Damage to nerve roots and plexuses. Diagnosis of cervicalgia: symptoms and treatment of neck pain Complications and prognosis for recovery

Lumbodynia is a collective pain syndrome that characterizes most diseases of the spine and is localized in the lumbar and sacrum areas. The pathology can be not only vertebrogenic or spondylogenic in nature (associated with the functional characteristics of the spine), but also be a consequence of disturbances in the functioning of internal organs: the bladder, kidneys, organs of the reproductive system and digestive tract. Regardless of the etiological factors, lumbodynia, according to the international classification of diseases (ICD 10), refers to vertebroneurological diagnoses and has a universal, single code - M 54.5. Patients with acute or subacute lumbodynia have the right to receive sick leave. Its duration depends on the intensity of pain, their effect on a person’s mobility and his ability to self-care, and the identified degenerative, deformational and dystrophic changes in the osteochondral structures of the spine.

Code M 54.5. in the international classification of diseases it is designated vertebrogenic lumbodynia. This is not an independent disease, therefore this code is used only for the primary designation of the pathology, and after the diagnosis, the doctor enters into the chart and sick leave the code of the underlying disease, which became the root cause of the pain syndrome (in most cases it is chronic osteochondrosis).

Lumbodynia is one of the types of dorsopathy (back pain). The terms “dorsopathy” and “dorsalgia” are used in modern medicine to refer to any pain localized in the region of the C3-S1 segment (from the third cervical vertebra to the first sacral vertebra).

Lumbodynia is called acute, subacute or recurrent (chronic) pain in the lower segment of the back - in the region of the lumbosacral vertebrae. The pain syndrome can have moderate or high intensity, unilateral or bilateral course, local or diffuse manifestations.

Local pain on one side almost always indicates a focal lesion and occurs against the background of compression of the spinal nerves and their roots. If the patient cannot accurately describe where exactly the pain occurs, that is, the unpleasant sensations cover the entire lumbar region, there can be many reasons: from vertebroneurological pathologies to malignant tumors of the spine and pelvis.

What symptoms are the basis for diagnosing lumbodynia?

Lumbodynia is a primary diagnosis that cannot be regarded as an independent disease and is used to designate existing disorders, in particular pain. The clinical significance of such a diagnosis is explained by the fact that this symptom is the basis for conducting an X-ray and magnetic resonance examination of the patient in order to identify deformities of the spine and intervertebral discs, inflammatory processes in paravertebral soft tissues, muscular-tonic status and various tumors.

The diagnosis of “vertebrogenic lumbodynia” can be made either by a local therapist or by specialists (neurologist, orthopedic surgeon, vertebrologist) based on the following symptoms:

• severe pain (stabbing, cutting, shooting, aching) or burning in the lower back with transition to the tailbone area, located in the area of ​​​​the intergluteal fold;

  

• impaired sensitivity in the affected segment (feeling of heat in the lower back, tingling, chills, tingling);
• reflection of pain in the lower limbs and buttocks (typical for a combined form of lumbodynia - with sciatica);

  

• decreased mobility and muscle stiffness in the lower back;
• increased pain after physical activity or exercise;

  

• easing of pain after prolonged muscle relaxation (at night).

In most cases, an attack of lumbodynia begins after exposure to any external factors, for example, hypothermia, stress, increased stress, but in an acute course, a sudden onset for no apparent reason is possible. In this case, one of the symptoms of lumbodynia is lumbago - acute lumbago in the lower back, occurring spontaneously and always having a high intensity.

Reflex and pain syndromes with lumbodynia, depending on the affected segment

Despite the fact that the term “lumbodynia” can be used as an initial diagnosis in outpatient practice, the clinical course of the pathology is of great importance for a comprehensive diagnosis of the condition of the spine and its structures. With lumbarization of various segments of the lumbosacral spine, the patient experiences a decrease in reflex activity, as well as paresis and reversible paralysis with various localizations and manifestations. These features make it possible, even without instrumental and hardware diagnostics, to assume in which part of the spine degenerative-dystrophic changes have occurred.

Clinical picture of vertebrogenic lumbodynia depending on the affected spinal segment

Affected vertebrae	Possible irradiation (reflection) of lumbar pain	Additional symptoms
Second and third lumbar vertebrae.	Area of ​​the hips and knee joints (along the front wall).	Flexion of the ankles and hip joints is impaired. Reflexes are usually preserved.
Fourth lumbar vertebra.	Popliteal fossa and shin area (mainly on the front side).	Extension of the ankles becomes difficult, abduction of the hip provokes pain and discomfort. Most patients have a pronounced decrease in the knee reflex.
Fifth lumbar vertebra.	The entire surface of the leg, including the legs and feet. In some cases, pain may be reflected in the first toe.	It is difficult to bend the foot forward and abduct the big toe.
Sacral vertebrae.	The entire surface of the leg from the inside, including the feet, heel bone and phalanges.	The Achilles tendon reflex and plantar flexion of the foot are impaired.

Important! In most cases, lumbodynia is manifested not only by reflex symptoms (this also includes neurodystrophic and vegetative-vascular changes), but also by radicular pathology that occurs against the background of pinched nerve endings.

Possible causes of pain

One of the main causes of acute and chronic lumbodynia in patients of various age groups is osteochondrosis. The disease is characterized by degeneration of the intervertebral discs, which connect the vertebrae to each other in a vertical sequence and act as a shock absorber. The dehydrated core loses its elasticity and elasticity, which leads to thinning of the fibrous ring and displacement of the pulp beyond the cartilaginous end plates. This shift can occur in two forms:

Neurological symptoms during attacks of lumbodynia are provoked by compression of nerve endings that extend from nerve trunks located along the central spinal canal. Irritation of the receptors located in the nerve bundles of the spinal nerves leads to attacks of severe pain, which most often has an aching, burning or shooting character.

Lumbodynia is often confused with radiculopathy, but these are different pathologies. (radicular syndrome) is a complex of pain and neurological syndromes, the cause of which is direct compression of the nerve roots of the spinal cord. With lumbodynia, the cause of pain can also be myofascial syndromes, circulatory disorders or mechanical irritation of pain receptors by osteochondral structures (for example, osteophytes).

Other reasons

The causes of chronic lower back pain may also include other diseases, which include the following pathologies:

• diseases of the spine (vertebral displacement, osteoarthritis, osteosclerosis, spondylitis, etc.);

  

• neoplasms of various origins in the spine and pelvic organs;
• infectious and inflammatory pathologies of the spine, abdominal and pelvic organs (spondylodiscitis, epiduritis, osteomyelitis, cystitis, pyelonephritis, etc.);

  

• adhesions in the pelvis (often adhesions form after difficult childbirth and surgical interventions in this area);
• injuries and damage to the lower back (fractures, dislocations, bruises);

  

  Swelling and bruising are the main symptoms of a lower back injury

• pathologies of the peripheral nervous system;
• myofascial syndrome with myogelosis (formation of painful compactions in the muscles due to inadequate physical activity that does not correspond to the age and physical training of the patient).

