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2014 | 10 | 3 | 253-264
Article title

Zespół bólowy kręgosłupa

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EN
Back pain
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EN PL
Abstracts
EN
Back pain is a symptom of a number of underlying diseases. The pain syndrome may be due to disorders of bone structures, apophyseal joints, ligaments, fascia, muscles or intervertebral discs, subsequently affecting or not the spinal cord and peripheral nerves. According to the pathophysiological mechanisms precipitating the pain, it can be classified as nociceptive or neuropathic pain. Nociceptive pain is precipitated by the mechanical irritation of nociceptors in ligamentous and muscular structures. Neuropathic pain is caused mostly by the compression of nerve roots. When acute nociceptive pain is not treated in a timely manner, it may develop into chronic neuropathic pain due to functional changes occurring in the central nervous system. Treatment of back pain involves a combination of myorelaxants, analgesics and non-steroidal anti-inflammatory drugs. It starts, as a first choice, with paracetamol because of a small number of its adverse effects. The combined administration of non-steroidal anti-inflammatory drugs and analgesics is preferable as it enhances the analgesic effect without increasing the toxicity. A similar combination is that of paracetamol with a mild opioid (tramadol). Neuropathic pain is influenced by several main groups of medications: antidepressants, anticonvulsants, membrane-stabilizing drugs, and GABA-B agonists. Early treatment of back pain is necessary in order to prevent pain chronification. Because of the different treatments of nociceptive and neuropathic pains, it is of particular importance to differentiate between them early.
PL
Ból okolicy kręgosłupa to objaw towarzyszący wielu chorobom. Zespół bólowy mogą powodować nieprawidłowości struktur kostnych, stawów międzykręgowych, więzadeł, powięzi, mięśni czy krążków międzykręgowych, które następnie mogą negatywnie wpływać na rdzeń kręgowy i nerwy obwodowe. Na podstawie mechanizmów patofizjologicznych ból dzielimy na nocyceptywny i neuropatyczny. Ten pierwszy powstaje przez podrażnienie mechaniczne nocyceptorów w strukturach mięśniowych i więzadłowych. Z kolei ból neuropatyczny zwykle jest spowodowany uciskiem na korzenie nerwowe. Gdy ostry ból nocyceptywny nie jest leczony w odpowiednim czasie, może rozwinąć się przewlekły zespół bólowy spowodowany wtórnymi zmianami czynnościowymi w ośrodkowym układzie nerwowym. Leczenie zespołu bólowego kręgosłupa polega na podawaniu środków zwiotczających mięśnie, leków przeciwbólowych i niesteroidowych leków przeciwzapalnych. Lekiem pierwszego rzutu jest paracetamol ze względu na niewielką ilość reakcji niepożądanych. Preferowane jest leczenie skojarzone niesteroidowymi lekami przeciwzapalnymi i środkami przeciwbólowymi, ponieważ zwiększa efekt przeciwbólowy, nie nasilając toksyczności. W skojarzonym leczeniu stosowane jest połączenie paracetamolu z łagodnym opioidem (tramadolem). W przypadku bólu neuropatycznego podaje się różne grupy leków: leki przeciwdepresyjne, przeciwdrgawkowe, leki stabilizujące błonę komórkową i leki z grupy antagonistów receptora GABA-B. Ze względu na różne sposoby leczenia bólu nocyceptywnego i neuropatycznego ważne jest wczesne ustalenie rodzaju bólu, aby nie dopuścić do rozwoju przewlekłego zespołu bólowego.
Discipline
Publisher

Year
Volume
10
Issue
3
Pages
253-264
Physical description
Dates
published
2014
Contributors
author
  • Prof. Ivan Milanov, MD, PhD, DSc, “St. Naum” University Hospital for Active Treatment in Neurology and Psychiatry, 1 Louben Roussev str., Sofia 1113, Bulgaria, tel.: +35 9888707880, milanovivan@yahoo.com
References
  • 1. Cohen SP, Rowlingson J, Abdi S: Low back pain. In: Warfield CA, Bajwa ZH (eds.): Principles and Practice of Pain Medicine. McGraw-Hill, New York 2004: 273–282.
