Pain due to osteochondrosis: causes, methods of diagnosis and treatment

Osteochondrosis of the spine is a disease in which a chronic degenerative process of intervertebral discs develops with their hernial protrusion towards the spinal canal. Reactive changes occur in the adjacent tissue, and arthrosis develops in the facet joints. To diagnose the disease, doctors at the Yusupov Hospital conduct a comprehensive examination of patients. The neurology clinic is equipped with the latest equipment from leading companies in Europe, the USA and Japan.

Pain syndrome during an exacerbation of clinical manifestations of spinal osteochondrosis can manifest itself at any level: in the cervical, thoracic, lumbar and coccygeal spine. How to quickly relieve pain due to osteochondrosis? Doctors at the Yusupov Hospital take an individual approach to treating each patient. They prescribe those painkillers that are most effective and safe. Non-drug treatment methods (physiotherapeutic procedures, manual therapy, physical therapy) are also used to relieve pain.

Causes of osteochondrosis of the lumbar spine

Osteochondrosis is based on the destruction of the intervertebral disc - a flat cartilaginous formation that connects the vertebrae and ensures their mobility. The base of the disc is a soft nucleus pulposus surrounded by a fibrous (dense) ring. The core is 88% water and cushions the movement of the spine during vertical loading, such as lifting weights or walking. The function of the annulus fibrosus is to prevent the nucleus from moving away from the center of the vertebra. Also, the correct positioning of the core is facilitated by many ligaments and the muscular “corset” of the spine1,11.

At the age of 35-40 years, the blood supply to the disc core and its metabolism weakens, and the water content in it decreases to 60%1. But age is not the only and far from the main cause of lumbar osteochondrosis.

The following factors play a role in the development of the disease1,5,11:

• prolonged standing or sitting, especially in an uncomfortable position;
• overload of the spine associated with walking in high heels;
• poor posture, flat feet;
• nervous tension, chronic stress;
• overweight, metabolic disorders;
• poor physical development;
• congenital anomalies of the structure of the spine;
• heredity.

Most of these factors are related to the modern rhythm of life. It makes its own changes in a person’s habits, which turn out to be very harmful to the spine. The main problem is the imbalance between physical activity and the ability of the spine to bear a certain load. If the spinal muscles lose tone but are regularly overstrained, the load is transferred to the intervertebral discs and ligaments11. On the one hand, this situation creates conditions for microtrauma11, on the other hand, the risk of blood stagnation in the muscles increases, which prevents normal blood flow in them5.

In addition, the lower back bears the heaviest load11. And if the work involves heavy lifting, sudden movements, turns, flexion and extension, the pressure on the intervertebral discs increases many times over11. Therefore, wear of the intervertebral discs in the lumbar region is more often observed in people of certain professions - athletes, loaders and drivers5.

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What is osteochondrosis, and why does the disease develop?

Osteochondrosis is a disease of the spine. It affects all tissues that form the spinal motion segment. The mineral density of the bone tissue of the vertebrae decreases, the intervertebral discs become thinner and destroyed, and the ligaments located along the spine lose their elasticity.

In most cases, pathology is detected in mature people who have crossed the age limit of 30 years. And after 50 years, one degree or another of osteoporosis is diagnosed in 90% of the population. By what principle does the disease select its victims?

Experts believe that the cause of its development is a disruption of metabolic processes in bone tissue due to hormonal imbalance. With age, the activity of the sex glands in producing hormones decreases. Testosterone concentration decreases. Namely, the rate of division of mesenchymal stem cells (precursors of bone cells) and their life expectancy depend on the amount of this androgen.

Testosterone deficiency entails a decrease in the strength of the vertebrae. Their bodies become fragile, cavities form in the spongy layer. The latter prevent the natural removal of metabolic products from the blood. Trying to dispose of accumulations of bio-waste, the body finds another way for this: it pushes them out through the chondrocyte layer of the cartilage of the intervertebral discs. Pathological growths form. It is obvious that without strengthening bone tissue and closing cavities, the progression of degenerative processes in the tissues of the spinal column cannot be stopped. How can folk remedies for osteochondrosis help with this?