  

Provoking factors that increase the risk of lumbodynia may be obesity, abuse of alcoholic beverages and nicotine, increased consumption of caffeine-containing drinks and foods, and chronic lack of sleep.

Factors in the development of acute shooting pain (lumbago) are usually strong emotional experiences and hypothermia.

Important! Lumbodynia during pregnancy is diagnosed in almost 70% of women. If the expectant mother has not been diagnosed with abnormalities in the functioning of internal organs or diseases of the musculoskeletal system that can worsen under the influence of hormones, the pathology is considered physiologically determined. Lower back pain in pregnant women can occur as a result of irritation of the nerve endings by the enlarging uterus or be the result of edema in the pelvic organs (swelling tissue puts pressure on the nerves and blood vessels, causing severe pain). There is no specific treatment for physiological lumbodynia, and all recommendations and prescriptions are aimed primarily at correcting nutrition, lifestyle and maintaining a daily routine.

Is it possible to get sick leave for severe lower back pain?

Disease code M 54.5. is the basis for opening a sick leave due to temporary disability. The duration of sick leave depends on various factors and can range from 7 to 14 days. In especially severe cases, when pain is combined with severe neurological disorders and prevents the patient from performing professional duties (and also temporarily limits the ability to move and fully self-care), sick leave can be extended to 30 days.

The main factors influencing the duration of sick leave for lumbodynia are:

• intensity of pain. This is the main indicator that a doctor evaluates when deciding on a person’s ability to return to work. If the patient cannot move, or movements cause him severe pain, the sick leave will be extended until these symptoms resolve;

  

• working conditions. Office workers usually return to work earlier than those performing heavy physical work. This is due not only to the characteristics of the motor activity of these categories of employees, but also to the possible risk of complications if the causes of pain are not completely relieved;

  

• the presence of neurological disorders. If the patient complains of any neurological disorders (poor sensitivity in the legs, heat in the lower back, tingling in the limbs, etc.), the sick leave is usually extended until the possible causes are fully clarified.

  

Patients who require hospitalization are issued a sick leave certificate from the moment of admission to the hospital. If it is necessary to continue outpatient treatment, the temporary disability certificate is extended for the appropriate period.

Important! If surgical treatment is necessary (for example, for intervertebral hernias larger than 5-6 mm), a sick leave certificate is issued for the entire period of hospital stay, as well as subsequent recovery and rehabilitation. Its duration can range from 1-2 weeks to 2-3 months (depending on the main diagnosis, the chosen treatment method, and the speed of tissue healing).

Limited ability to work with lumbodynia

It is important for patients with chronic lumbodynia to understand that closing sick leave does not always mean complete recovery (especially if the pathology is caused by osteochondrosis and other diseases of the spine). In some cases, with vertebrogenic lumbodynia, the doctor may recommend light work to the patient if the previous working conditions may complicate the course of the underlying disease and cause new complications. These recommendations should not be ignored, since vertebrogenic pathologies almost always have a chronic course, and heavy physical labor is one of the main factors in the exacerbation of pain and neurological symptoms.

Typically, people with limited ability to work are recognized as representatives of the professions listed in the table below.

Professions that require easier working conditions for patients with chronic lumbodynia

Professions (positions)	Causes of limited ability to work
	Forced inclined position of the body (impairs blood circulation in the lumbar region, increases muscle tension, increases compression of nerve endings).
	Lifting heavy objects (can cause an increase in hernia or protrusion, as well as rupture of the fibrous membrane of the intervertebral disc).
	Prolonged sitting (increases the intensity of pain due to severe hypodynamic disorders).
	Staying on your feet for a long time (increases tissue swelling, contributes to increased neurological symptoms in lumbodynia).
	High risk of falling on your back and spinal injury.

Is it possible to serve in the army?

Lumbodynia is not included in the list of restrictions for military service, however, a conscript may be declared unfit for military service due to an underlying disease, for example, grade 4 osteochondrosis, pathological kyphosis of the lumbar spine, spondylolisthesis, etc.

Treatment: methods and drugs

Treatment of lumbodynia always begins with the relief of inflammatory processes and the elimination of painful sensations. In most cases, anti-inflammatory drugs with an analgesic effect from the NSAID group (Ibuprofen, Ketoprofen, Diclofenac, Nimesulide) are used for this purpose.

The most effective regimen of use is considered to be a combination of oral and local dosage forms, but in case of moderate lumbodynia, it is better to avoid taking tablets, since almost all drugs in this group negatively affect the mucous membranes of the stomach, esophagus and intestines.

Back pain bothers most people, regardless of their age and gender. For severe pain, injection therapy may be performed. We recommend reading, which provides detailed information about injections for back pain: classification, purpose, effectiveness, side effects.

The following can also be used as auxiliary methods for the complex treatment of lumbodynia:

• medications to normalize muscle tone, improve blood flow and restore cartilaginous nutrition of intervertebral discs (microcirculation correctors, muscle relaxants, chondroprotectors, vitamin solutions);
• paravertebral blockades with novocaine and glucocorticoid hormones;

  

• massage;
• manual therapy (methods of traction, relaxation, manipulation and mobilization of the spine;
• acupuncture;

If there is no effect from conservative therapy, surgical treatment methods are used.

Video - Exercises for quick treatment of lower back pain

Lumbodynia is one of the common diagnoses in neurological, surgical and neurosurgical practice. Pathology with severe severity is the basis for issuing a certificate of temporary incapacity for work. Despite the fact that vertebrogenic lumbodynia has its own code in the international classification of diseases, treatment is always aimed at correcting the underlying disease and may include medications, physiotherapeutic methods, manual therapy, exercise therapy and massage.

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It has been established that back pain occurs in 80% of the population at different periods of life. Among adults, more than half suffer from long-term chronic symptoms. This prevalence includes the disease in the group of social problems.

The most susceptible and prone to clinical manifestations are:

• people without sufficient physical activity;
• those engaged in intense training or heavy physical labor;
• addicted to alcoholic beverages;
• smokers

Not just any pain is called dorsalgia. To identify it, an accurate diagnosis is required.

What is dorsalgia according to the International Classification?

Dorsalgia is defined in ICD-10 as a group of diseases manifested by such a common clinical symptom as back pain. Coded M54, included in the block “Dorsopathies”, subgroup “Other dorsopathies”, class “Diseases of the musculoskeletal system”.

It is important that dorsalgia does not include:

• osteocondritis of the spine;
• spondylosis;
• any lesions of the intervertebral disc;
• inflammation of the sciatic nerve.

It is interesting that in the ICD there are no diagnoses such as “spondyloarthrosis” or “facet syndrome”. According to many scientists, they most fully reflect the nature of pathological changes. However, they are forced to “cover” them with the term “Other spondylosis” with code M47.8.

What is hidden under the term “others”?

With this diagnosis, the patient can undergo examination and treatment until the cause and type of changes in the muscles, spine are clarified, or until referred back pain is identified due to diseases of the internal organs (most often duodenal ulcer, duodenitis, pancreatitis).

For a thinking doctor, such “diagnoses” are impossible.

