The main causes of wandering pain in the spine

general characteristics

By this term, doctors mean numerous nonspecific discomfort sensations in the body that do not have a clear localization.
Often the appearance of body aches occurs without a rise in temperature. Patients describe their condition differently: some say they “twist their joints,” experience pulling or squeezing pain in their muscles, or it feels like their bones and joints are being twisted, flattened, and stretched at the same time. Body aches are accompanied by severe weakness, fatigue, and loss of performance. Unpleasant symptoms persist for several days; constant painful stimuli cause increased nervousness and apathy. If a low-grade fever is observed, body aches are usually combined with chills and muscle tremors. The manifestation rarely occurs in isolation: against the background of discomfort in the joints and bones, a headache, runny nose or cough develops, and other symptoms that depend on the cause of the ailment. When body aches turn into severe diffuse pain without clear localization or the accompanying symptoms worsen, you need to consult a doctor.

Chronic abdominal pain and irritable bowel syndrome

Abdominal pain has been and remains a serious problem in internal medicine and gastroenterology. The greatest difficulties arise when identifying the causes of chronic abdominal pain syndrome. Understanding the mechanisms underlying the formation of pain can partly help in establishing its cause and choosing a way to relieve it [2].

The appearance of pain is associated with activation of nociceptors located in the muscular wall of a hollow organ, in the capsules of parenchymal organs, in the mesentery and peritoneal lining of the posterior wall of the abdominal cavity, stretching, tension of the wall of a hollow organ, and muscle contractions. The mucous membrane of the gastrointestinal tract (GIT) does not have nociceptive receptors, so its damage does not cause pain. Inflammation and ischemia of the gastrointestinal tract through the release of biologically active substances (BAS): bradykinin, serotonin, histamine, prostaglandins, etc. lead to a change in the sensitivity threshold of sensory receptors or directly activate them. The same processes can provoke or aggravate spasm of intestinal smooth muscles, which in turn causes irritation of nociceptors and a sensation of pain. Signals from the intestine are transmitted along afferent fibers through the spinal ganglia and reach the anterior parts of the brain, where the sensation of pain is realized in the postcentral gyrus. Efferent fibers travel to the periphery and cause contraction and relaxation of smooth muscles and vasodilation. A large number of different neurons modulate pain perception and response.

In general, there are four main mechanisms for the formation of abdominal pain: visceral, parietal, radiating and psychogenic.

One of the variants of abdominal pain due to organic causes may be parietal pain arising from involvement of the peritoneum. It is mostly acute, clearly localized, accompanied by tension in the muscles of the abdominal wall, and intensifies with changes in body position and coughing.

The most common mechanism of abdominal pain is visceral pain, which is caused by increased pressure, stretching, tension, circulatory disorders in the internal organs and can be the result of both organic and functional diseases. The pain is usually dull, spastic, burning, and has no clear localization. It is often accompanied by a variety of vegetative manifestations: sweating, anxiety, nausea, vomiting, pallor. Due to the large number of synapses between neurons, double innervation often occurs, which underlies the radiating nature of pain. The latter is understood as the reflection of pain during an intense visceral impulse in the area of ​​zones of increased skin sensitivity, at the site of projection of other organs innervated by the same segment of the spinal cord as the involved organ.

At the initial stages, organic diseases (appendicitis, diverticular disease, etc.) may be accompanied by visceral pain, then, in the case of inflammation of the peritoneum, parietal pain.

Psychogenic pain occurs in the absence of somatic causes and is caused by a deficiency of inhibitory factors and/or an increase in normal incoming afferent signals, due to damage to central control mechanisms and/or a decrease in the synthesis of BAS. The pain is constant, sharply reducing the quality of life, and is not associated with impaired motor skills, food intake, intestinal motility, defecation and other physiological processes.

In functional diseases, the mechanisms of pain formation are different and can be isolated or combined: visceral genesis is often combined with radiating and/or psychogenic mechanisms. The pain is mainly of a daytime nature and rarely occurs during sleep [4].

