accurate diagnosis.
3. The doctor prescribes specific medications and diet. At first, bed rest is observed.

If conservative methods do not help, surgery is prescribed. Sometimes surgery becomes necessary to relieve the effects of a hernia or nerve damage. After the acute phase of the disease passes, auxiliary measures and restorative procedures begin.

Anatomy of the spine and peripheral nervous system

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Article written according to scientific standards and reviewed by a medical professional

This text is consistent with medical literature, medical guidelines, and current research and has been reviewed by medical professionals. Sources and author.

The spinal cord is a very important organ of the central nervous system (CNS), on the proper functioning of which a person’s full functioning depends. The spinal cord begins at the base of the brain stem (in an area called the medulla oblongata) and ends in the lower back at the level of the first lumbar vertebra. At the bottom it narrows and becomes like a cone. This part is known medically as the conus medullaris. This is where the so-called “cauda equina” is located – a collection of nerve fibers, a bundle of nerves that resembles a horse’s tail.

photo: ru.wikipedia.org

The length of the spinal cord is about 45 centimeters. The shape resembles a cylinder with a diameter of up to 1.5 cm. It is protected by three shells: soft, arachnoid and hard. The spinal cord area also contains cerebrospinal fluid (CSF).

If you visually imagine the spinal cord, it resembles a wide cord that stretches along the spinal column with 33 vertebrae. Five of these vertebrae form the sacrum, four form the coccyx.

photo: yourspine.ru

The spine itself is divided into five regions and consists of 31 pairs of spinal nerves:

• 8 pairs of cervical ones, which are located on the neck. One nerve of the pair exits from the right side, the other from the left.
• 12 pairs of pectorals located in the upper back;
• 5 pairs of lumbar, which are found in the lower back;
• 5 pairs of sacral muscles located in the small pelvis;
• 1 tailbone.

Between the vertebral bodies are discs that serve as shock absorbers for the spine. These oval elements have a hard outer layer (annulus fibrosus) that surrounds a softer material called the core pulp. The ligaments attached to the vertebrae also perform a supporting function.

Why is it so important to protect your back, namely the spine and spinal cord from any injuries and diseases? The spinal cord is the channel through which nerve impulses travel through the peripheral nervous system to the brain and back to a specific location in the body. If the channel does not work correctly, the peripheral nervous system will also fail. And it is a complex system of nerves that are responsible for the functioning of the lower and upper extremities, as well as for the functioning of organs and muscles. Spinal cord dysfunction can cause sensory loss or even paralysis.

Glossary of terms

The annulus fibrosus is the ring-shaped fibrocartilaginous outer part of the intervertebral disc.

Arachnoiditis is an inflammation of the membranes of the spinal cord and brain.

Arthritis is inflammation of a joint, usually accompanied by swelling, pain and limited movement.

A bone spur is a rough edge of a bone, an overgrowth of bone tissue on the surface of the bones.

The cauda equina is a collection of nerves at the end of the spinal cord, similar to a horse's tail.

The coccyx is a bony structure in the spine area below the sacrum.

Conus medullaris is the floor of the spinal cord, resembling the shape of a cone.

The intervertebral disc is a cushion between the vertebrae that acts as a shock absorber.

Disc degeneration – disc wear, deformation.

A herniated disc is a condition in which the core of an intervertebral disc bulges or ruptures; the hernia can put pressure on the nerve roots and spinal cord.

A joint is a connection between two or more bones that allows them to move.

The lamina is the flattened or arched part of the vertebral arch that forms the roof or back of the spinal canal.

A ligament is a fibrous connective tissue that binds bones at joints or runs between the bones of the spine.

Nerves are tissue that conducts electrical impulses (messages) from the brain and spinal cord to all other parts of the body; also transmits sensory information from the body to the central nervous system.

The nerve root is the initial part of the spinal nerve that emerges from the spinal cord.

Neural arch is a bony arch at the back of a vertebra that surrounds the spinal cord; consists of a spinous process and a plate.

The pedicle is the “pedicle,” the bony portion of each side of the neural arch of a vertebra that connects the lamina (posterior) to the vertebral body (anterior).

The sacrum is the part of the pelvis just above the tailbone and below the lumbar spine.

Sciatica is an inflammation of the sciatic nerve that causes pain in the back of the buttocks and extends down the back of the leg and thigh below the knee.

Scoliosis is a pathological curvature of the spine to the side.

The spinal canal is a bony canal located in the spine that protects the spinal cord and nerve roots.