Localization differences

Depending on the location of the lesion, dorsalgia is distinguished:

• the entire spine, starting from the cervical region;
• cervicalgia - damage only in the neck;
• pain in the thoracic region;
• damage to the lumbar back in the form of sciatica;
• lumbosacral radiculitis (such as lumbago + sciatica);
• pain in the lower back;
• radiculopathy - when radicular syndrome predominates clinically;
• unspecified other varieties.

Clinical forms

Neurologists distinguish 2 forms of dorsalgia:

• acute - occurs suddenly and lasts up to three months, in 1/5 patients it turns into chronic;
• chronic - lasts more than three months.

Unilateral “long” pain speaks in favor of a root cause

One of the founders of Russian spinal neurology, Ya.Yu. Popelyansky identified a more precise time description of pain:

• episodic;
• chronic recurrent with rare exacerbations;
• chronic recurrent with frequent or prolonged exacerbations;
• gradual or continuous (permanent type of flow).

Studies using diagnostic blockades have established that the main cause of chronic pain is spondyloarthrosis (facet syndrome):

• with cervical localization - up to 60% of cases;
• at the thoracic level of damage - up to 48%;
• for lower back pain - from 30 to 60%.

Most patients are elderly.

The transition to a chronic form is facilitated by hereditary predisposition, stress, mental illness with impaired perception, with pathological sensitivity.

Causes

For the clinical characteristics of the disease, 4 etiological types of back pain are distinguished:

• nonspecific pain - associated with damage to the intervertebral joints, sacroiliac joint (facet);
• muscular - from overstrain or injury to muscles, ligaments, fascia;
• radicular - compression of the nerve roots emerging from the spinal canal;
• specific - this is the name given to pain caused by tumor decay, vertebral fractures, tuberculosis, infectious pathogens, systemic lesions in rheumatoid polyarthritis, psoriasis, lupus erythematosus.

Depending on the cause, dorsalgia is divided into 2 types:

1. vertebrogenic dorsalgia- includes all connections with spinal pathology; changes in the spinal column are more often associated with degenerative processes or unfavorable static and dynamic loads;
2. nonvertebrogenic- includes muscular, psychogenic, depending on various diseases.

Clinical manifestations

Symptoms of dorsalgia depend on the predominant mechanism in the pathology.

Radiculopathy is characterized by:

• unilateral pain in the leg with changes in the lumbar region, or in the arm, shoulder - in the thoracic part of the back, the intensity is stronger than in the back;
• according to irradiation it is regarded as “long” - from the lower back to the fingertips;
• numbness in certain areas;
• weakness of the muscles that are innervated by the affected roots;
• severe symptoms of tension (Lassegue);
• increased pain when coughing, sneezing;
• in a supine position, the pain decreases, scoliosis caused by spastic muscle contraction is leveled out.

The lumbar region is most susceptible to injury to the intervertebral joints, especially with sudden twisting to the side

An additional negative factor is the weakness of the abdominal wall muscles, which allows the shape of the spinal column in the lower part to change.

The following are typical for facet syndrome:

• each exacerbation changes the nature of the pain;
• aching, squeezing or pressing pain in the lower back;
• strengthening during extension, turning to the side, standing up;
• stiffness in the mornings and evenings with maximum severity of pain;
• localization in the paravertebral zone, unilateral or bilateral;
• with lumbosacral lesions, it radiates to the gluteal region, along the back of the thigh to the tailbone, to the groin, and does not “descend” below the knee;
• from the upper lumbar region, pain radiates to both sides of the abdomen, into the chest;
• from the cervical vertebrae - spreads to the shoulder girdle, shoulder blades, rarely lower;
• unlike radiculopathies, it is not accompanied by impaired sensitivity.

Diagnostics

Diagnosis of vertebrogenic dorsalgia is based on the experience of a neurologist. Upon examination, pain is detected in certain areas of innervation. Checking reflexes, sensitivity, and stretch symptoms allows one to suspect the nature of the lesion.

To exclude osteochondrosis of the spine and prolapse of the intervertebral disc, the following is carried out:

• radiographs in different projections;
• magnetic resonance imaging;
• CT scan.

The only standard way to prove pathology of the facet joints is to observe the disappearance of pain after performing a spinal nerve block under the control of computed tomography. The technique is used only in specialized clinics.

It should be taken into account that the patient may have manifestations of both vertebral and muscular symptoms. It is impossible to distinguish them.

Treatment

In the treatment of dorsalgia, doctors use the standards of European recommendations for the treatment of nonspecific back pain. They are universal in nature, do not depend on the source, and are calculated taking into account the maximum level of evidence.

• non-steroidal anti-inflammatory drugs in short courses or up to three months;
• a group of muscle relaxants to combat muscle spasm;
• analgesics (paracetamol-based drugs).

For persistent pain, paravertebral blockades with hormonal agents and anesthetics are used.

Before use, 1 packet is dissolved in half a glass of water, the dosage is convenient for teenagers and the elderly

The use of chondroprotectors for treatment is justified by damage to cartilage tissue. But serious studies of their effectiveness for dorsalgia have not yet been carried out.

It is strongly suggested not to put the patient to bed, but to maintain physical activity and engage in physical therapy. It is even considered an additional risk factor for pain chronicity.

The negative effect of non-steroidal drugs is exacerbation of diseases of the stomach and intestines. Nimesulide (Nise) in combination with Ketorol is currently considered the most effective and safe.

Most doctors approve of the use of physical therapy:

• phonophoresis with hydrocortisone;
• magnetic therapy.

Surgical treatment methods are used for persistent pain. They are associated with a blockade of the transmission of pain impulses through nerve roots. This is achieved by radiofrequency ablation. The method can be performed on an outpatient basis under local anesthesia.

Prevention of exacerbations

The information component of the treatment plan consists of explaining to the patient the nature of the disease and combating stress. It has been proven that the prognosis for treatment is much better if the patient himself participates in rehabilitation.

• exercises that strengthen the muscular frame of the spine;
• swimming lessons;
• repeated massage courses;
• use of orthopedic pillows, mattress, cervical collar;
• taking vitamins.

In case of long-term back pain, there are ways to help, so you don’t have to endure and suffer. Self-medication with various compresses and heating can lead to the opposite result.

5299 1

Almost all people have experienced pain in the neck area at some point.

In medicine, this condition is usually called “cervicalgia.”

As a rule, this pathology is the first and most common sign of cervical.

Without adequate treatment, this condition can cause serious complications and seriously impair a person's quality of life. Therefore, it is so important to immediately consult a doctor if discomfort occurs.

What is cervicalgia syndrome?

This pathology is included in the category of the most common diseases of modern people.

According to statistics, more than 70% of people experience neck pain. The term “cervicalgia” refers to pain that is localized in the neck and radiates to the shoulder, back of the head and arms. According to ICD-10, the disease has code M54.2 “Cervicalgia: description, symptoms and treatment.”

The presence of this pathology can be suspected when a person experiences difficulties with head movements - they are limited, often cause pain or are accompanied by muscle spasms.