In practice, the likelihood of an organic cause underlying visceral pain is much greater in the presence of “anxiety” symptoms, which include: predominantly nocturnal pain, waking the patient from sleep; onset of symptoms after the age of 50; presence of cancer in the family; the patient has a fever; unmotivated weight loss; changes identified during direct examination of the patient (hepatomegaly, splenomegaly, etc.); changes in laboratory parameters of urine, feces and blood; changes identified through instrumental studies (stones in the biliary tract, colon diverticula, dilated common bile duct, etc.).

The attempt to differentiate abdominal pain using the least number of examinations, often traumatic for the patient, can be well illustrated by irritable bowel syndrome (IBS). Despite the presence of the term “syndrome” in the name, this pathology refers to independent nosological forms. According to the World Gastroenterology Organization (WGO), IBS is a functional bowel disorder in which abdominal pain or discomfort is associated with bowel movements or changes in intestinal transit [20]. Associated symptoms may include bloating, rumbling, and defecation disorders. To make this diagnosis, according to the Rome III criteria, pain must be recurrent, present at least three days per month for the last three months or more, and be associated with at least two of the following three features: change after defecation, its occurrence must be associated with a change in frequency or stool shape. Symptoms must have bothered the patient for the last three months and first appeared six or more months ago [12]. IBS, like most other functional gastrointestinal diseases, is characterized by an increased level of depression, anxiety, and a tendency to hypochondria.

Abdominal pain in IBS is necessarily present, but depending on the prevailing disorders of intestinal passage, the following options are possible: IBS with diarrhea (frequency of loose stools more than 25% of the time, and dense stools less than 25%, more often in men), IBS with constipation (hard stool more than 25% of the time and, accordingly, liquid less than 25%, women are more likely to suffer), mixed or cyclic IBS (liquefied and solid stool more than 25%) [12, 20]. According to the WGO recommendations, it is possible to divide into subgroups depending on which symptoms dominate: IBS with a predominance of intestinal passage disorders, IBS with a predominance of pain, IBS with a predominance of bloating. And finally, according to the provoking factor, it is possible to subdivide the pathology into post-infectious IBS, food-induced IBS (or certain foods), and stress-induced IBS.

The algorithm for the actions of a practicing physician was developed by WGO and published in 2009 (

). If a patient is under 50 years of age with typical symptoms, no signs of alarm, a low incidence of parasitic infections and celiac disease in the population and no diarrhea, and no changes in the results of routine routine tests (complete blood count), the likelihood of IBS in this patient is so high that there is no need to conduct other examinations [20].

In the presence of persistent diarrheal syndrome, a high incidence of celiac disease or parasitic diseases, it is necessary, respectively, to conduct tests for celiac enteropathy, stool analysis to detect parasitic diseases and colonoscopy (for chronic diarrheal syndrome). In the absence of deviations from normal values, the diagnosis of IBS will be most likely.

Chronic abdominal pain syndrome with gastrointestinal transit disturbances, characteristic of IBS, is similar to the symptoms that occur with enteropathies (gluten, lactase, parasitic), colorectal cancer, microscopic, parasitic colitis, diverticulitis and some gynecological diseases: endometriosis, ovarian cancer. This is due to a single visceral mechanism of pain, which is often accompanied by its radiating genesis, which makes it even more difficult to determine the localization of the pathological process [17].

Relieving chronic abdominal pain is a serious independent problem, since not only elimination, but even an attempt to establish the main cause of its occurrence is not always possible. Considering that pain is often combined, in real practice it is often necessary to use a combination of various means.

One of the approaches to relieving visceral pain is the removal of muscle spasm, which is a universal mechanism of smooth muscles to respond to any pathological influences, which inevitably leads to excitation of nociceptors located in the muscular layer of the gastrointestinal tract [1–4, 18].