The spinal cord is a longitudinal cord of nervous tissue in the spinal canal. It is the pathway for nerve impulses to and from the brain and the control and coordination center for reflex actions independent of the brain.

Spinal stenosis is an abnormal narrowing of the spine that can put pressure on the spinal cord, spinal sac, or nerve roots leading from the spinal cord.

The spine is a flexible bony column that is located between the base of the skull and the tailbone. It is made up of 33 bones known as vertebrae.

Spondylitis is inflammation of the vertebrae.

Spondylolisthesis is a displacement of a vertebra forward or one vertebra onto another.

Spondylosis is degenerative bone changes in the spine, usually most pronounced in the vertebral joints and intervertebral discs.

Vertebrae are the 33 bones that make up the spine.

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Recovery from lumbar compression

To release a pinched nerve in the lower back, medication and diet are not enough. A set of additional classes is required. Physiotherapy treatments may be combined with massage specifically designed to help relieve pinched nerves in the lower back. Mud therapy and therapeutic exercises are also used. All measures are aimed at restoring mobility, strengthening muscles, and improving blood supply.

Special exercises to develop the lower back when a nerve is pinched consist of light daily exercise, swimming (necessarily in conditions of a comfortable water temperature). You should absolutely not overload your back. The patient should enjoy performing the techniques, then he will get used to leading an active lifestyle and benefit from it.

In addition to exercise therapy with a trainer, it is useful to perform some movements at home as exercise. The simplest of them are:

• bending forward, to the sides (small amplitude);
• walking with knees pulled up;
• swinging legs (performed lying down, standing);
• bending and pulling the knee joints to the chest (performed lying down);
• clasping your knees with your hands, rolling back and forth on your back;
• twisting the torso to the right, to the left (lying on the mat).

Each session lasts at least ten minutes. At the same time, blood flow and lymph outflow improve, muscles relax, and oxygen supply to tissues increases.

Gymnastics will benefit any person who complains that his back is stuck in the lower back and he does not know what to do in such cases. If there are no serious pathologies, regular exercise will serve as good prevention.

Massage and manual therapy for pinched nerves in the back should be carried out by a specialist with a medical education. You only need to contact professionals so as not to make things worse.

Neurological manifestations of back pain: problems and solutions

M.V.Putilina

Department of Neurology, Federal University of Internal Medicine, Russian State Medical University, Moscow

Neurological manifestations of back pain (dorsalgia) account for 71-80% of all diseases of the peripheral nervous system. Dorsalgia is characterized by a chronic course and periodic exacerbations of the disease, in which various pain syndromes are leading.

Moreover, according to a number of researchers, in 80% of cases acute pain regresses on its own or as a result of treatment within 6 weeks, but in 20% of cases it takes a chronic course [1, 2]. Hereditary predisposition, microtrauma, and incorrect motor stereotype lead to degeneration of the vertebral motor segment.

The degenerative process may involve various structures of spinal motion segments: intervertebral disc, facet joints, ligaments and muscles. Tissue deformations arising under the influence of static-dynamic loads are the cause of constant irritation of pain receptors.

In cases of concomitant damage to the spinal roots or spinal cord, focal neurological syndromes may appear [3, 4]. In dorsalgia, the determining factor is the appearance of severe pain syndromes associated with irritation of the nerve endings of the sinuvertebral nerves located in the soft tissues of the spine [5].

Currently, the pathogenesis of spinal pathology as the main cause of pain has been well studied, but many problems associated with dorsalgia have not been solved [6, 7].

Clinical manifestations

The initial stage of degenerative-dystrophic diseases of the spine has scanty clinical signs. Patients complain of moderate pain in the corresponding part of the spine, which occurs or intensifies with movement, changes in statics (flexion, extension, rotation), physical activity, and prolonged stay in one position [8].

During this period, it is difficult to make a correct diagnosis and prescribe adequate therapy; very often, doctors’ prescriptions are limited to the use of anti-inflammatory drugs and analgesics [6, 9]. Currently, there is an obvious overdiagnosis of spinal pathology as the main cause of pain. The role of myofascial syndromes in the origin of pain is usually underestimated (from 35 to 85% of the population suffers) [10]. The essence of myofascial pain syndrome is that the muscle suffers primarily, and not after morphological or functional disorders in the spine. Any muscle or muscle groups can be involved in the pathological process. Muscle spasm leads to increased stimulation of the nociceptors of the muscle itself. A spasmed muscle becomes a source of additional nociceptive impulses (the so-called vicious circle “pain - muscle spasm - pain”).