Classification of pathology

Currently, it is customary to distinguish two main types of cervicalgia: :

1. Vertebrogenic. It is associated with disorders in the cervical spine and is a consequence of spondylosis, intervertebral hernia, rheumatoid arthritis and other inflammatory processes.
2. Vertebral. This form of the disease develops as a result of muscle or ligament sprains, myositis, and occipital neuralgia. Sometimes this pathology has a psychogenic origin. It can be a consequence of epidural abscess, meningitis, subarachnoid hemorrhage.

Vertebrogenic cervicalgia

This therapy should not last very long as it can lead to problems with the digestive organs. In especially severe cases, the use of muscle relaxants is indicated - Baclofen, Tolperisone, Cyclobenzaprine.

If there is severe muscle tension, local anesthetics - novocaine or procaine - can be prescribed.

In some cases it should be used - it should be worn for 1-3 weeks. To To reduce pain, traction treatment may be prescribed, which consists of traction of the spine.

Of no small importance for the successful treatment of cervicalgia is physiotherapy. Also, many patients are prescribed physiotherapeutic procedures - massage, compresses, mud baths.

Surgery

In some cases, there is a need for surgical treatment of the pathology. Indications for the operation are the following:

• acute and subacute lesions of the cervical spinal cord, which are accompanied by sensory disturbances, pelvic pathologies, and central paresis;
• an increase in paresis in the area of ​​innervation of the spinal root in the presence of a danger of its necrosis.

The main methods of surgical treatment in this case include the following:

• laminectomy;
• iscectomy;
• foraminotomy.

Be careful, video 18+! Click to open

Preventive measures

To prevent the onset of the disease, you should be very careful about the condition of your spine. To keep it healthy, you must do the following: rules:

1. When working sedentarily, it is necessary to take breaks. It is very important to properly equip your workplace.
2. Do not jerk heavy objects.
3. The bed should be quite hard, in addition, it is advisable to choose an orthopedic pillow.
4. It is very important to eat properly and balanced. If you have excess weight, you need to get rid of it.
5. To strengthen your muscle corset, you should play sports. It is especially important to train the muscles of the back and neck.

Cervicalgia is a fairly serious pathology, which is accompanied by severe pain in the neck area and significantly worsens a person’s quality of life.

To prevent its development, you need to exercise, eat a balanced diet, and properly organize your work and rest schedule. If signs of the disease still appear, you should immediately consult a doctor.

Thanks to adequate and timely treatment, you can quickly get rid of the disease.

Vertebrogenic lumbodynia is a set of pathological symptoms that occur in diseases and include, first of all, pain in the lumbar region.

Information for doctors: according to ICD 10, it is encrypted with code M 54.5. The diagnosis includes a description of the vertebrogenic process (osteochondrosis, scoliosis, spondylosis, etc.), the severity of pathological syndromes, the stage and type of the disease.

Symptoms

Symptoms of the disease usually include pain and muscle-tonic disorders of the lumbar spine. The pain is localized in the lower back and, when exacerbated, has a sharp, piercing character. Symptoms of the disease also include a feeling of tension in the muscles of the lumbar region, stiffness of movements in the lower back, and rapid fatigue of the back muscles.

If chronic vertebrogenic lumbodynia occurs, diseases with similar symptoms should be excluded. After all, pain during a chronic process becomes aching, nonspecific, the spine may be painless when palpated, and there may be no tension in the lower back muscles at all. Similar signs are present in the presence of kidney disease, gynecological problems and other conditions. That is why it is important to carry out X-ray examination techniques (MRI, MSCT), and undergo a clinical minimum of somatic examination.

Treatment

This disease should be treated by a neurologist. Medicinal methods of influence should be used in combination with local, manual, physiotherapeutic methods of treatment and physical therapy.

The primary task is to relieve the inflammatory process and reduce pain. To do this, they most often resort to non-steroidal anti-inflammatory drugs (diclofenac, meloxicam, etc.). In the first days, it is preferable to use injectable forms of drugs. Typically, anti-inflammatory therapy lasts 5-15 days; if pain persists, they resort to central anesthesia (use drugs catadolone, tebantine, antiepileptic drugs such as finlepsin, lyrica).

You should also reduce the degree of muscle tension, either with the help of muscle relaxants, or, with mild and moderate manifestations, with local remedies, massage and exercise therapy. Various anti-inflammatory and warming ointments, gels, and patches are used as local remedies. You can also make compresses with liquid dosage forms (for example, compresses with dimexide).

Massage for vertebrogenic lumbodynia should be performed in courses of at least 7-10 procedures. The first three to four sessions may be painful; in subsequent sessions, as well as in cases of severe pain, massage should not be performed. The massage begins with stroking movements, which are then alternated with other massage techniques - such as rubbing, vibration, kneading. Massage is contraindicated in the presence of gynecological pathology, oncopathology (including a history), and skin diseases.

From physical influences, as with other problems with the spine, diadynamic currents should be used, as well as electrophoresis in the acute period, and magnetic fields and laser radiation as a preventive treatment.


Physical therapy exercises for vertebrogenic lumbodynia play a vital role. In addition to relieving and distracting pain during the acute period through stretching exercises, they lead to a number of therapeutic effects. Firstly, this concerns strengthening the muscle corset and thereby reducing the load directly on the vertebrae. Secondly, nutrition of intervertebral structures and microcirculation through the ligamentous apparatus improves. Exercises should be performed regularly, ideally throughout your life.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Pain in the thoracic spine (M54.6), Pain in the lower back (M54.5), Other dorsalgia (M54.8), Sciatica (M54.3), Lumbago with sciatica (M54.4), Lesions of the thoracic roots, not classified in other sections (G54.3), Lesions of the intervertebral discs of the lumbar and other parts with radiculopathy (M51.1), Lesions of the brachial plexus (G54.0), Lesions of the lumbosacral plexus (G54.1), Lesions of the lumbosacral roots, not classified elsewhere (G54.4), Cervical root lesions not elsewhere classified (G54.2), Radiculopathy (M54.1), Cervicalgia (M54.2)

Neurology

general information

Short description

Joint Care Quality Commission approved
Ministry of Health of the Republic of Kazakhstan
dated November 10, 2017
Protocol No. 32

Damage to nerve roots and plexuses can have both vertebrogenic(osteochondrosis, ankylosing spondylitis, spondylolisthesis, ankylosing spondylitis, lumbarization or sacralization in the lumbosacral region, vertebral fracture, deformities (scoliosis, kyphosis)), and non-vertebrogenic etiology(neoplastic processes (tumors, both primary and metastases), damage to the spine by an infectious process (tuberculosis, osteomyelitis, brucellosis) and others.

