The complex functional recovery of the patients suffering back pain

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THE COMPLEX FUNCTIONAL RECOVERY OF THE PATIENTS SUFFERING BACK PAIN

Badyin I.

Institute of transport medicine, Odessa, Ukraine

Pain accompanies many movement disorders. Especially often the pain occurs in the back. According to epidemiological research, almost 100% of people over 45 at least once experienced back pain [1]. This is one of the most frequent causes of temporary disability. Back pain can localize at different levels: occipital-at- lanto-axial, cervicothoracic, thoracic, lumbosacral, and sacral coccyx. But most often the pain syndrome is localized in the lumbosacral region. Significant frequency lesions of the lumbosacral spine is associated with a number of features, among which constitutional factors, in particular, the structure of the vertebrae, ligaments and the spine in general, age-related intervertebral disc changes, physical activities and spine biomechanics [2, 3]

Currently available clinical neurophysiological and radiological data allow to consider spinal oste-ochondrosis as a degenerative-dystrophic process, combined with a compensatory reorganization of the spinal-motor segment, first of all, a disc, and aimed at adapting the functionality of the spinal column as a whole [5, 7]. It is believed that as a result of this adjustment increases the supporting capacity of the affected bone, i.e., orthopedic compensation arises. Osteochondrosis of the disc how a multifactorial process turns off defective spinal-motor segment from spinal biomechanics.

Various factors play a role in the development of osteochondrosis. The first group of causes is congenital, or dysontogenetic: developmental anomalies of individual verte-brae and their joints, anomalies of articular tropism, underdevelopment of individual elements of the vertebra, disk, etc.

The second group of causes is acquired disorders; disc loss of elastic functions when overloading individual segments.

The third group of causes includes traumatic spinal lesions. In this regard, the most significant lesions of the discs, fractures of the extremities, true traumatic spondylosis, body fractures, etc.

The cost of treating back pain is three times the cost of treating cancer patients, with 28% of the popu-lation aged 20-69 suffering from periodic back pain and 84% suffering from a relatively long episode of back pain at least once during their life [2, 3, 5, 6, 8, 14].

Indicators of prevalence of vertebroneurological pathology tend to increase, especially in cases of dor- salgias at young age, frequent complications of the process, increase in the number of days of disability due to the disease [7, 15]

Up to modern methods of treatment aimed at functional recovery in patients with pathology of the spine include both conservative and operative. More than 97% of patients are currently being treated conserva-tively and only about 3% of them need surgical interventions [2, 9, 17]. The frequency of postoperative pain syndrome among operated patients is 25-30%, and 78% of them require repeated interventions [9]. Among the conservative methods of treating lumbar osteochondrosis, there are known methods for the local administration of drugs, as well as non-medicated efferent therapy, which affects the whole body as a whole [2, 5, 11]. Recently, the introduction of plasma-enriched platelets (PZT) has become more popular both paravertebrally and intradiskously [18, 20], but the available information on the appropriateness of this approach is highly controversial.

The aim of the study was to evaluate the clinical efficacy of plasma-enriched platelet-derived plasma for functional recovery in patients with vertebro neurological pathology.

Material and methods. The study was carried out at the clinical department of the DZ "Ukrainian Research Institute of Medical Rehabilitation and Resort Research of the Ministry of Health of Ukraine" during 2016-2018. 85 patients with manifestations of common spinal osteochondrosis with a predominant lesion of the cervical and lumbar-sacral department were examined. All patients were examined in accordance with the standards of the Ministry of Health of Ukraine, in particular general-clinical studies were performed, a gen-eral neurological examination was performed, a general blood test, a general urine test, a computer tomography (CT) on a Siemens Somatom apparatus (Germany), a cervical and lumbar radiograph Spine departments on the GE Discovery XR656 (USA). In order to confirm the presence of hemodynamic disorders in the posterior cerebral, internal carotid and vertebral arteries, transcranial doppler sonography (TSCDG) of the vessels of the head and neck was performed (MSLCU28Z, China).

Depending on age, duration of the chronic process, level of immobilization, decrease in the volume of ac-tive motions in the cervical and lumbar spine, the duration of treatment in each particular patient was individual.

In the 2nd group, in the younger patients (age 20 - 45 years) (n = 29), a single injection of PRP was per-formed. Patients aged 45 years (n = 56) were reintroduced by an interval of 7-10 days between the proce-dures.

The average duration of treatment for patients receiving local platelet-rich plasma therapy was from 3 to 5 days before the onset of pain relief, at the time of a sustained remission, 9 to 11 days. During the entire course of treatment in patients receiving local PRP therapy, there were no adverse reactions, intolerance to the therapies used, patients did not need to adjust or change the treatment regimen.