Several years after the first exacerbation, the pain has a clear localization, patients note heaviness, stiffness and stiffness in the affected segment of the spine, and there is pronounced tension in the back muscles. Subsequently, periods of activation of the process are observed more often and become longer [11, 12]. In cases of recurrent course, clinical manifestations during the exacerbation period are characterized by severe pain, sharp symptoms of tension, due to which the patient is unable to care for himself. During the period of regression, neurological manifestations begin to decrease, but the pain continues to be intense, there remains a significant limitation in the range of motion in the corresponding part of the spine, and the symptoms of tension are less pronounced than in the acute stage. As a rule, the patient is not able to fully care for himself and cannot perform work. During the period of incomplete remission, the pain is moderate, sometimes intermittent, the limitation of the range of motion of the corresponding area of ​​the spine can be significant, a forced posture remains, the patient is able to care for himself, but his ability to work is limited. During the period of complete remission, periodic mild pain and a slight limitation in the range of motion of the corresponding area of ​​the spine, the absence of tension symptoms, are noted, while the patients’ ability to work is preserved.

Clinically, the disease manifests itself in the form of a reflex syndrome (occurs in 90% of cases) and compression syndrome (detected in 5-10% of cases) [2, 4]. Reflex syndromes arise due to irritation of pain receptors (nociceptors) of the posterior longitudinal ligament as a result of one or more pathological factors and are accompanied by reflex blocking of the corresponding vertebral motor segment due to muscle tension (in particular striated muscles) with the creation of a muscle “corset”. Compression syndromes are caused by the mechanical effect of a hernial protrusion, bone growths or other pathological structure on the roots, spinal cord or arteries. Compression syndromes, in turn, are divided into radicular (radiculopathy), spinal (myelopathy) and neurovascular (for example, vertebral artery syndrome).

Problems

The lack of sufficiently effective care for patients with spinal diseases, which are usually chronic in nature, with alternating remissions and exacerbations, leads to a loss of confidence in the doctor [13]. In this case, the following problem arises - the lack of doctor-patient interaction and the latter’s confidence in the incurability of his disease. The passivity of the doctor is unacceptable, as it can lead to the psychosocial death of the patient long before his biological death. At the same time, the task of conducting adequate outpatient treatment is of particular importance due to the fact that currently used methods do not always take into account etiopathogenetic factors, the characteristics of sanogenetic reactions in a particular patient, often lead to “failure of compensatory reactions” [8] and worsen the process of rehabilitation events [4]. To solve this problem, first of all, it is necessary to remember that back pain can be both primary, associated with degenerative changes in vertebral structures, and secondary, caused by pathological conditions. Therefore, the main task of the doctor when examining a patient with acute back pain is to separate musculoskeletal pain from pain syndromes associated with somatic or oncological pathology.

Diagnostics

Diagnosing the neurological manifestations of back pain is a difficult task for a doctor, but with the proper use of additional examination methods, it can be easily solved. We cannot abandon traditional methods of X-ray diagnostics and neuroimaging methods (computer and magnetic resonance imaging), laboratory tests (general blood and urine tests, biochemical tests) [6]. In case of difficulties, electroneuromyographic studies are used: lesions of the peripheral neuron corresponding to a given nerve and a decrease in the speed of impulse transmission along the nerve distal to the place of its compression are determined.

Therapy

Treatment of degenerative-dystrophic diseases of the spine is one of the most pressing problems of modern neurology. In patients with this type of pain syndrome, without identifying the pathophysiological mechanisms, it is impossible to choose the optimal treatment strategy. When determining treatment tactics, it is necessary to take into account the localization, nature and severity of clinical manifestations of pain. In recent years, the pharmacological arsenal of treatments for patients with vertebrogenic pathology has significantly improved [1, 14]. However, the problem of back pain is still far from being solved. Drug treatment of neurological manifestations of dorsalgia is a complex task that requires deep knowledge of the pathogenesis and clinical manifestations of the disease. Treatment of patients should be comprehensive, using medications and non-drug therapy methods.

Principles

The main principles of drug therapy are early initiation, pain relief, and a combination of pathogenetic and symptomatic therapy. Therapeutic measures differ in the acute and interictal periods of the disease. First of all, measures are taken to relieve or reduce pain [1, 3].

In case of acute pain, it is necessary to recommend the patient to bed rest for 1-3 days. Drug therapy should be started immediately in the form of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and muscle relaxants, since the first and main task is rapid and adequate pain relief [9, 15]. When treating acute back pain, significant regression of pain should be expected within 1-2 weeks.