The group of antispasmodic drugs is diverse and quite heterogeneous in terms of the mechanism of action and point of application, since a rich receptor apparatus takes part in the contraction of muscle fiber, and this process itself is complex and multicomponent. Thus, drugs that suppress muscle fiber contraction can exert their effect in the following way:

• block the transmission of nerve impulses to muscle fibers (M-anticholinergics - atropine, platiphylline, hyoscine butyl bromide (Buscopan));
• suppress the opening of Na+ channels and the entry of Na+ into the cell (sodium channel blockers - mebeverine);
• suppress the opening of Ca+ channels and the flow of Ca+ from the extracellular space into the cytoplasm and the release of K+ from the cell - the initial stage of repolarization (calcium channel blockers - pinaveria bromide, otilonium bromide);
• suppress the activity of phosphodiesterase, the breakdown of cAMP, thereby blocking the energy processes of the muscle cell (phosphodiesterase blockers - alverine, drotaverine, etc.);
• act through serotonergic receptors, disrupting the regulation of ion transport;
• act on opioid receptors (trimebutine);
• influence oxidases (nitroglycerin and nitrosorbide).

The prescription of each drug must be justified from the standpoint of effectiveness and safety. The more selective the drug, the fewer systemic side effects it has.

Of all the selective antispasmodic drugs, the anticholinergic quaternary ammonium compound hyoscine butyl bromide (Buscopan) has been used the longest in Europe. The drug was first registered in Germany in 1951, and currently it is one of the most studied experimentally and clinically and selective antispasmodic drugs for the gastrointestinal tract. The most important pharmacological properties of hyoscine butylbromide are its dual relaxing effect through selective binding to muscarinic receptors located on the visceral smooth muscles of the gastrointestinal tract, and the parasympathetic effect of blocking nerve ganglia through binding to nicotinic receptors, which ensures selectivity of suppression of gastrointestinal motility.

Hyoscine butyl bromide, due to its high affinity for muscarinic and nicotinic receptors, is distributed mainly in the muscle cells of the abdominal and pelvic organs, as well as in the intramural ganglia of the abdominal organs. Because the drug does not cross the blood-brain barrier, the incidence of systemic anticholinergic (atropine-like) adverse reactions with hyoscine butyl bromide is very low and similar to placebo. Therefore, the feasibility of using this drug is obvious and proven to relieve pain of the visceral component of any origin [1, 3, 18, 19].

The onset of effect when taking Buscopan orally is approximately 30 minutes; duration of action is 2–6 hours. After a single oral administration of hyoscine butyl bromide in doses of 20–400 mg, average peak plasma concentrations are reached after approximately 2 hours. The half-life of the drug after a single oral dose of 100–400 mg ranges from 6.2 to 10.6 hours. Recommended oral dose: 10–20 mg 3–5 times daily. There is also a dosage form of Buscopan in rectal suppositories.

Published in 2006, a comparative placebo- and paracetamol-controlled study of the effectiveness and tolerability of hyoscine butylbromide in the treatment of recurrent cramping abdominal pain, conducted at 163 clinical centers under the leadership of such famous gastroenterologists as S. Müller-Lissner and G. N. Tytgat , included 1935 patients. It showed high efficacy and safety of hyoscine butyl bromide for recurrent abdominal pain [14].

Evidence of the antispasmodic effect of hyoscine butylbromide is the improvement in the results of instrumental examination of the intestine during endoscopic and x-ray examination, which is demonstrated by both an increase in the intestinal lumen and visualization of polyps, diverticula, as well as less pain during manipulations [11, 15].

An example of effective relief of abdominal pain with antispasmodics is their use in IBS [12].

A meta-analysis conducted by T. Poynard et al demonstrated that many antispasmodic drugs individually (mebeverine, cimetropium bromide, trimebutine, otilonium bromide, hyoscine butyl bromide, pinaveria bromide) and the entire group of antispasmodics (OR 2.13; 95% CI 1 .77–2.58) is more effective than placebo in the treatment of IBS pain [16]. Thus, the likelihood of improvement with the use of hyoscine butylbromide in the treatment of IBS is 1.56 times higher (95% CI 1.14–2.15) than with placebo. A number of studies have shown that, in addition to the antispasmodic effect, the good analgesic effect of Buscopan may also be associated with a decrease in the threshold of visceral hypersensitivity, which plays an important role in the pathogenesis of IBS [10].

