Pain in the lower back, microbial code. Vertebrogenic lumbodynia. Causes and symptoms

Dorsopathies (classification and diagnosis)

In 1999, in our country, the International Classification of Diseases and Causes Associated with Them, X revision (ICD10) was recommended by law. The formulation of diagnoses in case histories and outpatient cards with their subsequent statistical processing makes it possible to study the incidence and prevalence of diseases, as well as to compare these indicators with those of other countries. For our country, this seems to be especially important, since there are no statistically reliable data on neurological morbidity. At the same time, these indicators are the main ones for studying the need for neurological care, developing standards for the staff of outpatient and inpatient doctors, the number of neurological beds and various types of outpatient care.

Anatoly Ivanovich Fedin
Professor Department of Neurology and Neurosurgery, Russian State Medical University

The term "dorsopathies" refers to pain syndromes in the trunk and extremities of non-visceral etiology and associated with degenerative diseases of the spine. Thus, the term "dorsopathies" in accordance with ICD-10 should replace the term "osteochondrosis of the spine" still used in our country.

The most difficult for practitioners are the formulation of diagnoses in patients with pain syndromes associated with degenerative diseases of the spine. In the historical aspect of these diseases, there are various interpretations and diagnoses. In textbooks on nervous diseases of the late nineteenth and early twentieth centuries. pain in the lumbar region and in the lower extremity was explained by an inflammatory disease of the sciatic nerve. In the first half of the twentieth century. the term "sciatica" appeared, with which inflammation of the spinal roots was associated. In the 60s, Ya.Yu. Popelyansky, based on the works of German morphologists H. Luschka and K. Schmorl, introduced the term "spinal osteochondrosis" into Russian literature. In the monograph of H. Luschka (H. von Luschka. Die Halbgelenke des Menschlichen Korpers.

Berlin: G. Reimer, 1858) degeneration of the intervertebral disc was called osteochondrosis, while Ya.Yu. Popelyansky gave this term a broad interpretation and extended it to the entire class of degenerative lesions of the spine. In 1981, the proposed by I.P. Antonov classification of diseases of the peripheral nervous system, which included "osteochondrosis of the spine". It contains two provisions that fundamentally contradict the international classification: 1) diseases of the peripheral nervous system and diseases of the musculoskeletal system, which include degenerative diseases of the spine, are independent and different classes of diseases; 2) the term "osteochondrosis" is applicable only to disc degeneration, and it is wrong to call it the whole spectrum of degenerative diseases of the spine.

In ICD10, degenerative diseases of the spine are included in the class "diseases of the musculoskeletal system and connective tissue (M00-M99)", while highlighting: "arthropathies (M00-M25); systemic lesions of the connective tissue (M30-M36); dorsopathy (M40- M54); soft tissue diseases (M60-M79); osteopathies and chondropathy (M80-M94); other disorders of the muscular system and connective tissue (M95-M99)." The term "dorsopathies" refers to pain syndromes in the trunk and extremities of non-visceral etiology and associated with degenerative diseases of the spine. Thus, the term "dorsopathies" in accordance with ICD10 should replace the term "osteochondrosis of the spine" still used in our country.

Dorsopathies in ICD10 are divided into deforming dorsopathies, spondylopathies, other dorsopathies (degeneration of intervertebral discs, sympathetic syndromes) and dorsalgia. In all cases, the basis for the diagnosis should be the data of clinical examination and radiological diagnostics (spondylography, X-ray computed tomography or magnetic resonance imaging of the spine). Dorsopathies are characterized by a chronic course and periodic exacerbations of the disease, in which various pain syndromes are leading.

Various structures of the spinal motion segments can be involved in the degenerative process: intervertebral disc, facet joints, ligaments and muscles. In cases of concomitant damage to the spinal roots or spinal cord, there may be focal neurological syndromes.

Deforming dorsopathies

The section "deforming dorsopathies (M40-M43)" includes:

Excludes: due to damage to the intervertebral disc (M51.-) M54.8 Dorsalgia other M54.9 Dorsalgia, unspecified

M70.9 Soft tissue disorders associated with exercise, overload and pressure, unspecified M79.1 Myalgia

Excludes: myositis (M60.-)

M70.9 Unspecified stress-, overload- and pressure-related soft tissue disorders

Dorsalgia (M54)

[localization code see above]

Neuritis and sciatica:

• shoulder NOS
• lumbar NOS
• lumbosacral NOS
• thoracic NOS

Excluded:

• radiculopathy with:
  • spondylosis (M47.2)

Excluded:

• sciatica:
  • with lumbago (M54.4)

Tension in the lower back

Excludes: lumbago:

• with sciatica (M54.4)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Dorsopathy and back pain

4. Spondylolisthesis

Spondylolisthesis - displacement of the vertebra located above in relation to the lower one (Greek Spondylos - vertebra; Greek Olisthesis - slipping, displacement).

ICD-10 code: M43.1 - Spondylolisthesis.

Spondylolisthesis is diagnosed in 5% of people, but clinically manifests itself even less often, although such changes can cause spinal cord compression and severe neurological disorders. Distinguish:

• Anterior spondylolisthesis (the upper vertebra moves down and forward) is the most common.
• Posterior or retrograde spondylolisthesis (the overlying vertebra moves downward and backward) is extremely rare.

The most common location for spondylolisthesis is the lumbosacral level (L5). Spondylolisthesis at a higher level occurs in single observations. The main goal of surgical treatment is to stabilize the displaced vertebra by forming a bone block (spinal fusion).

5. Pathological fractures in osteoporosis

Osteoporosis is characterized by a decrease in bone density, leading to bone fragility and the risk of fractures (spontaneous or with minimal trauma). Osteoporosis is usually asymptomatic. Back pain in osteoporosis is caused by compression fractures of the vertebral bodies (in particular, this is one of the complications of manual therapy), more often in the thoracic region. It is one of the leading causes of back pain in the elderly. Kyphosis is also formed, leading to painful hypertonicity of the back muscles.

ICD-10 code: M80 - Osteoporosis with a pathological fracture.

There are the following types of osteoporosis:

• Postmenopausal osteoporosis (type I) - the most common form in women, is associated with the cessation of estrogen secretion.
• Senile osteoporosis (type II) - occurs in people older than 70 years of both sexes.
• Secondary osteoporosis is associated with long-term corticosteroid therapy, impaired calcium absorption, the presence of endocrine (thyrotoxicosis, hyperparathyroidism, etc.), oncological, rheumatic diseases, etc.

Taking non-steroidal anti-inflammatory drugs does not always effectively relieve pain in osteoporosis. Miacalcic has a good analgesic effect.

6. Spinal stenosis

Spinal stenosis is a narrowing of the lumen of the spinal canal. Back pain occurs due to compression of nerve structures.

ICD-10 code. M48.0 - Spinal stenosis.

Spinal stenosis can be either acquired or congenital. Diagnosis is confirmed by CT or MRI. The main causes of spinal stenosis:

• congenital narrowness of the spinal canal
• bulging of the posterior part of the fibrous ring into the lumen of the canal

The most common manifestation of spinal stenosis is neurogenic (caudogenic) intermittent claudication. Unlike vascular ischemia, neurogenic claudication is not relieved by cessation of walking; the pain stops when the patient sits or lies down. With a vascular nature, the intensity of pain is somewhat less, localization is mainly in the calves; with stenosis, the pain is significant, sometimes unbearable, localized in the lower back, buttocks and hips.

Symptoms increase with hyperextension of the lumbar spine and decrease with flexion. Therefore, at a late stage of the disease, many patients walk, leaning forward. With spinal stenosis, numbness, paresthesia, and weakness of the legs are also noted.

