Juosmens kryžmens neurologinių skausmo sindromų klinikinė įtaka pacientų funkcinei būklei ir su sveikata susijusiai gyvenimo kokybei

Show simple item record Petrikonis, Kęstutis 2017-08-21T08:06:42Z 2017-08-21T08:06:42Z 2005
dc.description.abstract INTRODUCTION Low back pain have become an urgent problem recently. Four out of five people already have or will experience backaches during their life span, for 10% of them this pain will become chronic. Due to its great spread and treatment, health institutions experience dramatic losses for backache diagnostics and morbidity. Together with financial losses related to patient incapacity to work, his/her care, sickness benefits, etc. the expenditure becomes enormous. Thus back pain are no longer considered a medical or a social problem, but it is regarded a complex bio- psycho-social issue in today’s community. The medical part of this issue remains very important. Solving the back pain problem, significant is the knowledge of fundamental neuro- and skeleton anatomy, pain neurophysiology and neurochemistry; in the clinical practice closely related are the basics of neurology, pain medicine, orthopedics, rehabilitation and other disciplines. Consequently, it is not simple for a medicine practitioner to find the right diagnostic direction or to choose the right treatment. The most complicated issues in the back pain clinical practice are neurological syndromes (neuropathic, neurogenic). These are related with nerve structure back radicular, dorsal ganglion or the damage of nerve branches. These syndromes make up to 10% of all backaches and are generally called radicular pain syndromes. There often emerges hyper-diagnostics or sometimes the syndromes are ignored completely. The treatment of neurological syndromes is peculiar, yet the tendency to apply general treatment of backaches is often noticed. In the last decade, the theoretical and practical pain recognition developed dramatically, however, the scientific data has not yet reached every patient. Neuropathic pain is such pain which is initiated or triggered by primal peripheral or central nervous system lesion or dysfunction. Neuropathic pain is one of the main disablement causes, concomitant with such neurological diseases as neuropathy, myolopathy, sclerosis or stroke. As stated by the European Federation of Neurologists Association, pain is a complex sensation strongly influenced by cognitive functions. Therefore, it is necessary for a neurologist as a future pain specialist to understand the function and dysfunction of nocicepsy in accordance with the notion and knowledge of pain, provided by contemporary medicine. Neuropathic pain is the most common neurological syndrome thus the neurologists should actively participate in diagnosing and treating it. Supposedly, there are 6-7.5 % inhabitants in every country diseased with neuropathic pain syndrome. The major part is constituted by lumbar-sacral radiculopathy that results from inter-vertebral disc degeneration. They are accompanied by pain. Radiculopathy is considered a syndrome with a complex inherent to a radicle damage, accompanied by sensory and/or motor and/or autonomic deficiency or dysfunction. Radicular pain is often (but not necessarily) accompanied by radiculopathy, but quite frequently usual clinical testing is not sufficiently sensible to diagnose radiculopathy. No definite epidemiological data on the spread of radicle pain has been presented so far. According to a group of authors, however, it is possible to assume that 1 to 40% of adults may get caught by the syndrome. In 1987, Heliovaara et al carried a research, according to which, 5.1 % men and 3.7 % women above 30 can be diagnosed with lumbar-sacral inter-vertebral disc syndrome, one of the symptoms being radiculopathy. In Finland, the incapacity to work dependent of the age of patients, triggered by radicle leg syndrome equals 14 %. In the classification of 10 diseases in TLK, radicular leg syndrome is encoded under M51.1, M51.2 and G55.1, but not M 54.5 that does not show the ache of lower back. According to the research that was carried in 2000, 2863 (27.7%) of all 10331 patients diagnosed with lumbar-sacral inter-vertebral disc syndrome were hospitalized in 6 Kaunas’ hospitals. Radicular syndrome was diagnosed to 2158 (75.38%) patients. Mixter&Barr adopted his attitude in 1934, according to which, radicular pain and other neurological symptoms may be cured after inter-vertebral disc hernia surgery. However, the attitude towards radicular pain etiology has changed a lot in the recent decade. In 1990, Boden et al declared that asymptomatic disc hernia is found in magnetic resonance, it was later proofed by other authors. In 1997, Ohnmeiss announced research results, in which it was stated that 25% of patients without disc hernia with only electrical inter-vertebral disc stimulation could feel leg pain, which could have reminded radicular pain due to its locality, since it was felt below the knee-joint. Before that, in 1991 Kuslich et al. announced a research, where during the surgery with only local anesthesia to access the damaged disc, spinal nerve, back radicular and back longitudinal spinal band were stimulated. The results were curious in that, that visually undamaged nervous structure was not painful. Moreover, the stimulation of back longitudinal spinal band or inter-vertebral disc fibrotic band caused only local pain, which did not extend to the leg. The contrasting results of both researches have been explained as follows: different stimuli were used –exterior and interior (within the disc), whose innervation is varied, nociceptors are ingrown and their stimulation may cause radicle/reflex pain. McCarron in 1987, later Olmaker in 1993 developed radicular inflammation pain theory, reasoning cytoid influence on radicle pain emergence and giving the reason to apply tumor necrosis factor inhibitors. 