Antispasmodics with proven effectiveness in the treatment of IBS from the point of view of the special American Gollege Gastroenterology (ACG) are hyoscine butyl bromide, cimetropium bromide, pinaveria bromide and peppermint oil. These drugs can relieve pain or discomfort associated with IBS [5].

Antispasmodics not only relieve pain, but also help restore the passage of contents and improve blood supply to the organ wall. Their administration is not accompanied by direct interference with the mechanisms of pain sensitivity and does not complicate the diagnosis of acute surgical pathology.

Of course, an important place in the relief of pain not only of parietal origin, but also of visceral and psychogenic origin is given to analgesics. The World Health Organization has proposed the following step-by-step approach to pain relief: 1st step - non-opioid analgesics, 2nd step - adding soft opioids, 3rd step - opioid analgesics. Among non-opioid analgesics, it is preferable to prescribe paracetamol due to fewer side effects on the gastrointestinal tract. A number of studies have shown a good effect for pain relief when combining the antispasmodic hyoscine butyl bromide with the analgesic paracetamol [13].

Sometimes it is necessary to use direct analgesics in case of functional diseases, in particular in IBS. The prescription of opiates should be avoided in every possible way, since with such chronic conditions there is a high risk of developing addiction and dependence. Such cases are described in the literature and are called “narcotic bowel syndrome” (intestinal syndrome caused by narcotic drugs). The criteria for this condition include chronic or often recurrent pain that progresses over time, which cannot be explained by a specific pathology, the relief of which requires large doses of narcotic drugs, which increases with the abolition of opiates and is quickly relieved with their use [8, 9].

The effect of antidepressants to potentiate and enhance the analgesic effect of other drugs is well known and proven. Taking into account the presence of a psychogenic mechanism of pain in functional diseases, clinically identified psycho-emotional characteristics of patients (tendency to depression, high levels of anxiety), the interest in psychotropic drugs for IBS is understandable. A recently published systematic review, although highlighting flaws in some study designs, provided evidence to support the use of antidepressants (both tricyclics and selective serotonin reuptake inhibitors) for IBS (amitriptyline 10–75 mg/day at bedtime; selective serotonin reuptake inhibitors: paroxetine, 10–60 mg/day, citalopram, 5–20 mg/day) [6, 20].

Explaining the genesis of symptoms and, above all, abdominal pain, taking into account the level of education, social status of the patient, and establishing a trusting, empathetic relationship between the doctor and the patient is effective in relieving symptoms [7].

Nutritional adjustments to reduce pain and relieve other symptoms should be used with some caution so as not to cause nutritional problems in the patient (deficiency of microelements, vitamins, other nutritional ingredients).

There is no convincing connection between abdominal pain and other symptoms of IBS. The use of drugs effective for relieving various disorders in IBS did not affect the severity of pain. In the presence of IBS with constipation, various classes of laxatives, fiber and other volume-forming drugs are used. A good evidence base exists for osmotic laxatives (lactulose preparations, polyethylene glycol in individual dosages). To speed up the normalizing effect on passage through the gastrointestinal tract in IBS with constipation, irritating laxatives (Dulcolax, etc.) can be prescribed in short courses. For the treatment of IBS with constipation in women, it is possible to use a selective activator of C-2 chloride receptors - lubiprostone [6]. There is evidence of the advisability of using the probiotic strain Bifidobacterium lactis DN-173 010 in order to accelerate intestinal transit.

The main drug for the treatment of IBS with diarrhea is loperamide, which requires individual dosage selection. For severe diarrheal syndrome in women, the serotonergic receptor antagonist (5-HT3)-alosetron has been registered for use in a number of countries [6, 20]. To reduce gas formation, sorbents and other defoamers are used, and some recommendations also call the antibiotic rifaximin (400 mg 3 times a day).

Some effects on improving the general condition and reducing pain were demonstrated by the antagonist of serotonergic receptors (5-HT3) - alosetron (in IBS with diarrhea syndrome), the selective activator of C-2 chloride receptors - lubiprostone (in women with constipation) and the probiotic strain Bifidobacterium infantis 35624 .

