Concept of a complex therapy in restorative treatment of discogenic lumbosacral radiculopathies.
DOI:
https://doi.org/10.26641/2307-0404.2020.1.200396Keywords:
radiculopathy, discogenic radiculopathy, stenosis, quantitative sensory testingAbstract
Currently, the treatment of lumbosacral radiculopathy (LSR) is an urgent problem due to the frequent chronic pain syndrome, the lack of a unified methodological approach to the recommendations, taking into account the pathological characteristics of the compressed root. The purpose of the work is the development of the concept of a comprehensive etiopathogenetic treatment of acute lumbosacral radiculopathy. 100 patients, divided into two groups were examined (the main – 45 people, the control – 55 people). Each group was divided into subgroups depending on the treatment received (basic and complex). Basic therapy included treatment according to European and American recommendations. Complex treatment consisted of a combination of basic therapy and vibrotraction postisometric muscle relaxation (PIMR) with biomechanical stimulation of the paravertebral muscles. Treatment control was based on the analysis of the neurological and neuroorthopaedic status, severity of a pain syndrome using a 5-point verbal scale, PainDETECT questionnaire, the muscle syndrome index, as well as quantative sensory testing. The stages of the study were chosen taking into account the pathological stages of the disease: 1-7 days and 30 days. When analyzing the results of ELISA to IgG for urogenital infections in 46.7% of patients of the main group and 47.3% of the control, urogenital chronic infections were detected, while in the main group mycoplasmic and ureaplasmic infections were more common, and in the control group patients mostly had chlamydial infection. When antibacterial drugs were included in the treatment, the most pronounced regression of the pain syndrome was determined. Thus, it was found that the use of vibrotractional postisometric relaxation with biomechanical stimulation of the paravertebral muscles in combination with the use of NSAIDs is aimed at quickly removing the muscular-tonic and compression symtoms during 10-14 days (p<0.05), and the further use of neurotropic therapy led not only to a persistent analgesic effect, but also contributed to the improvement of the biomechanical indicators of the spine (p<0.05), positively affecting the motor activity.
References
Dadasheva MN, Agafonov BV. [Radiculopathy, modern patient management tactics]. Russkiy meditcinskiy zhurnal. 2016;3:163-5. Russian.
Dzyak LA, Shul’ga AN, Shul’ga AA. [New features in the diagnosis of lumbosacral radiculopathy, caused by the intervertebral discs]. Mizhnarodnnyi nevrologichnyi zhurnal. 2012;5(51):58-65. Russian.
Ivanova MA, Parfenov VA, Isaykin AI. [Surgical and conservative treatments for discogenic lumbar radiculopathy]. Nevrologiya, neyropsikhiatriya, psikhosomatika. 2019;11(2):40-45. Russian.
Isaykin AI, Ivanova MA, Kavelina AV. [Discogenic lumbalgia]. 2016;24:1599-605. Russian. Available from: https://www.rmj.ru/articles/nevrologiya/Diskogennaya_lyumbalgiya/
Lang TA. [How to describe statistics in medicine. Guide for authors, editors and reviewers]. 2nd ed. Leonova VP, editor. Moskva: Prakticheskaya meditsina; 2016. p. 480. Russian.
Levin OS. [Vertebrogenic lumbosacral radiculopathy: modern approaches to diagnosis and treatment]. Effektivnaya farmakoterapiya. Terapiya boli. 2015;3:40-48. Russian. Available from: http://umedp.ru/upload/iblock/ac7/levin.pdf
Morozova OG, Yaroshevskiy AA. [Back pain: experience with the use of Sinmeton and Protekon in complex therapy]. Zhurnal nevrologii im. BM. Man'kovskogo. 2015;1(3):91-96. Russian.
Krupatkin AI, Kuleshov AA, Sokolova TV, Gospod AO. [Pathophysiological aspects of pain in the lower back]. Nevrologiya i psihiatriya. 2017;4:102-6. Russian.
[The method of combined conservative treatment of hernias of the intervertebral discs of the lumbosacral spine]. Ukrainian patent 37907, N 8. 2003. Aug 15. Ukrainian.
[Method of conservative treatment of neuropathic pain in lumbosacral radiculopathies caused by lateral stenoses, extrusions and hernias of the intervertebral discs]. Ukrainian patent 127314. 2018 Feb 23. Ukrainian.
[The method of treatment of vertebrogenic radiculopathies caused by herniation of the intervertebral discs of the lumbosacral spine using vibratory postisometric muscle relaxation]. Ukrainian patent 109943. 2016 Sept 26. Ukrainian.
Baron R, Binder A. How neuropathic is sciatica? The mixed pain concept. Orthopade. 2004;33:568-75. Available from: https://doi.org/10.1007/s00132-004-0645-0
Benyamin RM, Staats PS. MILD Is an Effective Treatment for Lumbar Spinal Stenosis with Neurogenic Claudication: MiDAS ENCORE Randomized Controlled Trial. Pain Physician. 2016;19(4):229-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27228511?dopt
Praveen Kumar, Geetika Khanna, Sumit Batra, Vinod K Sharma A, Sangita Rastog. Chlamydia trachomatis elementary bodies in synovial fluid of patients with reactive arthritis and undifferentiated spondyloarthropathy in India; International Journal of Rheumatic Diseases. 2014;1-6. doi: https://doi.org/10.1111/1756-185x.12364
Urquhart DM, Zheng Y, Cheng AC, et al. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015;13:13 doi: https://doi.org/10.1186/s12916-015-0267-x
Va/DoD Clinical Practice Guidelines. Diagnosis and treatment of low back pain (LBP).-2017. Available from: https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPG092917.pdf
Guideline for the evaluation and management of low back pain. American Pain Society; 2017. Available from: https://www.mccofaz.com/media/3741/evaluation-and-management-of-low-back-pain.pdf
Karcioglu O, Topacoglu H, Dikme O. A systematic review of the pain scales in adults: wich to use? The American Journal of Emergency Medicine. 2018;36(4):707-14. doi: https://doi.org/10.1016/j.ajem.2018.01.008
Low back pain and sciatica in over 16s: Assessment and management NICE Guideline [NG59]. Available from: https://www.nice.org.uk/guidance/ng59. doi: https://doi.org/10.1016/j.jphys.2017.02.012
Keller T, Freynhagen R, Tölle TR, Liwowsky I, Möller P, Hüllemann P, Gockel U, Stemmler E, Baron R. A retrospective analysis of the long-term test–retest stability of pain descriptors of the painDETECT questionnaire, Current Medical Research and Opinion. 2016;32(2):343-9. doi: https://doi.org/10.1185/03007995.2015.1125869
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