The long-standing policy of limiting physical activity, up to strict bed rest, has now been somewhat revised: for moderate pain, partial limitation is recommended, and for severe pain, the period of bed rest is reduced to 1-3 days. In this case, the patient must be taught the “correct” motor behavior: how to sit, how to stand up, how to walk, not to carry heavy objects, etc. If therapy is ineffective, other drugs in optimal doses can be tried within 1-2 weeks. Persistent pain for more than 1 month indicates a chronic process or an incorrect diagnosis of back pain.

The presence of compression syndrome is an indication for the prescription of anti-ischemic drugs: antioxidants, antihypoxants, vasoactin drugs. The issue of using antidepressants is decided individually for each patient.

NSAIDs

NSAIDs remain the first choice for pain relief. The main mechanism of action of NSAIDs is inhibition of cyclooxygenase (COX)-1, 2, a key enzyme in the arachidonic acid metabolic cascade, leading to the synthesis of prostaglandins (PGs), prostacyclins and thromboxanes [9, 14]. Due to the fact that COX metabolism plays a major role in the induction of pain at the site of inflammation and the transmission of nociceptive impulses to the spinal cord, NSAIDs are widely used in neurological practice. All anti-inflammatory drugs have anti-inflammatory, analgesic and antipyretic effects, are able to inhibit the migration of neutrophils to the site of inflammation and platelet aggregation, and also actively bind to serum proteins.

Features of the action

Differences in the action of NSAIDs are quantitative, but they determine the severity of the therapeutic effect, tolerability and side effects in patients. The high gastrotoxicity of NSAIDs, which correlates with the severity of their sanogenetic effect, is associated with non-selective inhibition of both COX isoforms. Currently, there are two groups of NSAIDs depending on their effect on COX. Non-selective NSAIDs block both constitutional COX-1, which is associated with the gastrointestinal side effects of these drugs, and inducible COX-2, the formation of which activates anti-inflammatory cytokines. Selective drugs act primarily on COX-2. Non-selective NSAIDs include: lornoxicam (Xefocam), ibuprofen, indomethacin.

Selective COX inhibitors include: nimesulide (Nise®), meloxicam, celecoxib.

Complications

At the same time, the use of NSAIDs is associated with a wide range of side effects, the risk of which seriously reduces their therapeutic value, primarily the problem of the negative impact of these drugs on the gastrointestinal tract (GIT), the development of NSAID gastropathy. In patients regularly taking NSAIDs, the risk of developing these complications is 4 or more times higher than in the population, and amounts to 0.5-1 cases per 100 patients. Moreover, according to long-term statistical data, every 10th patient who develops gastrointestinal bleeding while taking NSAIDs dies [12, 16].

In 20-30% of patients taking NSAIDs in the absence of significant damage to the gastrointestinal mucosa, various dyspeptic symptoms appear - gastralgia, nausea, a feeling of “burning” or “heaviness” in the epigastrium, etc. In addition, specific side effects of NSAIDs include increased the risk of developing cardiovascular accidents - myocardial infarction and ischemic stroke. However, the benefits of using NSAIDs as an effective and affordable treatment for dorsalgia significantly outweigh the harm associated with the risk of developing dangerous complications. First of all, this is due to the fact that specific complications can be successfully prevented. Most side effects occur in people with so-called risk factors. For NSAID gastropathy, this is age over 65 years, a history of peptic ulcers (the greatest danger is observed in patients who have previously suffered gastrointestinal bleeding), as well as concomitant use of drugs that affect the blood coagulation system [17]. Risk factors for cardiovascular complications are comorbid diseases of the heart and blood vessels - coronary heart disease, arterial hypertension not compensated by treatment. Taking these factors into account and using adequate preventive measures (prescribing proton pump inhibitors if there is a risk of developing NSAID gastropathy) can significantly reduce the risk of developing NSAID-associated complications.

Choosing a doctor

In recent years, on the Russian pharmacological market, a huge number of original drugs have been supplemented by an order of magnitude larger number of generics. It is not easy for a practicing doctor to make a choice among this variety, given the aggressive advertising, as well as the abundance of heterogeneous and sometimes biased information. When choosing an NSAID, your doctor should consider the following:

• Price/quality ratio of drugs.
• The spectrum of action of drugs in various forms of release.
• Background diseases of the patient.
• Patient finances.