According to ICD-10 vertebrogenic diseases are designated as dorsopathies (M40-M54) - a group of diseases of the musculoskeletal system and connective tissue, in the clinic of which the leading one is pain and/or functional syndrome in the area of ​​the trunk and extremities of non-visceral etiology [ 7,11 ].
According to ICD-10, dorsopathies are divided into the following groups:
· dorsopathies caused by spinal deformation, degeneration of intervertebral discs without their protrusion, spondylolisthesis;
· spondylopathies;
· dorsalgia.
Damage to the nerve roots and plexuses is characterized by the development of so-called dorsalgia (ICD-10 codes M54.1- M54.8 ). In addition, damage to nerve roots and plexuses according to ICD-10 also includes direct damage to roots and plexuses, classified in headings ( G 54.0- G54.4) (lesions of the brachial, lumbosacral plexus, lesions of the cervical, thoracic, lumbosacral roots, not classified elsewhere).
Dorsalgia is a disease associated with back pain.

INTRODUCTORY PART

ICD-10 code(s):

ICD-10
Code	Name
G54.0	brachial plexus lesions
G54.1	lesions of the lumbosacral plexus
G54.2	lesions of the cervical roots, not classified elsewhere
G54.3	lesions of the thoracic roots, not elsewhere classified
G54.4	lesions of the lumbosacral roots, not classified elsewhere
M51.1	lesions of the intervertebral discs of the lumbar and other parts with radiculopathy
M54.1	Radiculopathy
M54.2	Cervicalgia
M54.3	Sciatica
M54.4	lumbago with sciatica
M54.5	lower back pain
M54.6	pain in the thoracic spine
M54.8	other dorsalgia

Date of protocol development/revision: 2013 (revised 2017)

Abbreviations used in the protocol:

TANK	-	blood chemistry
GP	-	general doctor
CT	-	CT scan
Exercise therapy	-	Healing Fitness
ICD	-	international classification of diseases
MRI	-	magnetic resonance imaging
NSAIDs	-	nonsteroidal anti-inflammatory drugs
UAC	-	general blood analysis
OAM	-	general urine analysis
RCT	-	randomized controlled trial
ESR	-	erythrocyte sedimentation rate
SRB	-	C-reactive protein
UHF	-	Ultra high frequency
UD	-	level of evidence
EMG	-	Electromyography

Protocol users: general practitioner, therapists, neurologists, neurosurgeons, rehabilitation specialists.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review, randomized controlled trial (RCT), or large RCT with a very low probability of bias (++) whose results can be generalized to an appropriate population.
IN	High-quality (++) systematic review of cohort or case-control studies, or High-quality (++) cohort or case-control studies with very low risk of bias, or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+). The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the relevant population.
D	Case series or uncontrolled study or expert opinion.
GGP	Best clinical practice.

Classification

By localization:

· cervicalgia;
· thoracalgia;
· lumbodynia;
· mixed localization (cervicothoracalgia).

According to the duration of the pain syndrome :
acute - less than 6 weeks,
· subacute - 6-12 weeks,
· chronic - more than 12 weeks.

According to etiological factors(Bogduk N., 2002):
· trauma (muscle overextension, rupture of fascia, intervertebral discs, joints, sprained ligaments, joints, bone fractures);
· infectious lesion (abscess, osteomyelitis, arthritis, discitis);
· inflammatory lesion (myositis, enthesopathy, arthritis);
· tumor (primary tumors and sites);
· biomechanical disorders (formation of trigger zones, tunnel syndromes, joint dysfunction).

Diagnostics

DIAGNOSTIC METHODS, APPROACHES AND PROCEDURES

Diagnostic criteria

Complaints and anamnesis
Complaints:
· for pain in the area of ​​innervation of the affected roots and plexuses;
· for disruption of motor, sensory, reflex and autonomic-trophic functions in the area of ​​innervation of the affected roots and plexuses.

Anamnesis:
· long-term physical static load on the spine (sitting, standing);
physical inactivity;
· sudden lifting of weights;
hyperextension of the spine.

Physical examination
· in andzualinspection:
- assessment of the statics of the spine - antalgic posture, scoliosis, smoothness of physiological lordosis and kyphosis, defence of the paravertebral muscles of the affected part of the spine;
- assessment of dynamics - limitation of movements of the arms, head, various parts of the spine.
· PalpaciI: pain on palpation of paravertebral points, spinous processes of the spine, Walle's points.
· PerkussiI hammer of the spinous processes of various parts of the spine - positive Razdolsky's symptom - the "spinous process" symptom.
· positive tonut samples:
- Lassegue's symptom: pain appears when bending the straightened leg at the hip joint, measured in degrees. The presence of Lasegue's symptom indicates the compressive nature of the disease, but does not specify its level.
- Wasserman's symptom: the appearance of pain when lifting a straight leg back while lying on the stomach indicates damage to the L3 root
- Matskevich’s symptom: the appearance of pain when bending the leg at the knee joint while lying on the stomach indicates damage to the L1-4 roots
- Bekhterev's symptom (Lasègue's cross symptom): the appearance of pain in the supine position when bending the straightened healthy leg at the hip joint and disappearing when it bends at the knee.
- Neri's symptom: the appearance of pain in the lower back and leg when bending the head while lying on the back indicates damage to the L3-S1 roots.
- cough impulse symptom: pain when coughing in the lumbar region at the level of the spinal lesion.
· OpriceAmotorfunctions for the study of reflexes: decrease (loss) the following tendon reflexes.
- flexion-ulnar reflex: a decrease/absence of the reflex may indicate damage to the CV - CVI roots.
- ulnar extension reflex: a decrease/absence of the reflex may indicate damage to the CVII - CVIII roots.
- carpo-radial reflex: a decrease/absence of the reflex may indicate damage to the CV - CVIII roots.
- scapulohumeral reflex: a decrease/absence of the reflex may indicate damage to the CV - CVI roots.
- upper abdominal reflex: a decrease/absence of the reflex may indicate damage to the DVII - DVIII roots.
- average abdominal reflex: a decrease/absence of the reflex may indicate damage to the DIX - DX roots.
- lower abdominal reflex: a decrease/absence of the reflex may indicate damage to the DXI - DXII roots.
- cremasteric reflex: a decrease/absence of the reflex may indicate damage to the LI - LII roots.
- knee reflex: decreased/absent reflex may indicate damage to both the L3 and L4 roots.
- Achilles reflex: a decrease/absence of the reflex may indicate damage to the SI - SII roots.
- Plantar reflex: decreased/absent reflex may indicate damage to the L5-S1 roots.
- Anal reflex: decreased/absent reflex may indicate damage to the SIV - SV roots.

Scheme for express diagnostics of root lesions :
· PL3 root lesion:
- positive Wasserman symptom;
- weakness in the leg extensors;
- impaired sensitivity along the anterior surface of the thigh;

· L4 root lesion:
- violation of flexion and internal rotation of the leg, supination of the foot;
- impaired sensitivity on the lateral surface of the lower third of the thigh, knee and anteromedial surface of the leg and foot;
- change in knee reflex.
· L5 root lesion:
- impaired heel walking and dorsal extension of the big toe;
- impaired sensitivity on the anterolateral surface of the leg, dorsum of the foot and fingers I, II, III;
· S1 root lesion:
- impaired walking on toes, plantar flexion of the foot and toes, pronation of the foot;
- impaired sensitivity on the outer surface of the lower third of the leg in the area of ​​the lateral malleolus, the outer surface of the foot, IV and V fingers;
- change in the Achilles reflex.
· OpriceAsensitive functionAnd(sensitivity study using cutaneous dermatomes) - the presence of sensory disorders in the area of ​​innervation of the corresponding roots and plexuses.
· laboratoryresearch: No.