  • 2. Andersson GBJ: The epidemiology of spinal disorders. In: Frymoyer JW (ed.): The Adult Spine: Principles and Practice. 2nd ed., Lippincott-Raven, Philadelphia 1997: 93–141.
  • 3. Dixon ASJ: Progress and problems in back pain research. Rheumatol Rehabil 1973; 12: 165–175.
  • 4. Rubin DI: Epidemiology and risk factors for spine pain. Neurol Clin 2007; 25: 353–371.
  • 5. Kahanovitz N: Diagnosis and Treatment of Low Back Pain. Raven Press, New York 1991: 145.
  • 6. Deyo RA, Tsui-Wu YJ: Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976) 1987; 12: 264–268.
  • 7. Wiesel SW, Feffer HL, Rothman RH: Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treat- ment protocol. Spine (Phila Pa1976) 1984; 9: 199–203.
  • 8. Rockers D, Fishman SM: Psychopharmacology for the pain spe- cialist. In: Warfield CA, Bajwa ZH (eds.): Principles and Practice of Pain Medicine. McGraw-Hill, New York2004: 639–648.
  • 9. Westerling D, Jonsson BG: Pain from the neck-shoulder region and sick leave. Scand J Soc Med1980; 8: 131–136.
  • 10. Lawrence JS: Disc degeneration. It’s frequency and relationship to symptoms. Ann Rheum Dis1969; 28: 121–138.
  • 11. Mixter WJ, Barr JS: Rupture of  the intervertebral disc with involvement of the spinal canal. N Engl J Med1934; 211: 210–215.
  • 12. Hirsch C: Etiology and pathogenesis of low back pain. Isr J Med Sci1966; 2: 362–370.
  • 13. Kelsey JL: An epidemiological study of acute herniated lumbar intervertebral discs. Rheumatol Rehabil1975; 14: 144–159.
  • 14. Steiner AS, Gray DP: Facet syndrome. In: Warfield CA, Bajwa ZH (eds.): Principles and Practice of Pain Medicine. McGraw-Hill, New York2004: 285–291.
  • 15. van Tulder M, Becker A, Bekkering T et al.; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in  Primary Care: Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J2006; 15 Suppl 2: S169–S191.
  • 16. Borenstein DG, Wiesel SW, Boden SD: Low Back Pain: Medical Diagnosis and Comprehensive Management. 2nd ed., W.B. Saun- ders, Philadelphia 1995: 181–589.
  • 17. Marty M: Définition et évaluation des dimensions physiques et fonctionnelles des lombalgies. Rev Rhum2001; 68: 135–140.
  • 18. Deyo RA, Rainville J, Kent DL: What can the history and physi- cal examination tell us about low back pain?JAMA1992; 268: 760–765.
  • 19. Fricton JR: Myofascial pain. Baillieres Clin Rheumatol1994; 8: 857–880.
  • 20. MacFarlane BV,Wright A, O’Callaghan J et al.: Chronic neuropath- ic pain and its control by drugs. Pharmacol Ther1997; 75: 1–19.
  • 21. Attal N, Bouhassira D: Mechanisms of pain in peripheral neu- ropathy. Acta Neurol Scand Suppl1999; 173: 12–24.
  • 22. Johnson FN, Johnson RD, Armer ML: Gabapentin in the treat- ment of neuropathic pain. Rev Contemp Pharmacother2001; 12: 125–211.
  • 23. Urch CE: Pathophysiology of neuropathic pain. In: Bennett MI (ed.): Neuropathic Pain. Oxford University Press, New York 2007: 9–16.
  • 24. Coppes MH, Marani E, Thomeer RTWM et al.: Innervation of  “painful” lumbar discs. Spine (Phila Pa1976) 1997; 22: 2342–2350.