7. Inflammatory and non-inflammatory lesions of the spine

• Vertebral fractures, tumors and metastases of cancer of various localization in the vertebrae (extramedullary, intramedullary tumor of the spinal cord, metastatic cancer, tumor of the cauda equina.
  • A benign tumor of the spine osteoid osteoma has a peculiar symptomatology: back pain intensifies after drinking alcohol and decreases after taking aspirin. ICD-10 code: D16.
• Inflammatory processes: syphilitic meningomyelitis, tuberculous spondylitis, osteomyelitis, epidural abscess, etc.
  • Tuberculous spondylitis is often localized in the cervical spine (40% of cases of tuberculous bone lesions). Tuberculous spondylitis is characterized by strict localization of the pathological process at one level, abundant tissue decay, especially of the intervertebral disc, and sequestration quickly occur, which leads to destruction. ICD-10 code: M49.0.
  • Epidural abscess is most often caused by Staphylococcus aureus with hematogenous infection or with direct spread in the area of ​​osteomyelitis of the spine (in 30% of cases, epidural abscess develops against the background of osteomyelitis of the spine). If the preoperative paralysis lasts more than 48 hours (delay in diagnosis and treatment!), then there is unlikely to be a subsequent recovery of function. ICD-10 code: G07.
• Bechterew's disease (ankylosing spondylitis). Sacroiliitis and back pain are more common in ankylosing spondylitis, but similar changes can be seen in other seronegative arthritis. When conducting a differential diagnosis, one should take into account the nature of the damage to the peripheral joints and extra-articular manifestations. ICD-10 code: M45.
• Ankylosing hyperostosis Forestier, unlike ankylosing spondylitis, begins in old age. X-ray changes: calcification of the anterior longitudinal ligament and the formation of rather coarse osteophytes along the edges of the vertebral bodies. Sacroiliitis and laboratory signs of inflammatory activity are absent. ICD-10 code: M48.1 - Ankylosing hyperostosis Forestier.
• Paget's disease (deforming osteodystrophy). ICD-10 code: M88.
• Myeloma (Rustitzky's disease). ICD-10 code: C90.
• Scheuermann-Mau disease can cause pain in the spine in young people. Osteochondropathy of the apophyses (growth zones) of the vertebral bodies leads to a curvature of the spine (juvenile kyphosis). Clinically: fatigue, back pain when straightening the spine, pressure. Sacroiliitis and laboratory signs of inflammatory activity are absent.
• Rheumatoid arthritis. Pain that occurs in the spine is usually not associated with the underlying disease. However, sometimes pain in the neck can be induced by inflammation of the atlanto-axial joint, leading to a violation of its stability and the formation of subluxation. ICD-10 code: M05 and M06.

8. Referred pain

Reflected back pain is caused by the spread of pain impulses from the internal organs. These symptoms can be caused by:

• Diseases of the broncho-pulmonary system and pleura (acute pneumonia, pleurisy, etc.)
• Pathology of the abdominal cavity (pancreatitis or pancreatic tumor, cholecystitis, peptic ulcer of the stomach and duodenum, irritable bowel syndrome, etc.)
• Kidney diseases (urolithiasis, pyelonephritis, hypernephroma, etc.)
• Diseases of the pelvic organs (prostatitis and prostate cancer, endometriosis, chronic inflammatory gynecological processes, varicose veins of the small pelvis, fibromyoma of the uterine body and uterine cancer)
• Abdominal aortic aneurysm, Leriche's syndrome, massive hemorrhages in the retroperitoneal tissue (for example, while taking anticoagulants).

Contents of the file Dorsopathy and back pain:

Inflammatory, non-inflammatory lesions of the spine. Reflected pain.

Back pain according to ICD-10

Excludes: cervicalgia due to intervertebral disc disorder (M50.-)

M54.5 Pain in the lower back

Due to displacement of the intervertebral disc (M51.2)

M54.6 Pain in thoracic spine

Excludes: due to damage to the intervertebral disc (M51.-)

M54.8 Dorsalgia other

M54.9 Dorsalgia, unspecified

Excludes: myositis (M60.-)

M70.8 Other soft tissue disorders associated with exercise, overload and pressure

M70.9 Unspecified stress-, overload- and pressure-related soft tissue disorders

M76.0 Gluteal tendinitis

M76.1 Lumbar tendonitis

M77.9 Enthesopathy, unspecified

M54.0 Panniculitis affecting cervical and spine

Recurrent [Weber-Christian] (M35.6)

M42.0 Juvenile osteochondrosis of the spine

Excludes: positional kyphosis (M40.0)

M42.1 Osteochondrosis of the spine in adults

M42.9 Osteochondrosis of spine, unspecified

M51.4 Schmorl's nodes [hernia]

Note: In this block, the term "osteoarthritis" is used as a synonym for the term "arthrosis" or "osteoarthritis". The term "primary" is used in its usual clinical sense.

Excludes: osteoarthritis of the spine (M47 -)

Ml 5 Polyarthrosis

Inclusions: arthrosis of more than one joint Excludes: bilateral involvement of the same joints (Ml 6-M 19)

M49.4* Neuropathic spondylopathy

damage to the intervertebral disc of the cervical spine with pain syndrome

damage to the intervertebral discs of the cervicothoracic region

M50.0+ Damage to the intervertebral lis of the cervical region with myelopathy (G99.2*)

M50.1 Cervical intervertebral disc disease with radiculopathy

Excludes: sciatica NOS (M54.1)

M50.2 Displacement of cervical intervertebral disc of other type

M50.3 Other cervical intervertebral disc degeneration

M50.8 Other lesions of cervical intervertebral disc

M50.9 Disorder of cervical intervertebral disc, unspecified

M51 Damage to intervertebral discs of other departments

Includes: involvement of the intervertebral discs of the thoracic, lumbothoracic and lumbosacral regions

M51.0+ Disorders of lumbar and other intervertebral discs with myelopathy (G99.2*)

M51.1 Disorders of lumbar and other intervertebral discs with radiculopathy

Excludes: lumbar sciatica NOS (M54.1)

M51.2 Other specified displacement of intervertebral disc

M51.3 Other specified intervertebral disc degeneration

M51.8 Other specified lesion of intervertebral disc

M51.9 Disorder of intervertebral disc, unspecified

neuralgia and neuritis NOS (M79.2) radiculopathy with:

Damage to the intervertebral disc of the lumbar and other cases (M51.1)

Damage to the intervertebral disc of the cervical region (M50.1)

Sciatica NOS, shoulder NOS, lumbosacral NOS (M54.1). sciatica (M54.3-M54.4)

Caused by intervertebral disc disease (M51.1)

lesion of the sciatic nerve (G57.0) M54.4 Lumbago with sciatica

Excludes: due to intervertebral disc disease (M51.1)

M99.7 Connective tissue and disc stenosis of intervertebral foramens

M48.0 Spinal stenosis

Arachnoiditis (spinal) NOS

Inclusions: arthrosis or osteoarthritis of the spine facet joint degeneration

M47.0+ Compression syndrome of anterior spinal or vertebral artery (G99.2*)

M47.1 Other spondylosis with myelopathy

Excludes: vertebral subluxation (M43.3-M43.5)

M47.2 Other spondylosis with radiculopathy

M47.8 Other spondylosis

M47.9 Spondylosis, unspecified

M43.4 Other habitual antlanto-axial subluxations

M43.5 Other habitual vertebral subluxations

Excludes: biomechanical damage to the NKD (M99 -)

M88.0 Cranial involvement in Paget's disease

M88.8 Involvement of other bones in Paget's disease M

88.9 Paget's disease (of bones), unspecified

Inclusions: morphological codes M912-M917 with pattern code /O

Excludes: blue or pigmented nevus (D22.-)

Q28.8 Other specified congenital malformations of circulatory system

Congenital aneurysms of specified localization

Acute spinal cord infarction Arterial thrombosis of the spinal cord Hematomyelia

Non-pyogenic vertebral phlebitis and thrombophlebitis

Spinal edema

Subacute necrotizing myelopathy

If it is necessary to clarify the infectious agent, use an additional code (B95-B97).

D36 Peripheral nerves and autonomic nervous system

D42 Neoplasm of uncertain or unknown pattern of meninges

D43 Neoplasm of uncertain or unknown nature of brain and central nervous system

522.1 Multiple fractures of the thoracic spine

M46.2 Osteomyelitis of the vertebrae

M46.3 Intervertebral disc infection (pyogenic) Use additional code (B95-B97) if necessary to identify infectious agent

M46.4 Discitis, unspecified

M46.5 Other infectious spondylopathies

M46.8 Other specified inflammatory spondylopathies

M46.9 Inflammatory spondylopathies, unspecified

M49* Spondylopathies in diseases classified elsewhere

Excludes: psoriatic and enteropathic arthropathies (M07.-*, M09.-*)

M49.0* Spinal tuberculosis (A18.0+) M49.1* Brucellosis spondylitis (A23.-+)

M49.2* Enterobacterial spondylitis (A01-A04+)

Excludes: neuropathic spondylopathy in tassel dorsalis (M49.4*)

M49.5* Destruction of the spine in diseases classified elsewhere

M49.8* Spondylopathies in other diseases classified elsewhere

Pain in the lower back

Definition and background[edit]

The term "pain in the lower back" means pain, muscle tension or stiffness, localized in the region of the back between the XII pair of ribs and the gluteal folds, with or without radiating to the lower extremities.