To relieve pain and other symptoms in functional pathology, in particular in IBS, a variety of therapy methods are used, including psychological ones: cognitive/behavioral therapy, relaxation methods, hypnosis. The ACG states that psychological therapies including cognitive therapy, dynamic psychotherapy and hypnotherapy are more effective in relieving common IBS symptoms than standard treatments. The attitude towards herbal medicine and acupuncture in general today is optimistically restrained.

The course of any pathology and especially IBS is largely influenced by both the patient’s personal characteristics (attitude to treatment, level of anxiety and degree of trust/distrust in medical manipulations, the presence of chronic traumatic situations, individual emotional characteristics, as well as mental illness), and the behavior of the medical professional. staff (the ability to establish contact and trust, the ability to provide psychological support to the patient). An important point that always increases the patient’s confidence in the doctor is the rapid relief of pain. Therefore, the choice of drugs must be made competently and in a timely manner.

Literature

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2. Wiley J. Assessment and meaning of abdominal pain. Chapter 1. In the book: J. Henderson. Pathophysiology of the digestive organs. St. Petersburg: Nevsky Dialect, 1997. 275 p.
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4. Shulpekova Yu. V., Ivashkin V. T. Symptom of visceral pain in pathology of the digestive organs // Doctor. 2008. No. 9. pp. 12–16.
5. Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM American College of Gastroenterology Task Force on Irritable Bowel Syndrome An evidence-based position statement on the management of irritable bowel syndrome // Am J Gastroenterol. 2009, Jan; 104, Suppl 1: S1–35.
6. Camilleri M. Review article: new receptor targets for medical therapy in irritable bowel syndrome // Aliment Pharmacol Ther. 2010, Jan; 31 (1): 35–46.
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12. Longstreth G., Thompson W., Chey W., Houghton L., Mearin F., Robin C. Spiller. Functional Bowel Disorders // Gastroenterology. 2006; 130:1480–1491.
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14. Mueller-Lissner S., Tytgat GN, Paulo LG, Quigley EM, Bubeck J., Peil H., Schaefer E. Placebo- and paracetamol-controlled study on the efficacy and tolerability of hyoscine butylbromide in the treatment of patients with recurrent abdominal cramps pain // Aliment Pharmacol Ther. 2006, Jun 15; 23 (12): 1741–1748.
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M. F. Osipenko , Doctor of Medical Sciences, Professor S. I. Kholin , Candidate of Medical Sciences, Associate Professor A. N. Ryzhichkina , Candidate of Medical Sciences, Associate Professor Novosibirsk State Medical University, Novosibirsk

Contact information for authors for correspondence

Causes of body aches

Causes of muscle aches

There are symptoms of different nature: pulling, “twisting”, squeezing pain, discomfort, tingling and burning in the muscles. Unpleasant sensations occur in all muscle groups, but are most pronounced in the legs. Sometimes the symptoms of body aches are so severe that they interfere with daily activities. Muscle aches are caused by reasons such as:

• Nonspecific myositis
  : after hypothermia, heavy physical exertion, with unsuccessful sudden movements of the limbs or torso.
• Respiratory diseases
  : influenza, ARVI, rhinovirus or adenovirus infections.
• Prodromal period of viral infections
  : hepatitis, hemorrhagic fevers, chickenpox.
• Inflammatory diseases of internal organs
  : acute and chronic tonsillitis, pyelonephritis, pneumonia.
• Helminthiases
  : ascariasis, teniarinchiasis, echinococcosis and alveococcosis.
• Fibromyalgia, epidemic myalgia
  .
• Damage to the musculoskeletal system
  : falls from low heights, bruises, plexitis and tendinitis.
• Vascular damage to the lower extremities
  : varicose veins, thrombophlebitis, atherosclerosis.
• Psychoneurological problems
  : vegetative-vascular dystonia, prodromal period of migraine, hysterical reactions and neuroses.
• Immunodeficiency states
  : period of convalescence after serious illnesses, chronic stress, HIV infection.
• Poisoning
  : drugs, food, industrial poisons and chemicals.
• Rare causes:
  myoglobinuria, hereditary hemolytic anemia, botulism.