Stages of lumbar osteochondrosis

When an intervertebral disc is damaged, its displacement is observed with the formation of an intervertebral hernia6, but all this happens gradually, so there are several stages in the development of the disease6,7:

• Stage 1 is characterized by unexpressed pain that occurs when lifting heavy objects. The patient can no longer tolerate prolonged physical activity, but at rest the pain, as a rule, does not bother him.
• In stage 2, the distance between the vertebrae decreases, which leads to pinched nerve endings. Sharp pain (lumbago) appears, radiating to the buttock, thigh and lower leg, forcing the patient to take a forced position with the torso tilted to the healthy side.
• At stage 3, the fibrous ring is destroyed and an intervertebral hernia is formed. The hernial protrusion compresses or irritates the roots of the spinal cord, the pain becomes severe, and is accompanied by disturbances in sensitivity (numbness of the limbs) and motor activity (weakness of the muscles of the leg or foot).
• By stage 4 , a pronounced deformity of the spine occurs, the patient moves with great difficulty, and the pain syndrome may be less disturbing.

Types and symptoms of osteochondrosis

Treatment of osteochondrosis with folk remedies largely depends on the type of disease and its stage.

Depending on which part of the spine is affected by the disease, the following types are distinguished.

• Osteochondrosis of the cervical spine. Pathological processes affect the seven upper vertebrae (C1–C7) with the discs located between them and manifest themselves with the following symptoms:
• dizziness (surrounding objects seem to rotate before the patient’s eyes);
• pain in the back of the head, neck, collar area: from mild and episodic at an early stage to constant, intolerable at a late stage;
• noise or ringing in the ears when changing body position;
• feeling of lack of air, severe shortness of breath;
• nausea and vomiting, worse when trying to turn your head;
• decreased visual acuity, flashing spots and dots before the eyes (usually in advanced stages of the disease);
• surges in blood pressure that are practically uncorrectable with medications;
• sudden fainting caused by vasospasm;
• unpleasant sensations in the larynx (soreness, dryness, feeling of a foreign object in the throat);
• pain in the shoulder joint;
• numbness of fingers.
• Osteochondrosis of the thoracic spine. It affects the 12 middle vertebrae (T1–T12) and the intervertebral discs located between them. Signs of pathology are:
• pain in the sternum and between the shoulder blades, feeling of a lump in the chest;
• shortness of breath, feeling of lack of air when inhaling;
• panic attacks;
• feeling of cold, burning and tingling in the chest, abdomen, base of the neck;
• muscle tension (difficulty relaxing your back);
• rapid heartbeat, sensation of pulsation, “pins and needles” in the chest;
• causeless anxiety;
• numbness of the paravertebral and shoulder muscles and skin, pronounced upon pressure, contact with hot and cold;
• labored breathing;
• feeling of coldness in the hands and feet;
• peeling, thinning (or, on the contrary, thickening), pallor and cyanosis of the skin in certain areas;
• reflex reactions in the affected area are weak and inhibited;
• disturbances in the functioning of the gastrointestinal tract, colic, loss of appetite, difficult and painful digestion, stool disorders, heartburn, bloating;
• a characteristic cough (unproductive, dry, hacking, debilitating), usually appearing after sleep and does not bring relief;
• increased fatigue, feeling weak, very tired, especially in the morning;
• stoop, unsteadiness of gait;
• intercostal neuralgia.
• Osteochondrosis of the lumbosacral spine. The pathological process involves the five lower vertebrae of the spinal column and the intervertebral discs between them. The development of pathology is indicated by the following symptoms: a feeling of tension in the lower back that occurs during flexion and extension;
• weakness in the legs, decreased tendon reflexes;
• curvature of the spinal column in the lumbar region sideways or forward, reducing its natural curves;
• involuntary urination and defecation, in men – erectile dysfunction;
• feeling of cold in the lower back and buttocks;
• loss of sensitivity in the lumbar region, which lasts from several minutes to several hours, may increase, decrease or disappear, a crawling sensation, tingling.

Diagnostics

If you experience back pain, you should consult a neurologist. The history is followed by an examination of the patient, during which active and passive range of motion, muscle tone, limb strength, reflexes and sensation are assessed6.

The following instrumental diagnostic methods are used:6

• magnetic resonance imaging (MRI is a method for studying the layer-by-layer structure using magnetic fields);
• computed tomography (CT is a method for studying the layer-by-layer structure using x-rays);
• in rare cases, electromyography (a method for studying electrical potentials arising in muscles);
• functional spondylography (x-ray examination of any part of the spine).

You may additionally need to consult a urologist, gynecologist and proctologist1.