Pain in the lower back is one of the most common complaints of patients in general medical practice. According to a number of researchers, 24.9% of active requests for outpatient care of people of working age are associated with this condition. Particular interest in the problem of pain in the lower back is primarily due to its wide prevalence: at least once in a lifetime, at least 80% of the adult population of the globe experience these pains; approximately 1% of the population is chronically disabled and 2 times more is temporarily disabled due to this syndrome. At the same time, more than 50% of patients note a decrease in working capacity in the presence of pain in the lower back.

Pain in the lower back as a clinical manifestation is found in almost a hundred diseases, and, perhaps, therefore, there is no generally accepted classification of pain in the lower back. Practically all anatomical structures of the lumbosacral region, the abdominal cavity and the organs of the small pelvis can be the source of pain impulses in this area.

Based on pathophysiological mechanisms, the following types of pain in the lower back are distinguished:

Nociceptive pain occurs when pain receptors - nociceptors are stimulated due to damage to the tissues in which they are located. Accordingly, the intensity of nociceptive pain, as a rule, depends on the degree of tissue damage and the duration of exposure to the damaging factor, and its duration depends on the characteristics of the healing processes. Pain can also occur in case of damage or dysfunction of the structures of the central nervous system and / or the peripheral nervous system involved in the conduction and analysis of pain signals, i.e. when nerve fibers are damaged at any point from the primary afferent conduction system to the cortical structures of the central nervous system. It persists or occurs after the healing of damaged tissue structures, therefore, it is almost always chronic and does not have protective functions.

neuropathic called the pain that occurs when damage to the peripheral structures of the nervous system. When the structures of the central nervous system are damaged, central pain occurs. Sometimes neuropathic back pain is divided into radicular (radiculopathy) and non-radicular (sciatic neuropathy, lumbosacral plexopathy).

Psychogenic and somatoform pain occurs regardless of somatic, visceral or neurological damage and is determined mainly by psychological factors.

The scheme that has most taken root in our country divides pain in the lower back into two categories - primary and secondary:

Primary pain in the lower back - a pain syndrome in the back caused by dystrophic and functional changes in the tissues of the musculoskeletal system (facet joints, intervertebral discs, fascia, muscles, tendons, ligaments) with possible involvement of adjacent structures (roots, nerves). The main causes of the primary syndrome of pain in the lower back are mechanical factors that are determined in 90-95% of patients: dysfunction of the musculoskeletal apparatus; spondylosis (in foreign literature it is a synonym for osteochondrosis of the spine); herniated disc.

Secondary pain in the lower back due to the following main reasons:

Other diseases of the spine;

Projection pain in diseases of internal organs;

Diseases of the urinary organs.

On the other hand, A.M. Wayne divided the causes of back pain into two large groups - vertebrogenic and non-vertebrogenic.

By duration

Acute (up to 12 weeks);

Chronic (over 12 weeks).

Recurrent back pain occurring at intervals of at least 6 months after the end of the previous exacerbation;

Exacerbations of chronic back pain, if the specified interval is less than 6 months.

By specificity pain in the lower back is divided into:

At the same time, non-specific - as a rule, such acute pain, in which it is impossible to make an accurate diagnosis and there is no need to strive for this.

In turn, specific pain is determined in cases where pain in the lower back is a symptom of a certain nosological form, often threatening the further health and / or even life of the patient.

Etiology and pathogenesis[edit]

Clinical manifestations[edit]

Pain in the lower back, in its characteristics, has practically no differences from other pains, except for its localization. As a rule, the peculiarity of pain is determined by the organs or tissues, the pathology or damage of which led to its appearance, neurological disorders, as well as the psycho-emotional state of the patient himself.

In clinical terms, three types of back pain should be distinguished:

Local pain occurs at the site of tissue damage (skin, muscles, fascia, tendons and bones). Usually they are characterized as diffuse, and they are permanent.

Most often, they include musculoskeletal pain syndromes, among which are:

Myofascial pain syndrome;

Syndrome of segmental instability of the spine.

Muscular tonic syndrome occurs, as a rule, after prolonged isometric muscle tension due to a certain motor stereotype, exposure to cold, pathology of internal organs. Prolonged muscle spasm, in turn, leads to the appearance and intensification of pain, which enhances the spastic reaction, which further intensifies pain, etc., that is, the so-called "vicious circle" is launched. Most often, musculotonic syndrome occurs in the muscles that straighten the spine, in the piriformis and gluteus medius muscles.

Myofascial pain syndrome

It is characterized by local non-specific muscle pain due to the appearance of foci of increased irritability (trigger points) in the muscle, and it is not associated with damage to the spine itself. Its causes may be, in addition to congenital anomalies of the skeleton and prolonged muscle tension during antiphysiological postures, trauma or direct compression of the muscles, their overload and stretching, as well as the pathology of internal organs or mental factors. The clinical feature of the syndrome, as already mentioned, is the presence of trigger points corresponding to zones of local muscle compaction - areas in the muscle, the palpation of which provokes pain in the area remote from pressure. Trigger points can be activated by an “unprepared” movement, a minor injury to this area, or other external and internal influences. There is an assumption that the formation of these points is due to secondary hyperalgesia against the background of central sensitization. In the genesis of trigger points, damage to the peripheral nerve trunks is also not ruled out, since anatomical proximity between these myofascial points and peripheral nerve trunks is noted.

The following criteria are used to diagnose the syndrome.

Major criteria (requires all five):

Complaints about regional pain;

Palpable "tight" cord in the muscle;

Area of ​​hypersensitivity within the "tight" strand;

Characteristic pattern of referred pain or sensory disturbances (paresthesias);

Limitation of range of motion.

Minor criteria (one of three is enough):

Reproducibility of pain or sensory disturbances during stimulation (palpation) of trigger points;

Local contraction on palpation of the trigger point or injection of the muscle of interest;

Reducing pain with muscle strain, therapeutic blockade or dry needle injection.

A classic example of myofascial pain syndrome is the piriformis syndrome.

The source of back pain in this syndrome is the facet joints or sacroiliac joints. Usually, this pain is mechanical in nature (increased with exercise, decreases at rest, its intensity increases in the evening), especially it is aggravated by rotation and extension of the spine, which leads to localized pain in the area of ​​the affected joint. Pain may radiate to the groin, coccyx, and outer thigh. A positive effect is given by blockades with a local anesthetic in the projection of the joint. Sometimes (up to about 10% of cases) arthropathic pain is inflammatory, especially in the presence of spondyloarthritis. In such cases, patients complain, in addition to "blurred" pain in the lumbar localization, limitation of movement and stiffness in the lumbar region, which are more pronounced in the morning.

Segmental spinal instability syndrome

Pain in this syndrome occurs due to the displacement of the body of a vertebra relative to the axis of the spine. It occurs or increases with prolonged static load on the spine, especially when standing, and often has an emotional coloring, defined by the patient as "fatigue in the lower back." Often this pain is found in individuals with hypermobility syndrome and in middle-aged women with signs of moderate obesity. As a rule, with segmental instability of the spine, flexion is not limited, but extension is difficult, in which patients often resort to the help of their hands, "climbing on their own."

Reflected pain- pain that occurs when damage (pathology) of internal organs (visceral somatogenic) and is localized in the abdominal cavity, small pelvis, and sometimes in the chest.

Projected pains are widespread or precisely localized, and according to the mechanism of their occurrence, they are classified as neuropathic. They occur when the nerve structures that conduct impulses to the pain centers of the brain are damaged. Radicular, or radicular, pains - a kind of projected pains, usually have a shooting character. They can be dull and aching, but movements that increase irritation of the roots significantly increase the pain: it becomes sharp, cutting. Almost always, radicular pain radiates from the spine to some part of the lower limb, often below the knee joint. Bending the torso forward or lifting straight legs, other provoking factors (coughing, sneezing), leading to increased intravertebral pressure and displacement of the roots, increase radicular pain.