Causes of aching joints

Painful sensations, stiffness of movement, a painful pulling sensation of aching in all joints of the body are observed both without signs of a cold and with respiratory infections. In weather-dependent people, joints “twist” when there is a sudden change in weather, but in most cases the symptom indicates the development of the disease. Common causes of joint pain:

• Physiological factors
  : degenerative changes in tissues in old age, prolonged standing, first trimester of pregnancy.
• Increased load on joints
  : excess weight, curvature of the spine (scoliosis and kyphoscoliosis).
• Chronic diseases of the musculoskeletal system
  : osteochondrosis and osteoarthritis, ankylosing spondylitis (ankylosing spondylitis), gout.
• Collagenoses
  : rheumatoid arthritis, systemic lupus erythematosus, scleroderma, periarteritis nodosa.
• Infectious processes
  : respiratory system (tracheitis, bronchitis, pneumonia), gastrointestinal tract (typhoid fever, salmonellosis, food toxic infection), genitourinary system (acute and chronic pyelonephritis, purulent cystitis, urethritis).
• Minor injuries
  : sprains and tears of ligaments, bruises of the articular area, damage to the meniscus.
• Oncological diseases
  : osteosarcoma, leukemia (lymphoblastic, myeloblastic), Hodgkin lymphoma.
• Autoimmune processes
  : vasculitis, Hashimoto's thyroiditis.
• Endocrine pathology
  : hyper- and hypothyroidism, diabetes mellitus, Itsenko-Cushing syndrome.
• Rare causes
  : fasciitis in the recovery stage, carpal tunnel syndrome, hereditary abnormalities in the structure of the skeletal system.

The main causes of wandering pain in the spine

The disease is very difficult to diagnose, as well as to select the correct treatment measures. These difficulties can be explained quite simply - identifying all the main and “well-hidden” root causes is very problematic.

The term usually means all painful sensations that arise with noticeable frequency, “walking,” literally, throughout the entire back area. In this case, sharp and acute piercing pain occurs in the chest and lower back areas, and there are also cases when the pain radiates to the jaw.

The intensity of pain experienced can change dramatically and rapidly. And be accompanied by unfavorable symptoms and sensations. Pain can also vary:

• Spicy.
• Blunt.
• Aching.
• Paroxysmal.
• Shingles.
• Stabbing.

The time periodicity in the manifestations of pain is also very noticeable:

• Long term.
• Constantly and continuously.
• Periodically, suddenly, and sometimes completely disappearing.
• Like passing and falling.
• Wave-like, in the form of “successive jumps”.

Causes of the syndrome

The identified syndrome of wandering pain in the spine can be either acquired, acute or chronic. The main underlying causes of the disease remain unclear. It is also noted that there is not a single confirmed disease that could contribute to the processes of its development.

Among the observed pathologies where wandering pain is present, doctors most often identify:

• Inflammatory processes in the spine.
• Detected: osteochondrosis, osteoporosis, kyphosis of the back.
• Also, the reasons include a possible, previously suffered spinal fracture.
• The syndrome is often found in patients with osteoporosis.

The acute form can occur against the background of developing hernias and protrusions. Patients experience general physical weakness, soreness and partial loss of sensation in the arms and legs, with obvious disturbances in their coordination of movements.

What contributes to the development of the syndrome

Other key factors contributing to the rapid development of the syndrome:

• Ankylosing spondylitis.
• Malignant tumors, and their growth spreads not only to the spine, but also to internal organs.
• Diagnosed poliomyelitis and osteomyelitis.
• Tuberculosis of bones.
• A serious complication that was a consequence of the flu.
• Stressful and tense state.
• General fatigue of the body.
• Detected cervical artery syndrome.
• Excessive and clearly unnecessary physical activity.
• Staying in one position for a long time.

Diagnosis takes a long time, so at the first symptomatic signs you should immediately consult a doctor. In addition to pathologies related to the back area, diseases of the internal organs can also be direct causes. These include:

• Pyelonephritis.
• Intestinal obstruction.
• Found kidney stones.
• Pancreatitis and liver diseases.
• Pneumonia and pneumonia.
• Bronchitis.

