Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

/pdf/conservative-treatment-for-patients-with-discogenic-277ggqgtlt.pdf

Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

Pain syndrome accompanies absolute majority of diseases, therefore problems of adequate anesthesia remain acute not only for urgent conditions but also for everyday medical practice. Modern approaches of anesthetic therapy should consider not only pathogenic mechanisms of evolving pain syndrome by a certain patient but also necessity to administer drug combinations. It allows potentiating an analgesic effect, to decrease effective dosages of individual drugs and minimize adverse effects. The administration of non-steroidal anti-inflammatory drugs together with B vitamins and tolperisone is justified in a marked pain syndrome with a spastic component and/or spasms of skeletal muscles, muscle contractures, myofascial pain syndromes, as well in rehabilitation therapy after orthopedic and traumatology surgeries. The article considers pathogenic details of such combined therapy, discloses mechanism of synergic action of the proposed drug combination.

/pdf/combined-therapy-of-pain-syndromes-rationale-and-prospects-3dwibda6w9.pdf

Combined therapy of pain syndromes: rationale and prospects for potentiation of effects

<h3></h3> Представлен обзор опубликованных до января 2022 г. исследований эффективности и безопасности применения миорелаксанта циклобензаприна в лечении скелетно-мышечной боли. В ряде рандомизированных клинических исследований продемонстрирована эффективность циклобензаприна в лечении болевых синдромов, связанных со скелетно-мышечными нарушениями. Обсуждается вопрос о значении миорелаксантов, в том числе циклобензаприна, в лечении болевых синдромов в виде монотерапии и в комбинации с другими препаратами. 

Cyclobenzaprine in the treatment of musculoskeletal pain

The number of scoliotic disorders in children of preschool and school age has grown almost sixteen times over the past decades. The article presents the results of the scoliotic disease correction by the method of 
the body systemic mobilization by foot in children aged 8-13 whose scoliotic disease has been initiated by idiopathic scoliosis. The predisposition to the disease is considered through the prism of the causes which 
originate in the prenatal (before birth) period and evolve in the postnatal (after birth) period of the body’s development.

Piriformis syndrome. manifestation, diagnosis and treatment

Myofascial pain syndrome (MFPS) is a chronic pain syndrome characterized by the formation of myofascial trigger points (MTP). MFPS most frequently occurs in patients with neck pain. The peripheral and central aspects of the formation of MTP, MFPS diagnostic criteria, piriformis syndrome, fibromyalgia, the impact of MFPS on quality of life and functional activity in patients are discussed. MFPS is treated according to the international guidelines for the treatment of nonspecific spinal pain, which encompass patient education programs, therapeutic exercises, early mobilization, manual therapy techniques, and nonsteroidal anti-inflammatory drugs as first-line analgesic agents. Meloxicam is noted to be highly effective in treating low back pain, including myofascial pain. The application of a low back muscular corset and its ability to protect vertebral structures from damage are considered. At present, there is no evidence for a link between the status of spinal muscles (according to magnetic resonance imaging and computed tomography) and the intensity of pain syndrome and the degree of disability.

/pdf/rol-myshechnogo-faktora-v-razvitii-poiasnichnoi-boli-1y44lmu652.pdf

Роль мышечного фактора в развитии поясничной боли

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Роль мышечного фактора в развитии поясничной боли