Lower back pain: Diagnosis[edit]

Differential diagnosis[edit]

Differentiation of local, reflected and projection pains:

1. Local pain

The nature of the feeling: Precise indication of the area of ​​pain

Movement disorders

Provoking factors: Movement exacerbates pain

: Sources of pain are found in the tissues of the musculoskeletal system (muscles, tendons); pressing on them makes the pain worse

2. Referred pain

The nature of the feeling: Fuzzy sensation from inside out

Movement disorders: Movement is not limited

Provoking factors: Movement does not affect pain

Palpation of the area of ​​pain: Sources of pain cannot be found

3. Projection pain

The nature of the feeling: Spread of pain along a root or nerve

Movement disorders: Limited range of motion of the neck, trunk, limbs

Provoking factors: Movement of the head, torso increases pain, axial load causes shooting pain along the spine

Palpation of the area of ​​pain: Sources of pain are located in the back, they are absent in the limbs.

Lower back pain: Treatment[edit]

Treatment for low back pain can be divided into two categories.

The first is used in the presence of a potentially dangerous pathology, and it should be carried out only by narrow specialists.

The second - when there is non-specific pain in the lower back without "signs of danger" - can be carried out by therapists and general practitioners, it should be aimed at relieving the pain syndrome as quickly as possible.

NSAIDs are the main drugs prescribed to reduce the intensity of pain. At the same time, it must be emphasized: there is no evidence in favor of the fact that any NSAID is clearly more effective than others; in addition, there is insufficient evidence regarding the effectiveness of the treatment of chronic low back pain with their help.

Another aspect is the use of muscle relaxants. These drugs are classified as auxiliary analgesics (coanalgesics). Their use is justified in pain myofascial syndromes and spasticity of various origins, especially in acute pain. In addition, with myofascial syndromes, they allow you to reduce the dose of NSAIDs and achieve the desired therapeutic effect in a shorter time. If the pain in the lower back is chronic, the effectiveness of prescribing muscle relaxants has not been proven. This group of drugs includes primarily centrally acting drugs - tizanidine, tolperisone and baclofen.

It should also be noted that almost all types of physical effects, including electrotherapy, are considered doubtful and their clinical effectiveness in reducing pain intensity has not been proven. The only exception is exercise therapy, which really allows you to speed up recovery and prevent relapses in patients with chronic low back pain.

Prescribing bed rest for acute pain in the lower back is harmful. It is necessary to convince the patient that the continuation of daily physical activity is not dangerous, and advise him to start work as soon as possible. The only exception is patients with compression radiculopathy, in whom in the acute period it is necessary to achieve maximum unloading of the lumbosacral spine, which is easier to achieve with the help of bed rest (for 1-2 days) with the simultaneous appointment, in addition to analgesic therapy, and diuretics with vasoactive drugs for reduce swelling and improve microcirculation.

Dorsalgia

[localization code see above]

Excludes: psychogenic dorsalgia (F45.4)

Panniculitis affecting the cervical region and spine

radiculopathy

Neuritis and sciatica:

• shoulder NOS
• lumbar NOS
• lumbosacral NOS
• thoracic NOS

Excluded:

• neuralgia and neuritis NOS (M79.2)
• radiculopathy with:
  • injury of the intervertebral disc of the cervical region (M50.1)
  • lesions of the intervertebral disc of the lumbar and other parts (M51.1)
  • spondylosis (M47.2)

cervicalgia

Excludes: cervicalgia due to intervertebral disc disease (M50.-)

Sciatica

Excluded:

• lesion of the sciatic nerve (G57.0)
• sciatica:
  • due to intervertebral disc disease (M51.1)
  • with lumbago (M54.4)

Lumbago with sciatica

Excludes: due to intervertebral disc disease (M51.1)

Pain in the lower back

Tension in the lower back

Excludes: lumbago:

• due to displacement of the intervertebral disc (M51.2)
• with sciatica (M54.4)

Pain in the thoracic spine

Excludes: due to damage to the intervertebral disc (M51.-)

Back pain mcb 10

A striking discovery in the treatment of osteochondrosis

The studio was amazed at how easy it is to FULLY get rid of Osteochondrosis now.

It has long been firmly believed that it is impossible to get rid of osteochondrosis for good. To feel relief, you need to continuously drink expensive pharmaceuticals. Is it really? Let's figure it out!

Alexander Myasnikov in the program "About the most important thing" tells how to cure osteochondrosis.

Hello, I'm Dr. Myasnikov. And we start the program "About the most important thing" - about our health. I want to emphasize that our program is educational in nature. Therefore, do not be surprised if something seems unusual or unusual to you. So let's get started!

Osteochondrosis is a chronic disease of the spine that affects the intervertebral discs and cartilage. This common disease occurs in most people over the age of 40. The first signs of the disease often appear on the fly. Osteochondrosis of the spine is considered the main cause of back pain. It has been established that 20-30% of the adult population suffer from osteochondrosis. With age, the prevalence of the disease increases and reaches 50-65%.

It has been said more than once about the problems of the spine and cervical region. Much has been said about methods of preventing osteochondrosis! Basically it is a healthy diet, a healthy lifestyle, physical education.

Alexander Myasnikov: the causes of osteochondrosis are different

And what methods should be used to fight osteochondrosis?

Expensive drugs and devices are measures that only temporarily help relieve pain. Moreover, drug intervention in the body depresses the liver, kidneys and other organs. Surely those who have osteochondrosis know about these problems.

Alexander Myasnikov: who faced the side effects of drugs for osteochondrosis?

Raise your hands, who has experienced the side effects of drugs for high blood pressure?

Well, the forest of hands. We, in our program, often talk about surgery and medical procedures, but very rarely touch on folk methods. And not just recipes from grandmothers, but those recipes that have been recognized in the scientific community, and, of course, recognized by our viewers.

Today we will talk about the effects of medicinal teas and herbs on osteochondrosis.

Surely you are now wondering how tea and herbs can help us cure this disease?

If you remember, a few issues ago I talked about the possibility of "launching" the regeneration of the body, by influencing certain cell receptors. Thus, the causes of spinal disease are eliminated.

And how does it work, you ask? Will explain. Tea therapy, with the help of specific substances and antioxidants, affects certain cell receptors that are responsible for its regeneration and performance. There is a "rewriting" of information about diseased cells to healthy ones. As a result, the body begins the process of healing (regeneration), namely, it returns, as we say, to the “point of health”.

At the moment, there is a unique center that collects "Monastic Tea" - a small monastery in Belarus. There is a lot of talk about him both on our channel and on others. And for good reason, I tell you! This is not some simple tea, but a unique collection of the rarest and most powerful natural healing herbs and substances. This tea proved its effectiveness not only to patients, but also to science, which recognized it as an effective drug.

Herbal tea will help get rid of osteochondrosis!

Osteochondrosis goes away in 5-10 days, as studies have shown. The main thing is to strictly follow the instructions in the instructions! The method is absolutely working, I vouch for my reputation!

Due to the complex effect at the cellular level, tea therapy helps to cope even with such terrible diseases as diabetes, hepatitis, prostatitis, psoriasis, and hypertension.

We invited Anastasia Ivanovna Koroleva, one of the thousands of patients who were helped by Monastic Tea, to the studio.

Alexander Myasnikov: “Anastasia Ivanovna, tell us more about the treatment process?”

Anastasia Ivanovna Koroleva

A. Koroleva: “Every day I felt better. Osteochondrosis receded by leaps and bounds! In addition, there was a general improvement of the body: the ulcer stopped bothering me, I could afford to eat almost everything I wanted. I believed! I realized that this is the only way out for me! Then it was all over, the headaches were gone. At the end of the course, I became absolutely healthy! Fully!! The main thing in tea therapy is a complex effect.

Classical treatment does NOT remove the root cause of the disease, but only fights its external manifestations. And “Monastic Tea” restores the entire body, while our doctors are always bombarded with complex, incomprehensible terms and are constantly trying to impose expensive drugs that are of no use ... As I said, I tried it all on myself personally.