The main symptom of the disease is pain with varying intensity and manifestation anywhere. In the morning, painful sensations affect areas of the spine; by evening, the “pain zone” moves to the entire back. Office workers who spend most of their working time sitting and in one position are at high risk of getting sick and acquiring the syndrome. At the same time, pain can bother patients both daily and occasionally.

In the presence of any diseases of the internal organs, back pain is a direct result of irradiation - “painful return” to absolutely any place. The overlap of one disease with another significantly complicates diagnosis. The only option is an ultrasound of all internal organs.

Diagnostics

Pain in the back muscles always requires the necessary diagnostic measures and detailed consultations from specialist doctors:

• Neuropathologists.
• Surgeons.
• Cardiologists.
• Gastroenterologists.

Each doctor determines what tests and studies will need to be performed.

Diagnostic methods include ultrasound, MRI, CT, x-rays with detailed images. Special tests and blood and urine samples are carried out separately. It is also mandatory to take tests for tumor markers.

Treatment complex

All therapeutic measures taken will directly depend on the causes of the syndrome. For radiculitis, osteochondrosis and kyphosis, effective conservative therapy and back treatment

using drugs from the NSAID category.

They are assigned in the form:

• Special ointments.
• Kremov.
• Gels.
• Tablets.
• Solutions for further injections.

Popular remedies include Nurofen, Nise, Nimesulide.

To relieve muscle tension and pain in the back muscles, muscle relaxants and chondroprotectors are actively used. They are taken strictly according to the recommendations of the attending physicians, due to the presence of side effects and contraindications. For stressful reasons, an effective measure would be to consult a psychotherapist and prescribe a course of antidepressants.

If a hernia is detected in the spine, surgical intervention will be urgently required. In the case of pathologies of internal organs, all further treatment will completely depend on the main diagnoses.

Kidney stones and gall bladder problems will also require prompt surgery and subsequent removal. Bronchitis, pneumonia and various forms of pneumonia are treated with antibiotics.

After the pain syndrome is completely eliminated, additional therapeutic measures are prescribed. Among them:

• Physiotherapy.
• back massage.
• Complex therapeutic gymnastics.

Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Diagnostics

A general practitioner will determine the cause of body aches and weakness with or without fever. The condition can be caused by various etiological factors, so the initial examination involves an extensive range of laboratory and instrumental methods. First, the most common causes of the symptom are excluded, and if necessary, an in-depth diagnosis is carried out. The most valuable and informative are:

• Ultrasound scanning
  . Complaints of body aches without an increase in temperature are characteristic of traumatic and degenerative processes, which ultrasound of the joints can help eliminate. Arthrosonography is performed to assess cartilage tissue, joint capsule and ligamentous apparatus. If you have heaviness in the legs, it is necessary to do a duplex scan of the veins to identify dilation and blood flow abnormalities.
• X-ray examination
  . If aches and other symptoms are localized to one part of the body, an x-ray of the affected area is taken to evaluate bone structures, cavities, or pathological formations. To exclude chronic diseases that cause discomfort, X-rays of the lungs and abdominal organs are prescribed.
• Modern Imaging Techniques
  . Computed tomography is more informative for studying the bony elements of the joint, their relative position and the area of ​​attachment of the ligamentous apparatus. The method allows you to detect osteophytes, salt deposits that cause body aches. MRI is performed for a detailed study of the condition of hyaline cartilage and muscle tissue.
• Invasive procedures
  . If it is difficult to verify the diagnosis of body aches without fever, diagnostic arthroscopy is used to examine the joint cavity and identify changes in the early stages, when they are not visible on an x-ray. If a tumor of the blood system is suspected, the results of a puncture biopsy of the bone marrow and cytomorphological analysis of biopsy specimens are indicative.
• Blood tests
  . General and biochemical blood tests are intended to detect markers of an inflammatory or infectious process. If body aches occur without fever, indicators of cartilage tissue degradation (glycosaminoglycans, chondroitin sulfate), the amount of calcium and phosphorus are determined. The level of creatinine determines the condition of muscle tissue.
• Specific laboratory methods
  . To confirm the infectious cause of fatigue and aches felt in the body, bacteriological examination of sputum, throat swab, feces or other biological materials is indicated. The levels of antibodies to the most common pathogens are studied in the blood using ELISA. PCR is effective for searching for the genetic material of microorganisms.