Instrumental studies:
Electromyography: clarification of the level of damage to roots and plexuses. Detection of secondary neuronal muscle damage allows one to determine the level of segmental damage with sufficient accuracy.
Topical diagnosis of lesions of the cervical roots of the spine is based on testing the following muscles:
· C4-C5 - supraspinatus and infraspinatus, teres minor;
· C5-C6 - deltoid, supraspinatus, biceps humerus;
· C6-C7 - pronator teres, triceps muscle, flexor carpi radialis;
· C7-C8 - extensor carpi communis, triceps and palmaris longus muscles, flexor carpi ulnaris, abductor pollicis longus;
· C8-T1 - flexor carpi ulnaris, long flexor muscles of the fingers, intrinsic muscles of the hand.
Topical diagnosis of lesions of the lumbosacral roots is based on the study of the following muscles:
L1 - iliopsoas;
· L2-L3 - iliopsoas, graceful, quadriceps, short and long adductor muscles of the thigh;
· L4 - iliopsoas, tibialis anterior, quadriceps, major, minor and short adductor muscles of the thigh;
· L5-S1 - biceps femoris, extensor toes longus, tibialis posterior, gastrocnemius, soleus, gluteal muscles;
· S1-S2 - intrinsic muscles of the foot, flexor digitorum longus, gastrocnemius, biceps femoris.

Magnetic resonance imaging:
MRI signs:
- protrusion of the fibrous ring beyond the posterior surfaces of the vertebral bodies, combined with degenerative changes in the disc tissue;
- protrusion (prolapse) of the disc - protrusion of the nucleus pulposus due to thinning of the fibrous ring (without its rupture) beyond the posterior edge of the vertebral bodies;
- disc prolapse (or disc herniation), the release of the contents of the nucleus pulposus beyond the annulus fibrosus due to its rupture; disc herniation with its sequestration (the fallen part of the disc in the form of a free fragment is located in the epidural space).

Consultation with specialists:
· consultation with a traumatologist and/or neurosurgeon - if there is a history of trauma;
· consultation with a rehabilitation specialist - in order to develop an algorithm for a group/individual exercise therapy program;
· consultation with a physiotherapist - in order to resolve the issue of physiotherapy;
· consultation with a psychiatrist - in the presence of depression (more than 18 points on the Beck scale).

Diagnostic algorithm:(scheme)

Differential Diagnosis

Differential Diagnosisand rationale for additional research

Table 1.

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Landry manifestation	· the onset of paralysis in the muscles of the legs; · steady progression of paralysis with spread to the overlying muscles of the trunk, chest, pharynx, tongue, face, neck, arms; · symmetrical expression of paralysis; · hypotonia of muscles; areflexia; · objective sensory disturbances are minimal.	LP, EMG	LP: an increase in protein content, sometimes significant (>10 g/l), begins a week after the manifestation of the disease, for a maximum of 4-6 weeks, Electromyography - a significant decrease in the amplitude of the muscle response when stimulating the distal parts of the peripheral nerve. Nerve impulse transmission is slow
manifestation of multiple sclerosis	Impairment of sensory and motor functions	LHC, MRI/CT	Increase in serum immunoglobulin G, presence of specific scattered plaques on MRI/CT
lacunar cortical stroke	Impaired sensory and/or motor functions	MRI/CT	Presence of a cerebral stroke focus on MRI
referred pain in diseases of internal organs	Severe pain	UAC, OAM, BAK	Presence of changes in analyzes from internal organs
osteocondritis of the spine	Severe pain, syndromes: reflex and radicular (motor and sensory).	CT/MRI, radiography	Reduced height of intervertebral discs, osteophytes, sclerosis of endplates, displacement of adjacent vertebral bodies, “spacer” symptom, absence of protrusions and disc herniations
extramedullary tumor of the spinal cord	Progressive development of transverse spinal cord lesion syndrome. Three stages: radicular stage, half-damage stage of the spinal cord. The pain is first unilateral, then bilateral, intensifying at night. Spread of conduction hyposthesia from bottom to top. There are signs of blockade of the subarachnoid space, cachexia. Low-grade fever. Steadily progressive course, lack of effect from conservative treatment.	Possible increased ESR, anemia. Changes in blood tests are nonspecific.	Expansion of the intervertebral foramen, atrophy of the roots of the arches and an increase in the distance between them (Elsberg-Dyck symptom).
ankylosing spondylitis	Pain in the spine is constant, mainly at night, the condition of the back muscles: tension and atrophy, constant restriction of movements in the spine. Pain in the area of ​​the sacroiliac joints. The onset of the disease is between the ages of 15 and 30 years. The course is slowly progressive. The effectiveness of pyrazolone drugs.	Positive CRP test. Increasing ESR to 60 mm/hour.	Signs of bilateral sacroiliitis. Narrowing of intervertebral joint spaces and ankylosis.

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Treatment

Drugs (active ingredients) used in treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT TACTICS:

Non-drug treatment:
· mode III;
· Exercise therapy;
· maintaining physical activity;
· diet No. 15.
· kinesio taping;
Indications:
· pain syndrome;
· muscle spasm;
· motor dysfunction.
Contraindications:
· individual intolerance;
· violation of the integrity of the skin, sagging skin;

NB! In case of pain syndrome, it is carried out according to the mechanism of estero-, proprioceptive stimulation.

Drug treatment:
For acute pain ( table 2 ):


· non-narcotic analgesics - have a pronounced analgesic effect.
· opioid narcotic analgesic has a pronounced analgesic effect.

For chronic pain( table 4 ):
· NSAIDs - eliminate the effect of inflammatory factors during the development of pathobiochemical processes;
· muscle relaxants - reduce muscle tone in the myofascial segment;
· non-narcotic analgesics - have a pronounced analgesic effect;
· opioid narcotic analgesic has a pronounced analgesic effect;
· cholinesterase inhibitors - in the presence of motor and sensory disorders, improves neuromuscular transmission.

Treatment regimens:
· NSAIDs - 2.0 IM No. 7 e/day;
Flupirtine maleate 500 mg orally 2 times a day.
Additional drugs: in the presence of nociceptive pain - opioid narcotic analgesics (in transdermal and intramuscular form), in the presence of neuropathic pain - antiepileptic drugs, in the presence of motor and sensory disorders - cholinesterase inhibitors.

List of essential medications for acute pain(having a 100% probability of application):
Table 2.

Drug group		Mode of application	Level of evidence
	Lornoxicam		A
Non-steroidal anti-inflammatory drug	Diclofenac		A
Non-steroidal anti-inflammatory drug	Ketorolac		A
Non-narcotic analgesics	Flupirtine		IN
	Tramadol	Orally, intravenously 50-100 mg	IN
	Fentanyl		IN

Scroll additional medicines for acute pain ( less than 100% probability of application):
Table 3.