Natural remedy for osteochondrosis

Alexander Myasnikov: “Thank you, Anastasia Ivanovna!”

As you can see, the path to health is not so difficult.

Be careful! We recommend ordering the original "Monastic Tea" against osteochondrosis only on the official website, which we have checked. This product has all the necessary certificates, its effectiveness has been clinically confirmed.

Be healthy and see you soon!

Alexander Myasnikov, the program "About the most important thing."

Excluded:

• sciatica:
  • with lumbago (M54.4)

Tension in the lower back

Excludes: lumbago:

• with sciatica (M54.4)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Dorsalgia

[localization code see above]

Excludes: psychogenic dorsalgia (F45.4)

Panniculitis affecting the cervical region and spine

radiculopathy

Neuritis and sciatica:

• shoulder NOS
• lumbar NOS
• lumbosacral NOS
• thoracic NOS

Excluded:

• neuralgia and neuritis NOS (M79.2)
• radiculopathy with:
  • injury of the intervertebral disc of the cervical region (M50.1)
  • lesions of the intervertebral disc of the lumbar and other parts (M51.1)
  • spondylosis (M47.2)

cervicalgia

Excludes: cervicalgia due to intervertebral disc disease (M50.-)

Sciatica

Excluded:

• lesion of the sciatic nerve (G57.0)
• sciatica:
  • due to intervertebral disc disease (M51.1)
  • with lumbago (M54.4)

Lumbago with sciatica

Excludes: due to intervertebral disc disease (M51.1)

Pain in the lower back

Tension in the lower back

Excludes: lumbago:

• due to displacement of the intervertebral disc (M51.2)
• with sciatica (M54.4)

Pain in the thoracic spine

Excludes: due to damage to the intervertebral disc (M51.-)

Dorsalgia, unspecified

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ICD-10 disease classes

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International Statistical Classification of Diseases and Related Health Problems.

Dorsalgia (ICD code M54)

Excludes: cervicalgia due to intervertebral disc disease (M50.-)

M54.4 Lumbago with sciatica

Excludes: due to intervertebral disc disease (M51.1)

M54.5 Lower back pain

Excludes: due to damage to the intervertebral disc (M51.-)

M54.8 Dorsalgia other

M54.9 Dorsalgia, unspecified

Back pain NOS

Dorsalgia Code ICD M54

In the treatment of Dorsalgia, drugs are used:

The International Statistical Classification of Diseases and Related Health Problems is a document used as a leading framework in public health. The ICD is a normative document that ensures the unity of methodological approaches and international comparability of materials. The International Classification of Diseases of the Tenth Revision (ICD-10, ICD-10) is currently in force. In Russia, health authorities and institutions carried out the transition of statistical accounting to the ICD-10 in 1999.

©g. ICD 10 - International Classification of Diseases 10th revision

Dorsalgia: symptoms and treatment

Dorsalgia - the main symptoms:

• Headache
• Lower back pain
• Abdominal pain
• Dizziness
• Chest pain
• muscle weakness
• Pain in the spine
• Numbness of the limbs
• Hearing loss
• Spread of pain to other areas
• Pain in the lower extremities
• Redness of the skin at the site of injury
• Pain in the buttocks
• visual impairment
• Swelling in the affected area
• Decreased muscle tone
• Motor dysfunction
• Tingling in the limbs

Dorsalgia - in fact, is the fact of the presence of pain of varying degrees of intensity in the back. From this it follows that this is not a separate pathology, but a syndrome that occurs in any age category and regardless of gender.

In almost all cases, the source of such a disorder is the course of a disease that affects the skeletal system or the spinal column. In addition, clinicians also distinguish the category of predisposing factors.

As for the symptoms, it will be dictated by the ailment that served as the source of dorsalgia. The main clinical manifestation is pain syndrome, against which other symptoms gradually develop.

The clinician will be able to make a diagnosis of dorsalgia based on the data of instrumental examinations of the patient, which can also be supplemented by a physical examination and laboratory tests.

The tactics of therapy are dictated by the etiological factor, but are often based on conservative methods.

The International Classification of Diseases of the Tenth Revision has singled out a separate value for such a syndrome. The ICD 10 code is M 54. However, it is worth noting that unspecified dorsalgia has a value of M 54.9.

Etiology

A large number of predisposing factors can cause the appearance of pain in the back or dorsalgia, which is why they are usually divided into several groups.

• osteomyelitis is an infectious-inflammatory disease that primarily affects the area of ​​the bone marrow, after which it spreads to the bone tissue;
• benign or malignant neoplasms, as well as cancer metastasis;
• osteochondrosis - in this case, a hernia of the intervertebral disc is formed;
• osteoporosis - for such a pathology, increased fragility of all bones is characteristic;
• spondylolisthesis - in such cases, there is a displacement of one vertebra in relation to the rest;
• curvature of the spine;
• spondylarthrosis;
• bone tuberculosis;
• protrusion;
• narrowing of the lumen of the spinal canal;
• fractures and injuries.

The second group of causes includes muscle diseases, among which it is worth highlighting:

Dorsalgia can also be due to:

• hemorrhages in the pelvic area;
• hematomas located in the retroperitoneal space, in which a purulent process occurs;
• injuries and ailments of the pelvic organs;
• pathologies of the digestive tract and kidneys;
• aortic dissection;
• herpes zoster;
• rheumatological disorders.

In addition, there are such risk factors:

• extensive injuries;
• lifting weights by a physically weak person;
• prolonged stay in an uncomfortable position;
• prolonged hypothermia of the body.

In addition, in females, dorsalgia can be caused by the period of bearing a child and the course of menstruation.

Classification

Depending on the location of pain, there are the following forms of this syndrome:

• cervicalgia - has the second name "dorsalgia of the cervical spine";
• lumbodynia - while the pain is localized in the lumbar region, which is why the disorder is also known as dorsalgia of the lumbar spine;
• thoracalgia - differs in that the main symptomatology does not go beyond the sternum region, which means that in such cases dorsalgia of the thoracic spine will be diagnosed.

According to the duration of the expression of unpleasant sensations, the syndrome can occur in several forms:

• acute dorsalgia - is such if the pain bothers patients for no more than a month and a half. It differs in that it has a more favorable prognosis, in comparison with a sluggish variety;
• chronic dorsalgia - is diagnosed if pain in a particular part of the spine persists for more than twelve weeks. Such a course is fraught with loss of working capacity or disability of a person.

By origin, such a violation has two types:

• vertebrogenic dorsalgia - characterized by the fact that it is directly related to injury or diseases of the spine;
• non-vertebrogenic dorsalgia - the occurrence of this variety is caused by other etiological factors, for example, somatic ailments or psychogenic causes.

Symptoms

The clinical manifestations of dorsalgia consist in the expression of a pain syndrome, which can be both permanent and paroxysmal, aching or sharp. However, in all cases, the pain is aggravated by physical activity.

Against the background of the fact that such a syndrome develops due to the course of various diseases, it is natural that the symptoms in each case will be different.

With the course of rheumatological pathologies, the clinical manifestations will be as follows:

• localization of pain in the lumbar region;
• irradiation of discomfort in the buttocks and thighs;
• increased pain with prolonged rest;
• bilateral spinal injury.

In cases where infectious processes have become the source, then among the characteristic symptoms will be:

• sharp pain throughout the spinal column;
• foci of pain in the lower back, buttocks or lower extremities;
• swelling and redness of the skin in the problem area.

With muscle pathologies that caused dorsalgia of the spine, the symptoms will be as follows:

• distribution of pain on the left or right side of the body;
• increased pain during climate change or in cases of stressful situations;
• the occurrence of painful points located in various areas of the body, which are detected by accidental pressure on them;
• muscle weakness.

With osteochondrosis and spondylarthrosis, clinical signs are presented:

• back pain - exacerbation is observed when turning or bending;
• discomfort that occurs when you stay in one position for a long time;
• numbness or tingling of the hands or feet;
• decreased muscle tone;
• headaches and dizziness;
• impaired hearing or vision;
• tonic syndrome;
• movement disorders.

In cases of damage to other internal organs, the following will be expressed:

• abdominal pain and frequent urination - with kidney pathologies;
• girdle nature of pain - in diseases of the gastrointestinal tract;
• pain in the chest and under the shoulder blades - with lung diseases.