Nise®

One of the most successful drugs available on our pharmacological market is the drug Nise® (nimesulide) produced by Dr. Reddy's Laboratories Ltd. (India). The drug is used for rapid relief of moderate or severe acute pain, has anti-inflammatory, analgesic and antipyretic effects [15]. Reversibly inhibits the formation of PGE2 both at the site of inflammation and in the ascending pathways of the nociceptive system, including the pathways of pain impulses in the spinal cord. Reduces the concentration of short-lived PGN2, from which PGE2 is formed under the action of prostaglandin isomerase.

A decrease in the concentration of PGE2 leads to a decrease in the degree of activation of EP-type prostanoid receptors, which is expressed in analgesic and anti-inflammatory effects. It has a slight effect on COX-1 and practically does not interfere with the formation of PGE2 from arachidonic acid under physiological conditions, thereby reducing the number of side effects of the drug. Nise® suppresses platelet aggregation by inhibiting the synthesis of endoperoxides and thromboxane A2, and inhibits the synthesis of platelet aggregation factor. It also reduces the release of histamine and reduces the severity of bronchospasm caused by exposure to histamine and acetaldehyde [15, 16, 18-21]. The drug inhibits the release of tumor necrosis factor a, which causes the formation of cytokines. It is able to slow down the synthesis of interleukin-6 and urokinase, thereby preventing the destruction of cartilage tissue. Blocks the synthesis of metalloproteases (elastase, collagenase), preventing the destruction of proteoglycans and collagen of cartilage tissue. It has antioxidant properties and inhibits the formation of toxic oxygen breakdown products by reducing the activity of myeloperoxidase. Interacts with glucocorticoid receptors, activating them through phosphorylation, which also enhances the anti-inflammatory effect of the drug.

Properties and effect

Due to its high bioavailability, already 30 minutes after oral administration, the concentration of the drug in the blood reaches ~50% of the peak, and a clear analgesic effect is noted. After 1-3 hours, the peak concentration of the drug occurs and, accordingly, the maximum analgesic effect develops [19-21]. When applied topically, it causes a weakening or disappearance of pain at the site of application of the gel, including pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints and helps to increase range of motion. The drug is effective both for short-term relief of acute dorsalgia and for long-term treatment of chronic pain syndrome over many months.

A study was conducted in Finland in which 102 patients with acute back pain received nimesulide 100 mg 2 times a day or ibuprofen 600 mg 3 times a day for 10 days. Nimesulide was superior to the control drug in terms of pain relief and effect on spinal function. Moreover, among patients receiving nimesulide, side effects from the gastrointestinal tract occurred in only 7%, and among those taking ibuprofen - in 13% [18]. Scientists have concluded that nimesulide is superior in its tolerability to traditional NSAIDs, since it relatively rarely causes dyspepsia and other gastrointestinal complications. The most important advantage of the drug Nise® is its affordable price and good tolerability, proven by a series of post-registration studies [17]. Thus, when using nimesulides, the frequency of such common side effects as ulcers of the upper gastrointestinal tract and drug-induced liver damage, and the cardiotoxic effect that some highly selective NSAIDs are “burdened” are minimized. This allows us to recommend Nise® for use in general medical practice. Moreover, this drug has several dosage forms. Nise® is available in tablet and form for topical use, which allows you to individualize and optimize the targeted therapeutic effect of the drug. Since the drug on a gel matrix penetrates tissues quickly and in greater concentration, it is possible to combine local and systemic forms of the drug to achieve a better (greater) therapeutic effect.

In conclusion, we note that the problems of neurological manifestations of back pain are still far from a final solution, but their further study will make it possible to develop new strategies for the diagnosis and treatment of dorsalgia.

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Source consilium-medicum Neurology No. 1/2011

Prevention as the main means of fighting for spinal health

The question is often asked on the Internet: What to do if your back is locked? Most come to their senses only when the disaster has already happened. But the human body has a huge reserve of strength and the ability to heal itself. Therefore, preventive measures will help prevent muscle spasms, thinning of the cartilage layers, the occurrence of a hernia, and maintain healthy coordination of movements.

It's never too late to start. Restorative gymnastics for a pinched nerve in the lower back will help regulate the load and teach the muscles to stay in good shape. Muscle tissue, as the main protector of joints, should remain active at any age. It is especially important to remain active after menopause, when hormonal levels change and there is a predisposition to poor calcium absorption.

Regular training with an experienced mentor will teach you how to properly handle your spine, prevent recurrent attacks, and restore the joy of life, health and vigor.