Osteochondrosis: the truth about a non-existent disease

Mythical osteochondrosisAlexey Yakovlev for RIA Novosti 

The application contains tips on the treatment of back pain from an article that Alexey wrote much earlier for visitors to his blog.

Acute pain in the lower back or a jammed neck is always inappropriate. Neither sleep normally, nor sit down! I'm already silent about the gym, a pleasant vacation or hiking with heavy backpacks. But any of us can get caught. Two thirds of people suffer from acute lumbar pain at least once in their lives.

Our country is unique in everything, including in medical terminology and in understanding the pathogenesis (mechanism of development) of diseases.

For too long, the Soviet medical school has been developing in isolation from the rest of the civilized world. A natural consequence of a misconception about the nature and development of the disease is the unique means of treatment and approaches to prevention that are not used anywhere else in the world. Moreover, this uniqueness is usually synonymous with inefficiency. So it happened with osteochondrosis.

Despite the fact that the diagnosis of "osteochondrosis" exists all over the world, this term means completely different, quite rare, mainly pediatric pathologies. Nevertheless, many domestic doctors continue to persistently apply it to back and neck pain. Why? Partly because the patients themselves are used to "osteochondrosis".

Most patients firmly believe that their pain is caused by problems in the spine (deformity of the vertebrae, degradation and herniation of the intervertebral disc). In fact, this is not always the case.

What causes back pain?

Degenerative processes of intervertebral discs and joints account for no more than 10% of cases of back and neck pain (dorsalgia).

In 97% of cases, dorsalgia is caused by other mechanical causes: overload damage to the ligaments and muscles supporting the vertebral column (70%), compression fractures in osteoporosis (4%), etc. Quite often, pain occurs without any damage at all, many of them are of a psychogenic nature.

Extremely rarely, the pain is caused by the protrusion (the famous herniation) of the intervertebral disc, squeezing the nerve roots; then, for example, the hip or lower leg begins to hurt. Such a disaster is caused by no more than 1-3% of all pains.

Very rarely, the cause of pain is infections, or tumors (0.8%), or diseases of internal organs, when pain is projected into the back (about 1.5-2%).

Contrary to popular opinion, curvature of posture (kyphosis, scoliosis) by themselves lead to pain syndrome extremely rarely (less than 1%).

There are many other rare reasons that only a good specialist will understand.

In our country, no matter what back pain, the notorious herniated discs are everywhere to blame. At the same time, certain hernias occur in most people, and they are easy to demonstrate on magnetic resonance imaging (MRI) or computed tomography (CT) scans. How to avoid diagnostic misconceptions?

X-rays, MRI, CT scans for back and neck pain are usually not required. The doctor may prescribe such studies if you have signs of serious damage to the spinal cord and roots, accompanied by peripheral disorders (paresis or paralysis of the muscles of the lower extremities, sensitivity disorders, pelvic organ dysfunction). In 90% of cases of neck and back pain, such studies are completely unnecessary.

The doctor can still prescribe such a study even in the absence of the described violations, if the pain does not lose its intensity for 4-6 weeks, despite careful intake of anti-inflammatory drugs.

In our country, it is customary to frighten patients with images with herniated discs, often completely clinically insignificant. However, it has long been postulated throughout the civilized world that there is no direct correlation between back pain and the picture on an X-ray or tomogram. The researchers simply took 1,000 people with dorsalgia and 1,000 perfectly healthy ones and did tomograms for everyone. As a result, in both groups, the number of people with herniated discs and without them turned out to be approximately the same. Moreover, often people with the most severe hernias and spinal deformities do not experience any back pain, and sometimes vice versa. This experiment has already been repeated several times for the particularly distrustful, so there is no doubt left.

Herniated disc is generally very rarely involved in the development of dorsalgia (back and neck pain). Only in 4% of cases it is possible to make some kind of theoretical connection with the existing hernia, and serious protrusions and slips of the discs, requiring X-ray imaging and surgical treatment, are even less common.