Platelets rich in platelets were obtained as follows. Patients were taken with a total of 10 ml of venous blood in a volume of 10 ml from a cubital vein, centrifuged with subsequent plasma expansion of platelets enriched, added 0.04 ml of 10% CaCl2 solution to form a gel-shaped clot-plasmonagel. Preparation of PRP was carried out within 2 hours after taking blood. Injection method, intramuscularly, paravertebrally in soft tissue near the degenerative-degenerative defeat of intervertebral discs or in the trigger zones, patients were administered up to 2.5 ml of PRP [18].

For the quantitative assessment of pain in the group with lumbar OX (POSH), the visual analog scale (WAS) [10] was used.

The dynamics of volume in the shoulder joint was estimated using a goniometer [19].

Statistical processing was carried out using the methods of dispersion analysis using the software Sta- tistica 10.0 (Dell StatSoft Inc., USA) [1].

Research results

recovery patient back pain

In all patients, with palpation of paravertebral dots and spinal processes of vertebral bodies, sharp pain was observed. Also, there was pain in the points of Erba, Vala and Hara. Positive symptoms of stretch marks were noted in 83 (97,6%) patients.

In all patients, the volume of active movements in the neck and lower back was reduced. In general tests of blood and urine there were no significant changes indicating the presence of general signs of inflamma-tion.

Patients in the first and second groups on radiographs and CT scans showed a decrease in vertebrate bodies, a decrease in the height of intervertebral spaces, signs of spondylarthrosis, scoliosis, OX with the presence of intervertebral hernias and circular protrusions.

According to TCDDS, an increase in the pulsation index, one-sided or bilateral vasospasm in the arteries of the brain, one-or two-way reduction of hemodynamic parameters in arteries of large caliber was ob-served.

The baseline severity of pain according to the YES in patients before the onset of treatment was within the values of 6.3 ± 0.4 points and 6.1 ± 0.8 points in the main and control groups of patients, respectively (p> 0,

5) . In the group of patients treated with NSAIDs, after 3 days of follow-up, pain reduction was 1.2 ± 0.2 points on the VAS scale, while in the group on the use of PRP- therapy, the intensity of pain decreased by 0.6+0.1 points compared with the baseline the level

After 2 weeks, treatment in both groups was found to be significantly higher in comparison with the base-line pain reduction in the WAS scale in the 2 nd group by 2,1 ^0,2 points (p <0,05), and in the 1 st group - by

1,6 ^0,2 points (p <0,05). The 3-month follow-up period has shown that the use of ZTE therapy has reduced the pain in the VAS scale to 2.0 ± 0.2 points, which was an average of 4 points lower than baseline (p <0.05) . Treatment of NSAIDs was accompanied by a significant decrease in pain for VAS by 2.0 ± 0.2 points compared to baseline values (p <0.05). Comparing the dynamics of pain in YAS after 3 months of treatment revealed a statistically significant difference of 2,2 ^0,2 points (p <0,05) between PRP therapy and NSAIDs.

In the study of the Schober test, the data obtained by us showed that at the initial stage of the study (3 days after the start of treatment), the study rate increased in both groups with a slight excess in patients receiving PRP therapy, but without statistical certainty

Pharmacological effect when receiving NSAIDs was accompanied by anti-inflammatory, anti-edema re-action in the tissues of the intervertebral disc and contributed to the improvement of spinal mobility. How-ever, after 2 weeks of treatment, the mobility rate increased by almost 2-fold in the group of patients with PRP-therapy, while in the group receiving nonsteroidal anti-inflammatory drugs, this indicator increased by 1.6 times. Thus, the biological effects of thrombocyte concentrate growth factors are manifested both in the repression of the inflammatory reaction and in the formation of compensatory and adaptive mechanisms of cell-tissue interactions such as proliferation and differentiation of fibroblasts, chondroblasts, endothelial cells that may be involved in the repair of damaged tissue of the intervertebral disc .

After 3 months of treatment, both groups showed positive dynamics. In the group of patients taking NSAID there was a decrease in spinal mobility of 18.3% compared with the previous (2 weeks) study period (p>0.05). This fact can be explained by the activation of the inflammatory response with the alteration and exudative components. That is, the use of NSAIDs aimed at inhibition of cyclooxygenase, which blocks the synthesis of inflammatory mediators, does not provide long-term protection and, most importantly, does not contribute to the restoration and regeneration of damaged tissues.

Clinical efficacy of PRP therapy after 3 months of observation was expressed in a significant increase in the spine mobility index by 204% compared with baseline values (p <0,05) of this group and by 145,2% (p <0,05) compared with the group treated with NSAIDs. The introduction of thromboconcentrate contributed to the mobility of the spine as a result of restoring the elasticity and elasticity of the tissues of the intervertebral discs involved in the depreciation. The steady clinical effect of PRP-therapy was demonstrated by the restoration of the spinal mobility index to virtually normal values.