  • 25. Serra J: Overview of neuropathic pain syndromes. Acta Neurol Scand Suppl1999; 173: 7–11.
  • 26. Devereaux MW: Anatomy and examination of the spine. Neurol Clin2007; 25: 331–351.
  • 27. Frost HM: Personal experience in managing acute compression fractures, their aftermath, and the bone pain syndrome, in osteo- porosis. Osteoporos Int1998; 8: 13–15.
  • 28. Luoma K, Riihimäki H, Luukkonen R et al.: Low back pain in relation to lumbar disc degeneration. Spine (Phila Pa1976) 2000; 25: 487–492.
  • 29. Sella EJ: Noncompressive spinal radiculitis. Orthop Rev1992; 21: 827–832.
  • 30. Meleger AL, Krivickas LS: Neck and back pain: musculosceletal disorders. Neurol Clin2007; 25: 419–438.
  • 31. Park W: Radiological investigation of the intervertebral disc. In: Jayson MIV (ed.): The Lumbar Spine and Back Pain. Sector Pub- lishing, Ltd., London 1976.
  • 32. Adams MA, Dolan P, Hutton WC: Diurnal variations in stresses on the lumbar spine. Spine (Phila Pa1976) 1987; 12: 130–137.
  • 33. Tarulli AW, Raynor EM: Lumbosacral radiculopathy. Neurol Clin2007; 25: 387–405.
  • 34. Bogduk N: Chronic low back pain. In: Cervero F, Jensen TS (eds.): Handbook of  Clinical Neurology. Pain. Elsevier B.V., Amsterdam 2006, 81: 779–790.
  • 35. Lipman AG, Jackson KC: Opioid pharmacotherapy. In: Warf- ield CA, Bajwa ZH (eds.): Principles and Practice of Pain Medi- cine. McGraw-Hill, New York2004: 583–600.
  • 36. Conn DL, Hunder GG, O’Duffy YP: Vasculitis and related disor- ders. In: Kelley WN, Harris ED, Ruddy S et al. (eds.): Textbook of Rheumatology. 4th ed., W.B. Saunders Company, Philadelphia 1999: 1077–1097.
  • 37. Scadding JW: Clinical examination. In: Cervero F, Jensen TS (eds.): Handbook of  Clinical Neurology. Pain. Elsevier B.V., Amsterdam 2006, 81: 385–395.
  • 38. Traycoff RB: Chronic joint and connective tissue pain. In: Tolli- son CD, Satterthwaite JR, Tollison JW (eds.): Handbook of Pain Management. 2nd ed., Williams & Wilkins, Baltimore1994: 523–538.
  • 39. Ahmed M, Modic MT: Neck and low back pain: neuroimaging. Neurol Clin2007; 25: 439–471.
  • 40. Pech P, Daniels DL, Williams AL et al.: The  cervical neural foramina: correlation of microtomy and CT anatomy. Radiology1985; 155: 143–146.
  • 41. Jónsson H Jr, Cesarini K, Sahlstedt B et al.: Findings and outcome in whiplash-type neck distortions. Spine (Phila Pa1976) 1994; 19: 2733–2743.
  • 42. Polston DW: Cervical radiculopathy. Neurol Clin2007; 25: 373–385.
  • 43. Romanoff ME, Gilbert RL, Warfield CA: Neck pain. In: Warf- ield CA, Bajwa ZH (eds.): Principles and Practice of Pain Medi- cine. McGraw-Hill, New York2004: 260–272.
  • 44. Chou R, Huffman LH; American Pain Society; American College of Physicians: Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med2007; 147: 505–514.
  • 45. Deyo RA: Drug therapy for back pain. Which drugs help which patients? Spine (Phila Pa1976) 1996; 21: 2840–2850.
  • 46. Rozenberg S: Le traitement médicamenteux de la lombalgie commune. Rev Rhum2001; 68: 150–153.
  • 47. Marcus DA: Headache and Chronic Pain Syndromes: The Case- Based Guide to Targeted Assessment and Treatment. Humana Press, New Jersey 2007: 209.