In patients with aches that are felt in the body, accompanied by weakness and occurring without a rise in temperature, endocrine diseases should be excluded, so the blood is tested for levels of thyroxine, corticosteroids, and ACTH. To diagnose lesions of the peripheral nervous system, electroneurography and electromyography are performed, and a complete neurological examination is indicated. An extended immunogram allows you to exclude severe violations of the body's resistance.

If you have body aches, it is recommended to stay in bed

Treatment

Help before diagnosis

When joint and muscle aches appear, it is advisable to remain in bed or limit physical activity as much as possible. If symptoms are combined with chills, the person needs to be warmed up and given warm drinks regularly. For excruciating pain, you can take an NSAID tablet. Many patients begin to take antiviral or strong analgesics, which cannot be done when they have body aches, since self-administration of such drugs blurs the clinical picture and makes it difficult to diagnose the cause of the disorder.

Conservative therapy

Medical tactics depend on the etiological factor. Mostly, drugs are prescribed that affect the primary disease that caused the body aches, after which the painful sensations disappear after treatment. In case of severe illnesses or contagious infections, the patient is hospitalized in a hospital; in other cases, outpatient treatment is indicated. Most often used for drug therapy:

• Anti-inflammatory drugs
  . Drugs from the NSAID group effectively relieve signs of inflammation in myositis and arthritis of various etiologies. They are taken in case of respiratory infections accompanied by fever, since the drugs have a strong antipyretic effect.
• Antiviral drugs
  . For influenza, it is recommended to take specific medications that affect the formation and assembly of viruses in the body. These drugs speed up the recovery period and prevent the development of serious complications from the central nervous system. For bacterial infections, antibiotics are used.
• Chondroprotectors
  . For chronic osteoarthritis with body aches, but without fever and hyperemia of the skin over the affected joint, glucosamine and hyaluronic acid are recommended. These drugs help restore the structure of cartilage tissue and slow down degenerative processes.
• Glucocorticoids
  . Hormones are used in severe stages of joint damage and all rheumatic diseases to relieve inflammation and eliminate stiffness of movement. Sometimes, to increase effectiveness, medications are injected directly into the joint cavity.
• Detoxification compounds
  . To reduce body aches without fever caused by poisoning, massive parenteral infusion of saline solutions is indicated to accelerate the elimination of toxic substances. If a toxic compound is identified, a specific antidote is administered.

Physiotherapy

To reduce pain, electrophoresis with anti-inflammatory drugs on the area of ​​the affected muscle or joint is effective. Electromagnetic therapy, balneotherapy, and hydrotherapy help reduce the manifestations of synovitis. To eliminate pain after traumatic injuries, bruises, compresses with dimexide and glucocorticoids are prescribed. For aches throughout the body, accompanied by a runny nose and other signs of acute respiratory viral infections, rinsing the nasal passages with sea salt solutions and gargling with antiseptic solutions are recommended.

Surgery

Frequent causes of aches that occur in the body and joints without fever are degenerative changes in cartilage and bone tissue, which require surgical intervention. The modern method is therapeutic arthroscopy, during which osteophytes and pathologically altered areas of the synovial membrane are removed and abrasive chondroplasty is performed. Osteochondral autoplasty, aimed at restoring the anatomical structure of the joint, helps to reliably eliminate pain. In advanced situations, corrective osteotomies and arthrodesis are necessary.

For plexitis and neuritis caused by compression of nerve structures, decompression surgical interventions are indicated. In case of severe varicose veins, staged sclerosis of the damaged vessel or phlebectomy is performed. Treatment of body aches caused by rheumatoid arthritis includes total synovectomy, and in the case of irreversible changes in bone tissue, endoprosthetics becomes the operation of choice. For refractory endocrine diseases, removal of the affected organ is recommended (thyroidectomy, subtotal resection of the thyroid gland, adrenalectomy).