Diagnostics

If you experience back pain or dorsalgia, you should seek qualified help from a neurologist. It is this specialist who will conduct the initial diagnosis and prescribe additional examinations.

Thus, the first stage of diagnosis includes:

• collection of a life history and analysis of the patient's medical history - this will help determine which pathological condition provoked the appearance of such a syndrome. Symptoms and treatment will differ depending on the identified ailment;
• general physical examination aimed at palpation of the spine and assessment of the range of motion in it;
• a detailed survey of the patient - to establish the nature of pain, the presence and severity of additional symptoms.

Laboratory diagnostic measures are limited to the implementation of a general clinical analysis of blood and urine.

The most valuable during the establishment of the correct diagnosis are the following instrumental examinations of the patient:

• radiography - to detect pathological changes in the vertebrae;
• electromyography - will detect muscle pathologies;
• densitometry - determines the density of bone tissue;
• CT and MRI - for a more detailed picture of the spine. It is thanks to this that it is possible to distinguish non-vertebrogenic dorsalgia from the syndrome of vertebrogenic genesis;
• radioisotope bone scintigraphy - in this case, the radiopaque substance is distributed over the bones. The presence of foci of excessive accumulation will indicate the localization of the pathology, for example, the sacral spine.

In addition, you may need advice:

Treatment

In the vast majority of cases, elimination of the underlying disease is sufficient to relieve back pain.

Nevertheless, the treatment of dorsalgia involves the use of a whole range of conservative techniques, including:

• observance of bed rest from two to five days;
• wearing a special bandage designed to relieve the load from the spine;
• taking non-steroidal anti-inflammatory drugs - orally, by injection or use as ointments;
• the use of muscle relaxants - these are drugs that relax muscles;
• course of therapeutic massage;
• physiotherapy procedures;
• performing exercise therapy exercises - but only after the pain subsides.

The issue of surgical intervention is decided individually with each patient.

Prevention and prognosis

To reduce the likelihood of developing a syndrome such as dorsalgia, it is necessary:

• constantly monitor the correct posture;
• engage in timely treatment of those diseases that can lead to back pain;
• rationally equip the working and sleeping place;
• completely eliminate hypothermia of the body;
• prevent injuries to the spine, back and pelvic area;
• exclude the influence of heavy physical exertion;
• monitor body mass indicators - if necessary, lose a few kilograms or, conversely, increase body mass index;
• several times a year to undergo a complete preventive examination in a medical institution.

By itself, dorsalgia does not pose a danger to the patient's life. However, we should not forget that each disease-source of back pain has its own complications. The most unfavorable prognosis is observed with vertebrogenic dorsalgia, since in such cases it is not excluded that the patient will become disabled.

If you think that you have Dorsalgia and the symptoms characteristic of this disease, then a neurologist can help you.

We also suggest using our online disease diagnostic service, which, based on the symptoms entered, selects probable diseases.

Diabetic polyneuropathy manifests itself as a complication of diabetes mellitus. The disease is based on damage to the nervous system of the patient. Often, the disease is formed in people 15–20 years after diabetes has developed. The frequency of disease progression to a complicated stage is 40–60%. The disease can manifest itself in people with both type 1 disease and type 2.

Dorsopathy - does not act as an independent disease, i.e. is a generalized term that combines a group of pathological conditions that affect the spine and nearby anatomical structures. These include ligaments and vessels, nerve roots and fibers, as well as muscles.

Diabetic neuropathy is a consequence of ignoring symptoms or lack of therapy to control diabetes mellitus. There are several predisposing factors for the appearance of such a disorder against the background of the underlying disease. The main ones are addiction to bad habits and high blood pressure.

Thrombocytopenic purpura or Werlhof's disease is a disease that occurs against the background of a decrease in the number of platelets and their pathological tendency to stick together, and is characterized by the appearance of multiple hemorrhages on the surface of the skin and mucous membranes. The disease belongs to the group of hemorrhagic diathesis, it is quite rare (according to statistics, 10–100 people a year fall ill with it). It was first described in 1735 by the famous German physician Paul Werlhof, after whom it got its name. Most often, everything manifests itself under the age of 10 years, while it affects both sexes with the same frequency, and if we talk about statistics among adults (after 10 years of age), then women get sick twice as often as men.

Spondylolisthesis is a pathological condition characterized by the presence of displacement of the vertebrae in the spinal column relative to each other. It is worth noting that this condition is not a separate disease, but a consequence of congenital or acquired pathologies of the spinal column.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

Reprinting of materials is possible only with the permission of the administration and indicating an active link to the source.

All information provided is subject to mandatory consultation by the attending physician!

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ICD code: M54

Dorsalgia

Dorsalgia

ICD code online / ICD code M54 / International Classification of Diseases / Diseases of the musculoskeletal system and connective tissue / Dorsopathies / Other dorsopathy / Dorsalgia

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ICD-10: M54 - Dorsalgia

Chain in classification:

5 M54 Dorsalgia

Diagnosis code M54 includes 9 clarifying diagnoses (ICD-10 subcategories):

Excludes: cervicalgia due to damage to the intervertebral disc (M50.-).

For citation: Kukushkin M.L. Nonspecific pain in the lower back // BC. 2010, p. 26

Pain in the lower back (BNS) refers to pain localized in the back between the upper border of the 12th pair of ribs and the gluteal folds. BNS is a socially significant problem due to its high prevalence and large economic losses for society. It is believed that up to 90% of people have experienced LBP at least once in their lives. Depending on the cause of occurrence, primary (nonspecific) and secondary (specific) BNS syndromes are distinguished. In most cases, degenerative-dystrophic changes in the spine are considered the main cause of primary back pain: intervertebral discs and facet joints, followed by involvement of ligaments, muscles, tendons and fascia in the process. As a rule, primary back pain has a benign course, and their occurrence is associated with a "mechanical" cause due to overloading of the ligaments, muscles, intervertebral discs and joints of the spine. In the ICD-10, non-specific pain in the lower back (nBNS) corresponds to the code M54.5 - "pain in the lower back."