Methods for treating pain in lumbar osteochondrosis

The main manifestation of osteochondrosis of the lumbar spine is pain, which limits mobility, reduces the performance and quality of life of patients. Based on this, therapeutic measures in the treatment of this disease should primarily be aimed at pain relief4.

Pain with osteochondrosis of the lumbar spine can be 4:

• acute - lasts up to 6 weeks;
• subacute - from 6 to 12 weeks;
• chronic - more than 12 weeks.

In the treatment of osteochondrosis, conservative (non-surgical) and surgical methods are distinguished8. Therapy is selected individually, depending on the patient’s condition, his complaints and the data identified by the doctor during the examination4.

To relieve pain, complex drug therapy is used7.

Among the medications prescribed by the doctor may be4,7:

• muscle relaxants;
• antispasmodics;
• analgesics;
• non-steroidal anti-inflammatory drugs;
• tricyclic antidepressants;
• anticonvulsants;
• chondroitin sulfate and glucosamine.

Nonsteroidal anti-inflammatory drugs have been used successfully for the symptomatic treatment of back pain15. From this pharmacological group, the doctor may prescribe drugs containing naproxen15, for example, MOTRIN ®, which is intended for adult patients and adolescents over 15 years of age. One dose of MOTRIN ® is sufficient for up to 12 hours12. It should be borne in mind that the dosage and frequency of taking the drug is determined by the doctor.

Back in the 90s, patients with lower back pain were advised to limit active movements and observe strict and prolonged bed rest. This approach did not justify itself: it turned out that prolonged physical rest is harmful, since muscle function is impaired in this state. And this, in turn, leads to the pain becoming chronic and even often intensifying. According to research, acute low back pain is less of a concern for active patients. Therefore, by avoiding bed rest and following the recommendations of your doctor, you can recover faster13,14.

The task of the therapeutic course

If the presence of cervical osteochondrosis is confirmed, the doctor will prescribe an appropriate course of treatment, which, first of all, should be aimed at eliminating the symptoms of this pathological condition. To achieve maximum effect, therapy must be comprehensive, so doctors often prescribe different groups of drugs aimed at relieving pain, improving blood circulation in the affected area, as well as regenerating affected tissues.

Exercises for cervical osteochondrosis

Anesthesia

To eliminate pain, which is an integral sign of osteochondrosis, doctors prescribe muscle relaxants, the action of which is aimed at eliminating antispasmodic contractions . To relieve the inflammatory process in the cervical spine, anti-inflammatory drugs (non-hormonal or hormonal) are used. To reduce the sensitivity of nerve endings, doctors use conventional analgesics.

Pharmacological effects of muscle relaxants

Improved blood flow

Medicines are prescribed to improve blood supply to the affected areas of the body, which makes it possible to stop degenerative processes in this area or at least slow them down. Also, regular use of such medications helps to dilate blood vessels, thereby restoring normal blood clotting.

Taking pills for osteochondrosis

Slowing down destruction processes

As noted earlier, osteochondrosis (cervical or lumbar) is accompanied by the destruction of the cartilage tissue of the spine, but to slow down these processes, doctors resort to the use of chondroprotectors - effective medications based on chondroitin . As a rule, they need to be used for a long time, since the desired therapeutic effect can be achieved no earlier than after 5-6 months. As a supplement, antioxidants are prescribed that neutralize the negative effects of hypoxia (a pathological process caused by a lack of oxygen).

Chondroprotectors slow down the destruction of cartilage tissue

Non-drug therapy

Physical therapy plays an important role in the treatment of lumbar osteochondrosis5,10,11. To prevent the development of the disease and alleviate its symptoms, the lower back muscles must be kept in good shape. Dosed physical activity and exercises help strengthen the muscle corset, increase range of motion and prevent complications5,11.

There are various complexes, which usually include exercises such as “bicycle”, “scissors”, lifting the body, performed in a lying position11. It is useful to do the “penknife” exercise: lying on your back, you need to press your hips to your chest and your head to your knees, “folding” like a penknife. It is recommended to do the exercise 10 times in total11. Therapeutic swimming also helps with osteochondrosis5.

It is better to carry out training under the supervision of a specialist in physical therapy, since many exercises are allowed only in the interictal period, and bending the torso forward at a certain angle can displace the disc even more5,11.

In addition to physical therapy, for lumbar osteochondrosis they use5,10:

• corsets;
• “stretching” the spine;
• manual therapy and massage;
• physiotherapy (magnetic therapy, laser therapy, ultrasound therapy);
• acupuncture.

