The different approach depending on whether an acute or a chronic problem has to be faced. In the latter case, it is necessary to remove inflammation to allow targeted interventions
Spine pain is a problem that affects almost everyone in life at one time or another. Sometimes the pain affects the neck and shoulder areain other cases the lumbar one with painful radiation that also reaches the foot, with the risk that the feared chronic sciatica. The fact is that pain is not only insidious, but often also tends to become an uncomfortable travel companion. So much so that neck pain and low back pain are among the most common causes of disability under the age of 45. And this is partly due to the fact that, in most cases, they are not addressed optimally, increasing the chances of them becoming chronic.
How should back pain pain therapy be applied?
11 years afterapproval of Law 38/2010pain therapy still poorly guaranteed in our country. Instead of following a series of shared procedures, there is still a lot of “craftsmanship”: everyone follows, so to speak, his own formula – he observes Paolo Grossi, director of the UOC of anesthesia, resuscitation and pain therapy of the Asst Gaetano Pini-Cto of Milan -. Spinal pains are generally not the result of serious illnesses, rather their reflection on daily life is important. This is why proper pain management, both acute and chronic, is essential.
What to do in case of acute pain in the spine?
To counter it, we can first of all count on anti-inflammatory drugs
non-steroidi which serve to quickly extinguish the inflammatory fact. Valid allies are even cortisonewho are gaining altitude at modest dosages for a limited time, especially in the presence of arthritis. In sciatica so far cortisone has never been given in the first instance, but recent studies show that in some cases it can be administered for a limited time (about three days). Very useful associations, exploitable for intermediate periods, have been present for years now: they are uniting the analgesic effects of paracetamol and “minor” opiates. Instead they turn out muscle relaxants somewhat outdatedwith some exceptions, while supportive therapies that are always valid are those that involve the use of aids, such as braces to improve postures.
What should be the approach to chronic pain instead?
In these cases, the first thing to do identify the cause of the pain and the next step is to eliminate it with adequate therapies, otherwise the definitive phase cannot be started, the real cure, which is represented by the rehabilitation program. If the “fire” is not extinguished, respecting the succession of the phases described, the path is in fact nullified. Since spine pain is often associated with poor posture, postural re-education is required. Also for a good function of the spine It is very important to perform some muscle strengthening exercises which allow to lighten the load on the spine and prevent relapses.
The starting point for a correct approach to pain is its measurement, its subjective dimension, or better still the evaluation of the degree of disability it causes. There are specific scales that take numerous factors into consideration and can be of great help.Among these is the Oswestry Disability Index. In practice it is a multiple choice questionnaire, able to provide the doctor with valuable information on how much back pain affects the patient’s daily life – explains Paolo Grossi -. The questionnaire, which takes less than ten minutes to complete, it assesses not only the extent of the pain, but also the resulting disability in taking care of oneself (washing, dressing, etc.), lifting weights, walking, standing, sleeping as well as social and sexual life. Starting from the score obtained, the treatment can be better oriented.
Those involved in pain therapy can count on both mixed use of a number of drugsboth onphysical application of electrical currents, heat or very low temperatures. In this way we are able to get as close as possible to the pain generator and deliver drugs or energies (such as electrostimulation and radiofrequency) to that point.
Finally, the possibility to act directly on the pain generator (for example at the level of an intervertebral disc) with cell injection (autotransplantation of mesenchymal stem cells, platelet concentrates) which provide incentives for the reparative and regenerative phenomena of the structure affected by the pathology.
March 30, 2022 (change March 30, 2022 | 18:53)
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