Secondary back pain is the result of tumor, inflammatory or traumatic lesions of the spine, infectious processes (osteomyelitis, epidural abscess, tuberculosis, herpes zoster, sarcoidosis), metabolic disorders (osteoporosis), diseases of the internal organs in the chest and abdominal cavity or pelvic organs, damage muscles, damage to the nervous system (spinal cord, roots, peripheral nerves), etc. The frequency of occurrence of secondary back pain does not exceed 8-10%, however, it is them that must first be excluded by the doctor during a diagnostic study. When collecting an anamnesis, it is necessary to find out under what conditions the pains appeared, their nature (aching, shooting, burning), the presence or absence of irradiation, whether the pain is associated with movement, the presence of morning stiffness, numbness, paresthesia, weakness in the legs. Orthopedic examination is important when examining patients with back pain, since mild orthopedic symptoms with severe pain are a sign of a serious comorbidity. The search for symptoms and complaints in patients that indicate the possibility of a specific cause of back pain is associated with the concept of "red flags", which includes the identification of the following symptoms:
- onset of persistent back pain before age 15 and after age 50;
- non-mechanical nature of pain (pain does not decrease at rest, in the supine position, in certain postures);
- gradual increase in pain;
- the presence of oncology in history;
- the occurrence of pain on the background of fever, weight loss;
- complaints of prolonged stiffness in the morning;
- symptoms of damage to the spinal cord (paralysis, pelvic disorders);
- changes in urine, blood or other laboratory tests.
The psychological status of patients can also have a significant impact on the nature of back pain. In patients with back pain, signs of "pain behavior" are often detected, based on the fear of provoking pain with an incorrect movement, which worsens the clinical picture of the pain syndrome. Understanding the role of emotional and psychological factors in the intensity and duration of the pain syndrome led doctors to create the concept of "yellow flags", aimed at identifying predictors in the patient that aggravate the course of the pain syndrome. The "yellow flags" include the desire of patients for care, social protection, symptoms of anxiety and depressive disorders, excessive "catastrophization" of the patient's illness.
A complex algorithm for diagnosing BNS is due to the fact that this syndrome can occur in a variety of diseases and pathological conditions, and almost all anatomical structures of the lumbosacral region, abdominal cavity and pelvic organs can be a source of pain in the lower back. Therefore, the diagnosis of nBNS is always a diagnosis of exclusion.
Most often, nBNS occurs in patients whose professional activities are associated with monotonous physical work, weight lifting, vibration, and static load on the spine. Most often, people of working age suffer from back pain - from 30 to 55 years old, with a maximum prevalence at the age of 30-39 years.
In patients with nBNS, degenerative-dystrophic changes in the spine are almost always diagnosed, which can cause the activation of nociceptors - free nerve endings that perceive damaging stimuli. They were found in the periosteum of the vertebrae, the outer third of the fibrous ring of intervertebral discs, the ventral part of the dura mater, facet (facet) joints, posterior longitudinal, yellow, interspinous ligaments, epidural fatty tissue, in the walls of arteries and veins, paravertebral muscles, sensory and vegetative ganglia . The appearance of a pathological process in one of the listed structures of the vertebral motor segment can lead to the activation of nociceptors and pain.
However, the degenerative process in the spine can be considered only a prerequisite for the onset of back pain, but not its direct cause. The presence of signs of degenerative-dystrophic damage to spinal tissues in patients with nLNS does not correlate with either the nature of the pain or its intensity. According to magnetic resonance imaging in people who do not suffer from back pain, aged 25 to 39 years, more than 35% of cases, and in the group over 60 years old - in 100% of cases, degenerative-dystrophic changes in the spine are detected, in including disc protrusions up to 2-4 mm. Degenerative changes in the spine may contribute to the activation of nociceptors under conditions of overload, however, the final perception and assessment of pain will largely depend on the central mechanisms that regulate pain sensitivity.
Clinically, nBNS are manifested by musculoskeletal pains, among which muscular-tonic (reflex) pain syndrome and myofascial pain syndrome are traditionally distinguished.
Muscle-tonic pain syndrome occurs as a result of nociceptive impulses coming from the affected discs, ligaments and joints of the spine during static or dynamic overload. In more than half of the cases, the source of nociceptive impulses is the facet (facet) joints, which is confirmed by the positive effect of blockades of the projection of these joints by local anesthetics. As a result of nociceptive impulsation, a reflex muscle tension occurs, which at first has a protective character and immobilizes the affected segment. However, in the future, the tonically tense muscle itself becomes a source of pain.
The formation of myofascial pain syndrome (MFPS) occurs under conditions of excessive load on the muscles. MFPS can occur during prolonged muscle immobilization (long-term maintenance of one posture during professional activities, during deep sleep), due to muscle hypothermia, muscle overstrain in case of psycho-emotional disorders, etc. Myofascial pain syndrome is characterized by complaints of limited pain and decreased range of motion. On palpation of the muscle, pain increases. The palpable muscle feels spasmodic in the form of a tight band. Painful seals (trigger zones) are found in the muscle, pressure on which causes local and reflected pain.
The pathogenesis of MFPS development is largely associated with the sensitization of muscle nociceptors. Nociceptors localized in muscles are mostly polymodal and respond to mechanical, thermal, and chemical stimuli. They can be activated by metabolic products (lactic acid, ATP) during muscle contraction or by tissue and plasma algogens (prostaglandins, cytokines, biogenic amines, neurokinins, etc.) during muscle damage. After excitation of nociceptors from the terminals of C-afferents, neurokinins are secreted into the tissue - substance P, neurokinin A, calcitonin - a gene related to the peptide, which contribute to the development of aseptic neurogenic inflammation in the muscles innervated by them and the development of sensitization (increased excitability) of nociceptors. With sensitization of nociceptors, the nerve fiber becomes more sensitive to damaging stimuli, which is clinically manifested by the development of muscle hyperalgesia (the appearance of areas with increased pain sensitivity). Sensitized nociceptors become a source of enhanced afferent nociceptive impulses, which results in an increase in the excitability of nociceptive neurons in the structures of the spinal cord and brain. An increase in the excitability of nociceptive neurons in the structures of the central nervous system inevitably causes reflex activation of motor neurons in the corresponding segments of the spinal cord and muscle contraction. Prolonged muscle tension through the mechanisms of neurogenic inflammation contributes to the appearance of painful muscle thickening loci, which further enhances the afferent flow of nociceptive impulses to the CNS structures. As a consequence, more central nociceptive neurons are sensitized. This vicious circle plays an important role in the prolongation of pain and the development of MFPS.
Treatment of patients with nBNS should primarily be aimed at regression of pain symptoms, contributing to the restoration of the patient's activity and reducing the risk of chronic pain. In the acute period, it is necessary to limit physical activity, you should avoid lifting weights, prolonged sitting in a sitting position. Although bed rest is comfortable and relieves nBNS, it is not necessary to adhere to it even in the first days of the disease. It is necessary to convince the patient that a slight physical activity is not dangerous, moreover, it is useful, since in conditions of early motor activity, tissue trophism improves and recovery occurs faster. Recommendations based on the results of numerous randomized controlled trials are effective in the treatment of nBNS:
. maintaining physical activity (good level of evidence); the benefit of maintaining bed rest has not been proven;
. use of non-steroidal anti-inflammatory drugs - NSAIDs (good level of evidence);
. use of central muscle relaxants (good level of evidence).
Acute pain symptoms in patients with back pain, as a rule, are stopped by NSAIDs, which have analgesic and anti-inflammatory effects. Their analgesic and anti-inflammatory properties are due to the weakening of the synthesis of prostaglandins from arachidonic acid by inhibiting the activity of cyclooxygenase enzymes - COX-1 and COX-2 both in peripheral tissues and in the structures of the central nervous system. Among non-selective NSAIDs, diclofenac sodium, aceclofenac, ketoprofen, lornoxicam, ibuprofen are used, blocking both isoforms of cyclooxygenase. Of the selective COX-2 inhibitors, celecoxib and meloxicam are prescribed. Almost all NSAIDs available on the pharmacological market (including relatively new drugs - aceclofenac, dexketoprofen and lornoxicam) have been tested in LBP and have shown a good analgesic effect. There is no evidence of analgesic benefit of any member of the NSAID group in LBP. NSAIDs for acute nBNS are usually prescribed for 10-14 days. Therefore, the choice of a specific NSAID depends on the individual tolerance of the drug by the patient, the spectrum of side effects, and the duration of the drug. The use of NSAIDs can significantly reduce the severity of pain, improve overall well-being and accelerate the restoration of normal function in both acute and chronic LBP. Population-based studies suggest a lower risk of GI injury with non-selective NSAIDs such as aceclofenac and ibuprofen. A meta-analysis of the safety of aceclofenac, based on 13 double-blind randomized trials in which 3574 patients took part, demonstrated a better safety profile of this drug compared to classic NSAIDs, including diclofenac, indomethacin, naproxen, piroxicam and tenoxicam. Aceclofenac is prescribed 100 mg 2 times / day.
The combination of NSAIDs and muscle relaxants in patients with nBNS is more effective than monotherapy with these drugs. This combination reduces the duration of treatment and reduces the risk of side effects of NSAIDs by reducing the duration of use of the latter. Muscle relaxants, eliminating muscle spasm, interrupt the vicious circle: pain - muscle spasm - pain. It has been proven that muscle relaxants, by eliminating muscle tension and improving the mobility of the spine, contribute to the regression of pain and the restoration of the patient's motor activity. In clinical practice, tolperisone and tizanidine are primarily used in the treatment of nBNS.
Mydocalm (tolperisone hydrochloride) has been used for many years as a centrally acting muscle relaxant for the treatment of painful muscle spasm. Mydocalm is a muscle relaxant with sodium channel blocker properties. The structure of tolperisone hydrochloride is close to the structure of local anesthetics, especially lidocaine. Like lidocaine, tolperisone is an amphoteric molecule, has hydrophilic and lipophilic parts in its composition and has a high affinity for sodium channels of neuronal cell membranes and inhibits their activity in a dose-dependent manner. The leading effect in these effects of Mydocalm is the effect aimed at stabilizing cell membranes. The membrane-stabilizing effect of Mydocalm develops within 30-60 minutes. and stays up to 6 hours. The analgesic effect of Mydocalm was previously associated only with inhibition of the conduction of signals in the polysynaptic reflex arc. Modern studies have proven that Mydocalm, partially blocking sodium channels in nociceptive C-afferents, weakens the impulses arriving at the neurons of the posterior horns of the spinal cord, and thereby reduces the number of pain signals entering the central nervous system. There is a suppression of the secretion of glutamic acid from the central terminals of the primary afferent fibers, the frequency of action potentials in sensitized nociceptive neurons decreases, and hyperalgesia decreases. At the same time, Mydocalm inhibits increased mono- and polysynaptic reflex activity in the spinal cord and suppresses pathologically increased impulses from the reticular formation of the brain stem. The drug selectively weakens the pathological muscle spasm, without affecting the normal sensory and motor functions of the central nervous system (muscle tone, voluntary movements, coordination of movements) in therapeutic doses and without causing a sedative effect, muscle weakness and ataxia. In outpatient practice, Mydocalm is usually prescribed orally at 150 mg 3 times / day; in stationary conditions, an ampouled form of Mydocalm can be used - intramuscularly at 100 mg 2 times / day.
To date, there is a large evidence base for the positive effect of tolperisone hydrochloride on the intensity of back pain, based on the results of randomized, double-blind, placebo-controlled clinical trials.
A double-blind, randomized, placebo-controlled study in 138 patients aged 18 to 75 years, conducted in eight centers in Germany, showed that patients who received 300 mg of Mydocalm per day, significantly more than in the placebo group, decreased painful muscle spasm. The difference between the treatment and placebo groups was noted as early as day 4, gradually increasing and becoming statistically significant on days 10 and 21 of treatment, which were selected as endpoints for evidence-based comparison.
In a number of other studies, it was also noted that with vertebrogenic muscular-tonic syndrome, the addition of Mydocalm at a dose of 150-450 mg / day to standard therapy (NSAIDs, analgesics, physiotherapy, physiotherapy) leads to a faster regression of pain, muscle tension and improved mobility of the spine, without being accompanied by any side effects.
The use of injectable forms of Mydocalm in a hospital has shown that in case of pain vertebrogenic syndrome, intramuscular injection of 100 mg of Mydocalm after 1.5 hours leads to a statistically significant decrease in the severity of pain syndrome, tension symptoms and an increase in the household adaptation coefficient. In addition, treatment with Mydocalm for a week at 200 mg / day. intramuscularly, and then for 2 weeks at 450 mg / day. orally has a significant advantage over standard therapy, while treatment with Mydocalm not only reduces pain, but also relieves anxiety, increases mental performance and is accompanied by an improvement in the functional state of the peripheral nervous system according to electroneuromyography. During treatment with Mydocalm, the examined patients did not experience any adverse reactions: headache, nausea, drowsiness, weakness, increased irritability, arterial hypotension, and a feeling of slight intoxication.
According to the results of a multicenter, randomized, double-blind, placebo-controlled study in accordance with the requirements of the GCP and the Declaration of Helsinki, the use of tolperisone hydrochloride not only improves subjective pain scores, but also increases muscle pain thresholds. The study included 255 patients with acute low back pain, aged 18 to 60 years. The analysis of the conducted clinical study showed that Mydocalm causes a significantly more significant improvement in the quality of life compared to placebo. An excellent result was also noted in the assessment of physical activity. During therapy with Mydocalm, the period of stay on the sick leave was reduced by an average of 1-2 days. All these observations confirm that in the nBNS syndrome, the use of Mydocalm significantly accelerates the healing process, contributing to the early mobilization of patients and the fastest recovery of their ability to work.
It is advisable to include physiotherapy exercises, methods of reflexology, manual therapy (post-isometric relaxation), and massage in complex therapy. As a rule, this combination of drug and non-drug treatments helps to accelerate the recovery of patients with nBNS.