Considering that osteochondrosis in advanced cases can lead to complications, it is important to pay close attention to the spine at any age. Prevention of disease and pain requires active action - normalizing weight, choosing comfortable shoes and regular physical activity. If the pain is severe, you should consult a doctor who will select the optimal treatment.

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

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Literature:

1. Biktimirov R.G., Kedrov A.V., Kiselev A.M., Kachkov I.A., Osteochondrosis of the spine - Almanac of Clinical Medicine - 2004. P.329,330,333,334, https://cyberleninka.ru/article/n/osteohondroz-pozvonochnika/viewer
2. Human anatomy: textbook. -method. manual / M. V. Ulitko, I. M. Petrova, A. A. Yakimov; [under general ed. M. V. Ulitko]; Ministry of Science and Higher Education education Ros. Federation, Ural. federal n-t. - Ekaterinburg: Ural Publishing House. University, 2021. - 88 p. ISBN 978-5-7996-2447-7
3. Oleynik A.D., Kovalev S.A. // Criteria for a comprehensive assessment of foci of lumbar osteochondrosis // Bulletin of the International Scientific Surgical Association - 2008 P. 84 https://cyberleninka.ru/article/n/kriterii-kompleksnoy-otsenki-ochagov-poyasnichnogo-osteohondroza/viewer
4. Nikiforov A.S., Avakyan G.N., Mendel O.I., Modern approaches to the treatment of complications of spinal osteochondrosis - RMZh No. 26 from November 26, 2010 - P.1633 https://www.rmj.ru/articles/nevrologiya /Sovremennye_podhody_k_lecheniyu_osloghneniy_osteohondroza_pozvonochnika/
5. Velichko T.I., Loskutov V.A., Loskutova I.V. // Exercise therapy and therapeutic swimming in orthopedics // 2014 -2.5 — Osteochondrosis https://monographies.ru/en/book/section?id=7270
6. Gushcha A.O., Konovalov N.A., Dreval O.N., Grin A.A., Dzhindzhikhadze R.S., Arestov S.O., Dreval M.D., Kashcheev A.A., Vershinin A. V.V., Asyutin D.S., Korolishin V.S., Clinical guidelines for the diagnosis and treatment of herniated intervertebral discs of the lumbosacral spine. - 2014 - pp.4,7,8 https://www.mst.ru/information/manual/lumbar_disc_herniation.pdf
7. Pilipovich A.A., Treatment and prevention of osteochondrosis - 2015. — S.1,17,18,19 https://cyberleninka.ru/article/n/lechenie-i-profilaktika-osteohondroza/viewer
8. Rodichkin P.V., Shalamanov N.S. Pathophysiological rationale for complex therapy of intervertebral hernias -2012-P.32 https://www.vmeda.org/wp-content/uploads/2016/pdf/31-36.pdf
9. Instructions for medical use of the drug Motrin ® tablets, Reg. number P N002874/01 ///o-motrin
10. Buchakchiyskaya N.M., Maramukha V.I., Maramukha A.A., Maramukha I.V., Non-drug treatment of patients with neurological manifestations of osteochondrosis of the lumbar spine - Science of Life and Health - 2013. P.104 https://cyberleninka.ru/article/n/nemedicamentoznoe-lechenie-bolnyh-s-nevrologicheskimi-proyavleniyami-osteohondroza-poyasnichnogo-otdela-pozvonochnika-sovremennyy/viewer
11. Therapeutic physical education for spinal osteochondrosis: textbook / O. V. Bezrukova, G. I. Bulnaeva; GBOU VPO IGMU of the Ministry of Health of Russia. – Irkutsk: IGMU, 2013. – 58 p.
12. Frick et al. Efficacy and safety of naproxen sodium and ibuprofen for pain relief after oral surgery. Current Therapeutic Research. 1993;54(6):619-27.
13. Clinical recommendations. Diagnosis and treatment of musculoskeletal (nonspecific) pain in the lower back. Russian Interregional Society for the Study of Pain. 2021
14. Cochrane Database of Systematic Reviews. (2010.) “Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.” https://pubmed.ncbi.nlm.nih.gov/20556780/
15. Svetoslav Nikolaev Stoev, Stanislav Radoslavov Gueоrguiev, Vasil Georgiev Madzharov, Hristina Viktorova Lebanova (2021). “Naproxen in Pain and Inflammation – A Review”, International Journal of Pharmaceutical and Phytopharmacological Research, 11(1), pp.142-148.