Conclusions

The obtained data illustrate the improvement of the indicators of functional tests of the spine against the background of anti-inflammatory therapy, and in the group of patients receiving PRP- therapy demonstrated a more stable positive dynamics.

Література

1. Боровиков В.П. Statistica - Статистический анализ и обработка данных в среде Windows / В.П. Боровиков, И.П. Боровиков - М.: Информац. - из- дат. дом “Филинъ”. - 1998. - С. 608

2. Вакуленко, Л. А. Остеохондроз: возможности аддитивного биорегуляционного подхода [Текст] / Л. А. Вакуленко // Міжнародний неврологічний журнал. - 2015. - № 6. - С. 107-111

3. Кобзева М.Ф. Опыт лечения неврологических синдромов шейного остеохондроза / Кобзева М.Ф. // Научный альманах. 2015. № 10-3 (12). С. 334-336.

4. Кулуа Т.К. Боль в шейно-плечевой области: диагностика и лечение / Кулуа Т.К. // Совре-менная терапия в психиатрии и неврологии. 2016. № 2. С. 21-23.

5. Томчук А.Г. Реабилитационная терапия при неврологических синдромах поясничного осте-охондроза / Томчук А.Г., Богданов А.Н. // Инновации в науке. 2015. № 41. С. 171-175.

6. Цервикокраниалгия при миофасциальном синдроме ременных мышц головы и шеи. Патогенетические и топико-диагностические особенности триггерных точек / Бобунов Д.Н., Комиссаров Д.А., Щербаков Л.В., Кочук М.Н., Попова Д.Б., Попов А.Б., Смагин Д.И. // Sciences of Europe. 2017. № 112 (11). С. 50-54.

7. Чебыкин А.В Экспертные вопросы в медицинской реабилитации вертебрологических паци-ентов / Чебыкин А.В., Минасов Т.Б., Назаров А.Ф. // Здоровье семьи - 21 век. 2016. № 1 (1). С. 104-121.

8. Юрик О. Є. Нетипові неврологічні прояви остеохондрозу хребта / О. Є. Юрик // Збірник нау-кових праць співробітників НМАПО ім. П. Л. Шу- пика. - 2015. - Вип. 24(2). - С. 302-310

9. Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016 Nov 7;9:979-987.

10. Behrend CJ, Schonbach EM, Vaccaro AR, Coyne E, Prasarn ML, Rechtine GR. Maximum pain on visual analog scales in spinal disorders. Spine J. 2017 Aug;17(8):1061-1065

11. Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG. Non-Specific Low Back Pain. Dtsch Arztebl Int. 2017 Dec 25;114(51-52):883-890.

12. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011 Feb;12(2):224-33

13. Gimigliano F, Negrini S. The World Health Organization "Rehabilitation 2030: a call for action". Eur J Phys Rehabil Med. 2017 Apr;53(2):155-168?

14. Golob AL, Wipf JE. Low back pain. Med Clin North Am. 2014 May;98(3):405-28.

15. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:21-4

16. Navani A, Li G, Chrystal J. Platelet Rich Plasma in Musculoskeletal Pathology: A Necessary Rescue or a Lost Cause? Pain Physician. 2017 Mar;20(3):E345-E356.

17. Parker SL, Mendenhall SK, Godil SS, Si- vasubramanian P, Cahill K, Ziewacz J, McGirt MJ. Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res. 2015 Jun;473(6):1988-99.

18. Shuhtin V. V., Leszczynskiy M. V., Badyin I. Y. Comparison of the effectiveness of nsaids monother-apy and combination therapy with platelet-rich plasma in patients with osteochondrosis of the cervical spine. Journal of Education, Health and Sport. 2015;5(10):269-274.

19. Tsang SM, Szeto GP, Lee RY. Normal kinematics of the neck: the interplay between the cervical and thoracic spines. Man Ther. 2013 Oct;18(5):431-7

20. Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, Harrison JR, Gribbin CK, LaSalle EE, Nguyen JT, Solomon JL, Lutz GE. Lumbar Intradiskal Platelet- Rich Plasma (PRP) Injections: A Prospective, DoubleBlind, Randomized Controlled Study. PM R. 2016 Jan;8(1):1-10

21. Vanti C, Conti C, Faresin F, Ferrari S, Piccar- reta R. The Relationship Between Clinical Instability and Endurance Tests, Pain, and Disability in Nonspecific Low Back Pain. J Manipulative Physiol Ther. 2016 Jun;39(5):359-68. Wu PI, Diaz R, Borg-Stein J. Platelet-Rich Plasma. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):825-853.

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