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Vertebrogenic lumbodynia is a pathological condition that manifests itself as symptoms of pain in the lumbar region.

Pain syndrome can be associated with a number of diseases, among which osteochondrosis ranks first in frequency.

In general, the lumbar spine is subject to heavy loads, which is why both muscles and ligaments, and the spinal column itself are often affected. People who lead a sedentary, sedentary lifestyle, who are obese or, conversely, who work hard physically, suffer the most. This pattern is due to the fact that the muscles of the lumbar girdle are most tense at the time of lifting and carrying weights, as well as during long sitting. To identify the true cause of lumbalgia, a person is assigned x-ray examinations, magnetic resonance imaging.

Like any disease, lumbodynia has its own ICD-10 code. This is an international classification of diseases, with the help of which diseases are encrypted in different countries. The classification is regularly reviewed and supplemented, which is why the number in the title means 10th revision.

Lumbodynia, according to the ICD-10 code, has the code M-54.5, the disease is included in the group of dorsalgia and refers to pain in the lower back. If we analyze the code M-54.5 in more detail, then the term lumbar pain, tension in the lower back, or lumbago may sound in the description.

Reasons for the development of pathology

In most cases, lumbalgia is associated with degenerative-dystrophic processes in the spinal column. Most often, the pain syndrome is caused by osteochondrosis associated with damage to the intervertebral discs and cartilage.

Osteochondrosis is a chronic disease that torments a person for more than one month, and even more than one year. The disease also has its own international code according to ICD-10 - M42, but such a diagnosis is made only after a comprehensive examination. Osteochondrosis is dangerous due to infringement of nerve roots, blood vessels, destruction of intervertebral discs and a number of other complications when severe back pain occurs. So, until the patient has an accurate diagnosis, he is given a preliminary one, that is, vertebrogenic lumbalgia.

Another cause of pain in the lower back is protrusion and intervertebral hernia. These two states are somewhat similar:

• During protrusion, the fibrous ring of the intervertebral disc is destroyed, which causes the semi-liquid core to partially protrude, squeezing the nerve roots, resulting in pain.
• But with an intervertebral hernia, a complete displacement of the nucleus pulposus occurs, while the fibrous ring breaks and the symptoms are more vivid.

In any case, these conditions are dangerous with the appearance of back pain and the development of neurological symptoms. The causes of osteochondrosis, hernia and protrusion are almost the same:

• excessive physical activity during sports, during physical labor;
• getting injuries in the lumbar region;
• sedentary lifestyle;
• disturbed metabolism;
• infections affecting the musculoskeletal system;
• age changes.

This is not the whole list of causes leading to lumbodynia, which is why if you have back pain, you need to consult a doctor who will not only prescribe treatment, but also help eliminate the causes of pain.

Other pathological conditions leading to lumbalgia include spinal stenosis, arthrosis of the joints of the spine, curvature and back injuries.

Characteristic symptoms

Vertebrogenic lumbodynia in each patient manifests itself differently. It all depends on the cause that caused it, on the age of the person and his lifestyle. Of course, the main symptom of the disease is pain, which most often has an acute character, increases with exertion and decreases at rest. Palpation determines the state of muscle tension in the lumbar spine.

Due to pain and inflammation, the patient has signs of stiffness in movements. People suffering from an attack of lumbodynia are quickly tired, irritable. It becomes difficult for them to bend over, they cannot abruptly get up from a bed or chair. In chronic diseases, such as osteochondrosis or arthrosis, a person has periods of exacerbation and remission.

Even if the symptoms are mild and the person can tolerate pain, he is recommended to see a doctor. Most of the diseases leading to lumbodynia tend to progress, and the symptoms will only increase over time.

Signs of lumbodynia may appear in a pregnant woman, which leads to the development of pain syndrome. This happens due to muscle strain due to weight gain and redistribution of the load. Women do not need to panic, but if possible, it is necessary to take a course of physical therapy.

Diagnosis of patients

The purpose of diagnostics for lumbodynia is to determine the cause of damage to the spinal column and exclude other pathologies. Lower back pain can be associated with diseases of the kidneys, female genital organs, and with oncological processes.

The main diagnostic method is an X-ray examination of the spine. With the help of an x-ray, it will be possible to examine the bone elements of the spinal column and identify pathological areas. Another modern method of examining patients with back pain is magnetic resonance imaging. Thanks to this procedure, deviations can be detected not only in the bone tissue itself, but also in soft tissues. This method is considered the best in diagnosing oncological processes.

An ultrasound technique is used to examine the internal organs. First of all, the kidneys and pelvic organs are examined. All other manipulations are carried out at the discretion of the doctor. And of course, we must not forget about blood and urine tests.