Why is it that in our country only a lazy doctor does not prescribe a picture or a tomogram of the spine? In recent years, the main source of income of individual figures from health departments and chief doctors of hospitals have become "rewards" received from manufacturers of medical equipment and consumables. MRI (magnetic resonance imaging), CT (computed tomography), and at worst digital X-ray machines have become a real gold mine here. So we bought this equipment everywhere, where it is needed and where it is not. You come to some tiny Siberian town, and there you have an MRI, and two CT scans, and God knows what!

And often no one in this clinic knows how to use all this good. And then the problem arises: how to recapture this equipment, and even earn extra money on such a small population of the town? And there is only one way out: to drive everyone to the diagnostics in a row. Other enterprising doctors provide such a flow that there are queues for an MRI for a week ahead! And people in such towns do not mind at all: MRI is harmless to health and in most cases costs nothing to the patient, since it is covered by mandatory medical insurance.

This does not mean that I urge you to give up expensive MRI every time. I just want to emphasize that this study should not be assigned by default for any back pain; there should be clear indications for it to be carried out.

I want to address my colleagues separately.

In the International Classification of Diseases ICD-10, which we are all obliged to use when making a diagnosis, the collective term "osteochondrosis" refers to a very specific group of rare diseases:

1. diseases of the spine: under the code M-42 (juvenile Sheyerman-Mau disease and Calve disease, as well as their consequences and analogues in adults);
2. diseases of other joints: Legg-Calve-Perthes disease (femoral head), Koehler's disease and Freiberg's disease (metatarsal bone heads) and other rare (mostly children's) pathologies, combined with codes M91-M93.

In the vast majority of cases, what you and your patients call osteochondrosis is not! Let's be competent doctors. For 13 years now, you and I cannot call dorsopathies classified under M-50-54 osteochondrosis, or not dorsopathies at all. This is not just an innocent inertia of the mind or following the traditions of the old school! By substituting concepts, we mislead our patients about the nature of their back and neck pain, turn them into hypochondriacs, and recommend unnecessary and very expensive examinations and therapies.

Lumbar pain is a tedious thing! But it usually passes by itself. Studies show that lower back pain without any treatment passes in a week in 30-60% of patients, after 6 weeks 60-90% are already healthy, and after a year 95% recover. However, recovery can be accelerated.

Unhappy patients are bred so that mom does not grieve. And what a grateful thing! After all, any pain is ultimately a product of the analysis of the central nervous system, which means that the placebo effect will work in any case – even if you apply leeches, even hot stones, even burdocks. Especially suggestible will help both conspiracies and favorable horoscopes. One bad thing is that the placebo effect is limited by definition.

Application
Acute back pain: how to be treated so as not to go brokeSerious studies show that the following popular methods of treating acute back pain are pure placebos:

– physical therapy (link);
– therapeutic massage (link);
– traction (traction of the spine) – link.

In the acute phase, these methods are not only not shown, but can also harm!

I won't even mention leeches and other stupid things.

There is no advantage over normal drug therapy methods such as:

– manual therapy (manipulations of chiropractors other than massage) – links here and here;
– physical therapy;
– acupuncture = acupuncture (link).

But they are much more expensive than effective therapy, both in money and in time!

Some short-term effect can be provided by methods of distracting therapy such as pepper patches, cans, burning ointment (Finalgon, Capsicum, etc.). Here the effect is achieved by switching the brain from the focus of pain to a new focus of irritation. As a result, the brain does not focus on one place and the pain subsides.

Thermal warming of stretched muscles gives a good effect. The effect, however, is short-lived, but still.

And what really helps with back/neck pain?

Only 3 things have proven their irrefutable effectiveness:

1. drugs from the NSAID group (nonsteroidal anti-inflammatory drugs);
2. drugs from the group of central muscle relaxants (for example, Sirdalud), prescribed together with NSAIDs;
3. maintaining active activity (bed rest not only does not help, but, on the contrary, prevents recovery!) – link.

And that's it! Cheap and angry! :) Everything else is just a placebo effect or a divorce for money! Although I will make a reservation right away that elderly people can be recommended to go to the polyclinic for any placebo procedures, as long as they do not lie around. By itself, walking to dokhtur will have a healing effect for such people.

According to the effectiveness , the main methods of treatment can be ranked in the table:

Does it matter which NSAID to drink? Or maybe give injections? Or maybe it's better to rub it into a sore spot?