Drug group	International nonproprietary name of the drug	Mode of application	Level of evidence
Cholinesterase inhibitors	Galantamine		WITH
Muscle relaxant	Cyclobenzaprine		IN
	carbamazepine		A
Antiepileptic drug	Pregabalin		A

List of essential medications for chronic pain(having a 100% probability of application):
Table 4.

Drug group	International nonproprietary name of the drug	Mode of application	Level of evidence
Muscle relaxant	Cyclobenzaprine	Orally, daily dose 5-10 mg in 3-4 divided doses	IN
Non-steroidal anti-inflammatory drug	Lornoxicam	Orally, intramuscularly, intravenously 8 - 16 mg 2 - 3 times a day	A
Non-steroidal anti-inflammatory drug	Diclofenac	75 mg (3 ml) IM/day No. 3 with transition to oral/rectal administration	A
Non-steroidal anti-inflammatory drug	Ketorolac	2.0 ml IM No. 5. (for patients from 16 to 64 years old with a body weight exceeding 50 kg, no more than 60 mg intramuscularly; patients with a body weight less than 50 kg or with chronic renal failure are administered no more than 30 mg per 1 injection)	A
Non-narcotic analgesics	Flupirtine	Orally: 100 mg 3-4 times a day, for severe pain 200 mg 3 times a day	IN
Opioid narcotic analgesic	Tramadol	Orally, intravenously 50-100 mg	IN
Opioid narcotic analgesic	Fentanyl	Transdermal therapeutic system: initial dose 12 mcg/hour every 72 hours or 25 mcg/hour every 72 hours;	IN

Scroll additional medications for chronic pain(less than 100% chance of application):
Table 5

Drug group	International nonproprietary name of the drug	Mode of application	Level of evidence
Antiepileptic drug	Carbamazepine	200-400 mg/day (1-2 tablets), then the dose is gradually increased by no more than 200 mg per day until the pain stops (on average, up to 600-800 mg), then reduced to the minimum effective dose.	A
Antiepileptic drug	Pregabalin	Orally, regardless of food intake, in a daily dose of 150 to 600 mg in 2 or 3 divided doses.	A
Opioid narcotic analgesic	Tramadol	Orally, intravenously 50-100 mg	IN
Opioid analgesic	Fentanyl		IN
Glucocorticoid	Hydrocortisone	Locally	WITH
Glucocorticoid	Dexamethasone	V/v, v/m:	WITH
Glucocorticoid	Prednisolone	Orally 20-30 mg per day	WITH
Local anesthetic	Lidocaine		B

Surgical intervention: No.

Further management:
Dispensary activities indicating the frequency of visits to specialists:
· examination by a GP/therapist, neurologist 2 times a year;
· carrying out parenteral therapy up to 2 times a year.
NB! If necessary, non-drug treatment: massage, acupuncture, exercise therapy, kinesiotaping, consultation with a rehabilitation therapist with recommendations for individual/group exercise therapy, orthopedic shoes, splints for foot drop, and specially adapted household items and instruments used by the patient.

Indicators of treatment effectiveness:
· absence of pain syndrome;
· increase in motor, sensory, reflex and autonomic-trophic functions in the area of ​​innervation of the affected nerves.

Treatment (inpatient)

TREATMENT TACTICS AT THE INPATIENT LEVEL:
· leveling of pain syndrome;
· restoration of sensitivity and motor disorders;
· use of peripheral vasodilators, neuroprotective drugs, NSAIDs, non-narcotic analgesics, muscle relaxants, anticholinesterase drugs.

Patient observation card, patient routing: No.

Non-drug treatment:
Mode III
· diet No. 15,
· physiotherapy (thermal procedures, electrophoresis, paraffin treatment, acupuncture, magnetic, laser, UHF therapy, massage), exercise therapy (individual and group), kinesio taping

Drug treatment

Scroll essential medicines(having a 100% probability of application):

Drug group	International nonproprietary name of the drug	Mode of application	Level of evidence
Non-steroidal anti-inflammatory drug	Lornoxicam	Inside, intramuscularly, intravenously 8 - 16 mg 2 - 3 times a day.	A
Non-steroidal anti-inflammatory drug	Diclofenac	75 mg (3 ml) IM/day No. 3 with transition to oral/rectal administration;	A
Non-steroidal anti-inflammatory drug	Ketorolac	2.0 ml IM No. 5. (for patients from 16 to 64 years old with a body weight exceeding 50 kg, no more than 60 mg intramuscularly; patients with a body weight less than 50 kg or with chronic renal failure are administered no more than 30 mg per 1 injection)	A
Non-narcotic analgesics	Flupirtine	Adults: 1 capsule 3-4 times a day with equal intervals between doses. For severe pain - 2 capsules 3 times a day. The maximum daily dose is 600 mg (6 capsules). Doses are selected depending on the intensity of pain and the patient’s individual sensitivity to the drug. Patients over 65 years of age: at the beginning of treatment, 1 capsule in the morning and evening. The dose may be increased to 300 mg depending on the intensity of pain and tolerability of the drug. In patients with severe signs of renal failure or hypoalbuminemia, the daily dose should not exceed 300 mg (3 capsules). In patients with reduced liver function, the daily dose should not exceed 200 mg (2 capsules).	IN

Additional drugs: in the presence of nociceptive pain - opioid narcotic analgesics (in transdermal and intramuscular form), in the presence of neuropathic pain - antiepileptic drugs, in the presence of motor and sensory disorders - cholinesterase inhibitors.

List of additional medicines(less than 100% chance of application):

Drug group	International nonproprietary name of the drug	Mode of application	Level of evidence
Opioid narcotic analgesic	Tramadol	Orally, intravenously 50-100 mg	IN
Opioid narcotic analgesic	Fentanyl	Transdermal therapeutic system: initial dose 12 mcg/hour every 72 hours or 25 mcg/hour every 72 hours).	IN
Cholinesterase inhibitors	Galantamine	The drug is prescribed at 2.5 mg per day, gradually increasing after 3-4 days by 2.5 mg, divided into 2-3 equal doses. The maximum single dose is 10 mg subcutaneously, and the maximum daily dose is 20 mg.	WITH
Antiepileptic drug	Carbamazepine	200-400 mg/day (1-2 tablets), then the dose is gradually increased by no more than 200 mg per day until the pain stops (on average, up to 600-800 mg), then reduced to the minimum effective dose.	A
Antiepileptic drug	Pregabalin	Orally, regardless of food intake, in a daily dose of 150 to 600 mg in 2 or 3 divided doses.	A
Glucocorticoid	Hydrocortisone	Locally	WITH
Glucocorticoid	Dexamethasone	V/v, v/m: from 4 to 20 mg 3-4 times/day, maximum daily dose 80 mg up to 3-4 days	WITH
Glucocorticoid	Prednisolone	Orally 20-30 mg per day	WITH
Local anesthetic	Lidocaine	5-10 ml of 1% solution is injected intramuscularly to anesthetize the brachial and sacral plexus	B

Drug blockades according to the spectrum of action:
· analgesic;
· muscle relaxants;
· angiospasmolytic;
· trophostimulating;
· absorbable;
· destructive.
Indications:
· severe pain syndrome.
Contraindications:
· individual intolerance to drugs used in the medicinal mixture;
· presence of acute infectious diseases, renal, cardiovascular and liver failure or diseases of the central nervous system;
· low blood pressure;
· epilepsy;
· pregnancy in any trimester;
· presence of damage to the skin and local infectious processes until complete recovery.