10 patients who suffered from refractory lumbar-sacral radiculopathy were dripped infliximab, the tumor necrosis inhibitor. After a year all of them were working in their regular positions, the pain and dysfunction eased significantly. A conclusion may be drawn, that further research is needed, where the efficiency of such treating methods would come to light. Magnetic resonance tomography results did not differ from the auditorial group patients who were given izotonic solution injection in epidural space. The genetic radicular pain etiology theory is becoming more popular these days. Besides surgical and experimental methods, for the treatment of lumbar-sacral radicular pain non-steroid medicaments, glucocorticoids more rarely, are applied. There is only one source in which the radicular leg pain is described separately from lower back pains. Applying anti-flogistic medicaments the prognosis of pain is very positive, after a month 60% of patients were treated. Radicular pain is a complex of nocicepsic, neuropathic and psychogenic pains. It is not clear why some patients continue to feel the pain for 3 months. When surgical or conservative treatment is applied distant treatment results after 5 to 10 years do not differ. It was discovered in Maine Lumbar Spine Study research that 63% of patients are satisfied with the results of inter-vertebral disc surgery after 5 years, although 91% got back to work. The number of satisfied patients is smaller in the non-operated group – 46%. 56% of non-operated patients noticed that the pain also relieved in the leg as well as in the lumbar area. More of such patients were among the operated – 70%. It is worthwhile to mention that the operated patients felt a more intense pain and dysfunction before the surgery, therefore their pain decrease differs from non-operated. The pain disappeared to 28% after the surgery, to 12% without the surgery. Disability pensions were allowed to 27% of non-operated and to 50% of the operated patients. 19% were repeatedly operated in the period of 5 years, 92% of them due to disc sequester. 56% of the operated patients and 40% of non-operated felt recovered in the period of 10 years, 71% of operated and 56 % of non-operated were satisfied with their current condition. 69% reported that pre-surgical symptoms have diminished, 61% felt much better. 25% of all patients in both groups were operated either for the first time or repeatedly. The researchers draw the conclusions that the operated patients felt marginally better than the non-operated. It is not known exactly why after so many years the condition of some patients got better. Nevertheless, every patient should be chosen individual treatment program. Loupasis carried out a research with the patients 7-20 years after the surgery. The conclusions are much more emphatic since there are more unsatisfied patients in the remote periods, one fourth of them feel the persistent pain. Hard work and lower education negatively influence the results. In 1994 Hasenbring declared that the following risk factors are needed in order for the lumbar-sacral pain to become chronic: the size of disc hernia, negative psychological factors (depression, suffering with the tendency not to move, the search of social support and non-verbal pain behavior), other social factors and sedentary job. In 2001 Karppinen denied the hypothesis provided in MRT research that inter-vertebral changes are associated with pain evaluation and dysfunction. Morbidity and disablement rates related to lower backaches are increasing in Lithuania. In 2002 due to backaches 1850 people were acknowledged disability for the first time, one year after – 2064 people. 2974 applied for disability for the first time in 2002, 3390 patients applied in 2003. In 2003 439 patients were acknowledged disabled in Kaunas (116/100000), 185 patients in Vilnius (33.4/100000), 59/100000 in Lithuania on the whole. In 2003, 51.3% of the disabled were 45-61 years old, 31.9% were among 30-44 years old. In conclusion it may be stated that radicular pain has its own peculiarities which are not characteristic to uncomplicated backache syndrome. In the case of such pain, neuropathic injury and concomitant pain is related to osteo-muscular system structures and possible adjacent
dc.language.iso lit
dc.subject Nugaros skausmas
dc.subject Su sveikata susijusi gyvenimo kokybė
dc.subject Funkcinė būklė
dc.subject Šaknelinis skausmas
dc.title Juosmens kryžmens neurologinių skausmo sindromų klinikinė įtaka pacientų funkcinei būklei ir su sveikata susijusiai gyvenimo kokybei
dc.title.alternative Lumbosacral radicular syndrome: influence of pain parameters to functional status and health related quality of life Lumbosacral radicular syndrome: influence of pain parameters to functional status and health related quality of life
dc.type Daktaro disertacija

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