The answer to the first question is unambiguous: pain is equally effectively relieved by any NSAIDs, be it ibuprofen (Nurofen, Advil), naproxen (Aliv), nimesulide (Naiz) or the newfangled lornoxecam (Xefocam). But there are nuances everywhere.

The mechanism of action of all NSAIDs is such that they inhibit the enzyme cyclooxegenase (COX), which is involved in the synthesis of prostaglandins – regulators of inflammation. At the same time, COX is of 2 types - COX–1 and COX-2. COX-2 is responsible for the synthesis of "bad" inflammatory prostaglandins, and COX-1 participates in the synthesis of "good" protective ones. Most NSAIDs are non-selective, i.e. they hit both COX. As a result, both inflammation and protection of the gastric mucosa are removed. The latter is an undesirable property of NSAIDs and leads to an exacerbation of gastritis and ulcers in people prone to this. Especially malicious drugs like indomethacin, ketoprofen (Ketonal), piroxicam. It is better not to take them for long courses, and people with existing problems are not prescribed them at all. Ibuprofen or diclofenac are well tolerated by most patients, even with prolonged use. For ulcers, there are also selective COX-2 inhibitors of the meloxicam type (Movalis).

I've been chewing all this for so long that you understand: it doesn't matter how exactly you take an anti–inflammatory drug – through the mouth or in the form of an injection, with food or on an empty stomach - the side effect on the stomach works the same way. The ulcer is aggravated not because the tablet irritates the gastric mucosa with direct contact, but because the synthesis of COX-1 is suppressed.

Now as for all kinds of ointments, creams and gels based on NSAIDs such as ketonal, Dolgid, Fastum Gel, etc.

It is important to understand the following: the fact that you smear a gel or cream on the skin over the source of pain does not mean at all that the drug will fall directly into this focus. The drug, of course, will penetrate to the skin and subcutaneous capillaries, but then, alas! If you think that the cream you spread penetrates directly into a sore muscle or joint, as the ubiquitous advertising colorfully illustrates, you are feeding an illusion. Such drugs cannot penetrate beyond the subcutaneous tissue. However, if you smear thickly and often, sooner or later a sufficient concentration of NSAIDs will appear in the blood of the whole body due to the absorption of the drug by the skin capillaries, and then the analgesic effect will be achieved, as if you drank this drug or injected it. That's just it's easier to drink a pill, and the proper concentration of the active substance in the blood is provided by a tablet more reliably. Ointment, of course, is also possible, but this way is kind of crooked, not to say perverted :).

Nuance: old ladies, along with pills, I still recommend prescribing mazyukalki. Everything that makes them move is good for them! Again, ointments, especially burning-smelling ones, traditionally have an invariable placebo effect on them, whether it's badger fat or mud from the Dead Sea. It is especially useful if the grandmother herself goes into the forest, will kick the lopushkov-roots and knead the miraculous ointment herself :).

Prevention Tips:

Never lift weights in a standing position. Sit down, grab the handle of the suitcase and stand up with him. Lift weights with your feet, not with your back!

Under no circumstances lift or pull anything at an angle of 45% to the axis of the spine! The spine under load must make movements exclusively in 2 planes - strictly forward-backward and strictly lateral left-right!

It is impossible to bend and unbend the back with its simultaneous rotation (rotation around the axis of the spine)! Especially dangerous when lifting and carrying heavy loads.

When carrying a heavy burden in one hand, press the other hand tightly against the hip (this technique allows you to redistribute the load on the back muscles more correctly)

Since the monkey got up on its hind legs, the back has become its weak point. Do not load your back unnecessarily! Buy suitcases on wheels, use trolleys at airports and train stations, do not skimp on tea to movers. If you are already loaded, have the right orthopedic backpack, distribute the weight evenly over the body.

And, of course, strengthen your back with regular exercises as soon as the acute pain subsides, and get rid of excess weight.

The effectiveness and ineffectiveness of certain methods of treating back pain is well described for chronic pain here and for acute conditions here.

Portal "Eternal youth" http://vechnayamolodost.ru05.05.2011