  • 48. Venesy DA: Physical medicine and complementary approaches. Neurol Clin2007; 25: 523–537.
  • 49. van Tulder MW, Scholten RJPM, Koes BW et al.: Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the  framework of  the Cochrane Collaboration Back Review Group. Spine (Phila Pa1976) 2000; 25: 2501–2513.
  • 50. van Tulder MW, Koes BW, Bouter LM: Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine (Phila Pa1976) 1997; 22: 2128–2156.
  • 51. Holmes GP, Kaplan JE, Gantz MM et al.: Chronic fatigue syn- drome: a working case definition. Ann Intern Med1988; 108: 387–389.
  • 52. Parfitt AM, Gallagher JC, Heaney RP et al.: Vitamin D and bone health in the elderly. Am J Clin Nutr1982; 36: 1014–1031.
  • 53. Миланов И: Лечение на болката с tramadol hydrochloride. Cephalgia2002; 4: 40–44.
  • 54. Bennett MI: Opioids. In: Bennett MI (ed.): Neuropathic Pain. Oxford University Press, New York 2007: 105–116.
  • 55. Hameroff SR, Crago BR, Cork RC et al.: Doxepin effects on chron- ic pain, depression and serum opioids. Anest Analg1982; 61: 187.
  • 56. Chou R, Huffman LH; American Pain Society; American College of Physicians: Nonpharmacologic therapies for acute and chron- ic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guide- line. Ann Intern Med2007; 147: 492–504.
  • 57. Borenstein DG, Lacks S, Wiesel SW: Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle. Clin Ther1990; 12: 125–131.
  • 58. Gallagher RM: Muscle relaxant medications. In: Tollison CD, Sat- terthwaite JR, Tollison JW (eds.): Handbook of Pain Manage- ment. Williams & Wilkins, Baltimore1994: 173–180.
  • 59. Gallagher RM: Management of neuropathic pain: translating mechanistic advances and evidence-based research into clinical practice. Clin J Pain2006; 22 (Suppl): S2–S8.
  • 60. Eisenberg E, McNicol ED, Carr DB.: Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized con- trolled trials. JAMA2005; 293: 3043–3052.
  • 61. Watson CPN, Moulin D, Watt-Watson J et al.: Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain2003; 105: 71–78.
  • 62. Browsher D: Central neuropathic pain. In: Bennett MI (ed.): Neu- ropathic Pain. Oxford University Press, New York 2007: 49–56.
  • 63. Fast A, Shapiro D, Ducommun EJ et al.: Low-back pain in preg- nancy. Spine (Phila Pa1976) 1987; 12: 368–371.
  • 64. Ginsberg L: Specific painful neuropathies. In: Cervero F, Jen- sen TS (eds.): Handbook of Clinical Neurology. Pain. Elsevier B.V., Amsterdam2006, 81: 635–652.
  • 65. Sindrup SH, Finnerup NB, Otto M et al.: Principles of pharma- cological treatment. In: Cervero F, Jensen TS (eds.): Handbook of Clinical Neurology. Pain. Elsevier B.V., Amsterdam 2006, 81: 843–853.
  • 66. Argoff CE, Katz N, Backonja M: Treatment of postherpetic neu- ralgia: a review of therapeutic options. J Pain Symptom Manage2004; 28: 396–411.
  • 67. Boivie J: Central post-stroke pain. In: Cervero F, Jensen TS (eds.): Handbook of Clinical Neurology. Pain. Elsevier B.V., Amsterdam 2006, 81: 715–730.
  • 68. Attal N, Cruccu G, Haanpää M et al.; EFNS Task Force: EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol2006; 13: 1153–1169.
  • 69. Bennett MI: Drug synergy and sequencing. In: Bennett MI (ed.): Neuropathic Pain.Oxford University Press,New York 2007: 145–153.
Document Type
article
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YADDA identifier
bwmeta1.element.psjd-1734-1531-2014-10-3-4
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