Surgical intervention: No.

Further management:
· observation by a local therapist. Subsequent hospitalization as planned in the absence of effectiveness of outpatient treatment.

Indicators of treatment effectiveness and safety of diagnostic and treatment methods described in the protocol:
· reduction of pain syndrome (assessment on VAS scales, G. Tampa kinesiophobia scale, McGill pain questionnaire, Oswestry questionnaire);
· increase in motor, sensory, reflex and autonomic-trophic functions in the area of ​​innervation of the affected nerves (assessment without a scale - based on neurological status);
· restoration of ability to work (assessed by the Barthel index).

Hospitalization

INDICATIONS FOR HOSPITALIZATION, INDICATING THE TYPE OF HOSPITALIZATION

Indications for planned hospitalization:
· ineffectiveness of outpatient treatment.

Indications for emergency hospitalization:
· severe pain syndrome with signs of radiculopathy.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1. Barulin A.E., Kurushina O.V., Kalinchenko B.M. Application of the kinesiotaping technique in neurological patients // RMZh. 2016. No. 13. pp. 834-837. 2. Belskaya G.N., Sergienko D.A. Treatment of dorsopathy from the standpoint of effectiveness and safety // Breast Cancer. 2014. No. 16. P.1178. 3. Danilov A.B., N.S. Nikolaeva, Efficacy of a new form of flupirtine (Katadolon forte) in the treatment of acute back pain //Manage pain. – 2013. – No. 1. – P. 44-48. 4. Kiselev D.A. Kinesio taping in the medical practice of neurology and orthopedics. St. Petersburg, 2015. –159 p. 5. Clinical protocol “Damage to nerve roots and plexuses” dated December 12, 2013 6. Kryzhanovsky, V.L. Back pain: diagnosis, treatment and rehabilitation. – Mn.: DD, 2004. – 28 p. 7. Levin O.S., Shtulman D.R. Neurology. Handbook of a practicing physician. M.: MEDpress-inform, 2012. - 1024s. 8. Neurology. National leadership. Brief edition/ed. Guseva E.I. M.: GEOTAR – Media, 2014. – 688 p. 9. Podchufarova E.V., Yakhno N.N. Backache. - : GEOTAR-Media, 2014. – 368 p. 10. Putilina M.V. Features of diagnosis and treatment of dorsopathies in neurological practice // Consilium medicum. – 2006.– No. 8 (8). – pp. 44–48. 11. Skoromets A.A., Skoromets T.A. Topical diagnosis of diseases of the nervous system. SPb. “Polytechnics”, 2009 12. Subbotin F. A. Propaedeutics of functional therapeutic kinesiological taping. Monograph. Moscow, Ortodinamika Publishing House, 2015, -196 p. 13. Usmanova U.U., Tabert R.A. Features of the use of kinesio tape in pregnant women with dorsopathies // Materials of the 12th international scientific and practical conference “Education and Science of the XXI Century - 2016”. Volume 6. P.35 14. Erdes S.F. Nonspecific pain in the lower back. Clinical recommendations for local therapists and general practitioners. – M.: Kit Service, 2008. – 70 p. 15. Alan David Kaye Case Studies In Pain Management. – 2015. – 545 rub. 16. Bhatia A., Bril V., Brull R.T. et al. Study protocol for a pilot, randomized, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: The PREPLANS study.// BMJ Open/ - 2016, 6(6) . 17. Bishop A., Holden M.A., Ogollah R.O., Foster N.E. EASE Back Study Team. Current management of pregnancy-related low back pain: A national cross-sectional survey of UK physiotherapists. //Physiotherapy.2016; 102(1):78–85. 18. Eccleston C., Cooper T.E., Fisher E., Anderson B., Wilkinson N.M.R. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 8 Art. No.: CD012537. DOI: 10. 1002 / 14651858. CD 012537. Pub 2. 19. Elchami Z., Asali O., Issa M.B. and Akiki J. The efficacy of the combined therapy of pregabalin and cyclobenzaprine in the treatment of neuropathic pain associated with chronic radiculopathy. // European Journal of Pain Supplements, 2011, 5(1), 275. 20. Grant Cooper Non-operative Treatment Of The Lumbar Spine. – 2015. – 163 rub. 21. Herrmann W.A., Geertsen M.S. Efficacy and safety of lornoxicam compared with placebo and diclofenac in acute sciatica/lumbo-sciatica: an analysis from a randomized, double-blind, multicentre, parallel group study. //Int J Clin Pract 2009; 63 (11): 1613–21. 22. Interventional Pain Control in Cancer Pain Management/Joan Hester, Nigel Sykes, Sue Pea RUR 283 23. Kachanathu S.J., Alenazi A.M., Seif H.E., et al. Comparison between kinesio taping and a traditional physical therapy program in treatment of nonspecific low back pain. //J. Phys Ther Sci. 2014; 26(8):1185–88. 24. Koleva Y. and Yoshinov R. Paravertebral and radicular pain: Drug and/or physical analgesia. //Annals of physical and rehabilitation medicine, 2011, 54, e42. 25. Lawrence R. Robinson M.D. Trauma Rehabilitation. – 2005. – 300 rub. 26. McNicol E.D., Midbari A., Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. 27. Michael A. Überall, Gerhard H.H. Mueller-Schwefe, and Bernd Terhaag. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study October 2012, Vol. 28, No. 10, Pages 1617-1634 (doi:10.1185/03007995.2012.726216). 28. Moore R.A., Chi CC, Wiffen P.J., Derry S., Rice ASC. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010902. 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Information

ORGANIZATIONAL ASPECTS OF THE PROTOCOL

List of protocol developers with qualification information:
1) Tokzhan Tokhtarovna Kispaeva - Doctor of Medical Sciences, neuropathologist of the highest category of the RSE at the National Center for Occupational Health and Occupational Diseases;
2) Aigul Serikovna Kudaibergenova - Candidate of Medical Sciences, neuropathologist of the highest category, Deputy Director of the Republican Coordination Center for Stroke Problems of JSC National Center for Neurosurgery;
3) Smagulova Gaziza Azhmagievna - Candidate of Medical Sciences, Associate Professor, Head of the Department of Propaedeutics of Internal Diseases and Clinical Pharmacology of the West Kazakhstan State Medical University named after Marat Ospanov.

Disclosure of no conflict of interest: No.

Reviewer:
Baimukhanov Rinad Maratovich - Associate Professor of the Department of Neurosurgery and Neurology of the FNPR RSE at the Karaganda State Medical University, a doctor of the highest category.

Specifying the conditions for reviewing the protocol: review of the protocol 5 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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