A method of treating acute and chronic myofascial pain of the lumbar-sacral spine

 

(57) Abstract:

The invention relates to medicine, namely to vertebrology in the treatment of myofascial pain of the spine. Essence: the trigger point press your finger to feel the heat under your finger and muscle relaxation strand, then injected into trigger points subcutaneously in the center of the zone antireticulin cytotoxic serum by A. A. the Petitioner that restores peripheral blood flow. 2 C.p. f-crystals, 1 table.

The invention relates to medicine and can be used in neurological and orthopedic practice for the treatment of patients with myofascial pain of the lumbar-sacral spine.

Causes of myofascial pain (painful muscle seals) are forced body position (working position), local and General vibration, muscle tension in the lumbar region, hypothermia or overheating of the body, which lead to poor circulation in the microvasculature of the affected muscles of this region. The difference myofascial pain from radicular is that this pathology is not compromised the integrity of the spine, i.e., not broken ligaments, there is no displacement of the cartilage of the body Paul characterized by the presence of so-called trigger points [1] , areas with increased irritability and seal (strands) bundles of skeletal muscles or muscle fascia. In these places there is peretaplivanii muscular fibers of the blood vessels that lead to this pathology. Pathological changes can be registered by using special methods of research (rheovasography, capillaroscopy, electrocardiography).

The known method of the traditional medical treatment of acute myofascial pain of the lumbar-sacral spine [2] by assigning strict bed rest with receiving analgesic means, minor tranquilizers, sedatives, and antihistamines.

The disadvantages of this method are:

the short duration of action of therapeutic drugs, because it is the addiction to analgetika and sedative drugs, which causes a reduction in the threshold of sensitivity to these drugs and, accordingly, the effectiveness of treatment;

the intoxication of the organism.

In addition, the ongoing procaine blockade lead to worsening pain syndrome by increasing swelling of this area, and it is to increase its temperature and disturbance of the functions.

Known SP[3] by assigning neuropeptides - modulators of pain, which stimulate the production of neurohormones for pain relief.

The disadvantages of this method are:

the limited use of the drug caused by frequent individual intolerance hormones;

high risk of complications due to effects on the endocrine system;

the body's dependency (addiction) and a decrease in therapeutic effect and enforced, therefore, increase the dose;

age limit when a drug (you cannot assign at a young age and over the age of fifty years, especially women).

The General disadvantages of the known methods are:

the long duration of treatment;

the possibility of recurrence of the disease (when the treatment does not restore function of the microvasculature, and only stopped the pain).

The closest in technical essence is a method of treatment of myofascial pain of the lumbar-sacral spine [1], which consists in determining the zone of pain and trigger points with subsequent manual therapy each trigger point. Manual therapy is carried out by ischemic compression, which naprawiam finger pressure (up clenched skin), followed by reactive hyperemia.

The disadvantage of this method is the short duration of therapeutic effect, since the insufficiency of trigger zones there is the aggravation of reducing blood flow to this area on the background of already existing shortage of blood flow. Occur after ischemic compression reactive hyperemia causes transient vasodilatation, which leads to swelling of this area muscles, hyperextension fascia and, consequently, to increased pain effect. The known method does not restore the microcirculation, because not included reflex Central nervous system - the hypothalamus, which receives and provides emotional and autonomic components of the pain response of the body.

When insufficiency of this section does not activate effectors impact on the hypothalamus, the autonomic nervous system, resulting in not produced catecholamines, adrenaline and other neurohormones, which are aimed at suppressing pain, because the known method does not interrupts the reflex arc. The known method is briefly relieves pain, but still muscular fibers, and full recovery bolney and chronic myofascial pain of the lumbar-sacral spine, in which the holding surface massage painful areas, manual exposure trigger point (through deep finger pressure until you feel the heat under your fingers and relaxation of muscle fibers) and the introduction of immunostimulant in the area of the projection of each trigger points helps to ensure full recovery of microcirculation, Central and peripheral blood flow, restoring full mobility of the muscles, the disappearance of muscle fibers and pain, shorten the duration of treatment, full medical, occupational and social rehabilitation of the patients.

The problem is solved in that in the method of treatment of acute and chronic myofascial pain of the lumbar-sacral spine, including the definition of the zone of pain and trigger points, manual therapy each trigger points, according to the invention, carried out surface area massage, covering the painful area, after manual therapy all trigger points injected adjuvant in the area of the projection of each trigger points, with manual therapy each trigger points is carried out by deep finger pressure until you feel the heat under your fingers, relaxing the muscle bundle is unstimulated use antireticulin cytotoxic serum by A. A. The Bogomolets.

The inventive method is based on a fundamentally new approach - the combined effect of superficial massage, manual therapy for trigger points and the introduction of immunostimulant subcutaneously in the area of the projections of these points.

Surface massage the painful area allows you to activate pain receptors for activity from the skin and muscles, to include in the reflex arc of the hypothalamus, which receives and provides for the formation of emotional and autonomic component of the pain response of the body. In parallel with it activated the adrenal glands, increasing the release of adrenaline, which accumulates mainly in the painful areas. When superficial massage increases the release of corticosteroids, which have a stimulating effect on the muscles, resulting in the dilation of blood vessels, improves microcirculation, reduces pain.

Surface massage prepares the trigger points for the effects of manual therapy. Appearing in the muscles after superficial massage blood flow bypasses the stage of hypoxia and decreases pain.

The manual therapy (by deep palitinate his seal. When the effects of manual therapy on the affected muscles is a reflex effect on the receptors in the fascia and muscle fibers, resulting in the inclusion of the Central, peripheral, somatic and autonomic nervous systems. This interrupts the reflex arc that supports the disease. Manual trigger point therapy provides penetration immunostimulant in the area of pain and pain syndrome.

Subcutaneous administration of an immunostimulant in prepared with the help of chiropractic treatment area projection pain points allows to localize the action of a medicinal product, to delay the spread of pain in trigger point and to accelerate the recovery of microcirculation of the affected muscle.

One of the most effective Immunostimulants is antireticulin cytotoxic serum by A. A. the Petitioner (KL ACC). KL ACC - protein preparation obtained from the blood serum of horses. So immunostimulant acts as a regulator of plastic features on the connective tissue system. I.e. immune reflex, through the connective tissue (which consists of the drug) acts on the capillaries, nerve oodit to improve metabolic processes in the affected muscles and restore homeostasis affected area. The effect of the protein preparation as a component of connective tissue, connective tissue of the affected area of the muscles leads to a full recovery of the muscles and circulation of deep muscles. In addition, immune and performs its usual function - improves the immune function of the body, which leads to faster recovery.

Thus, the claimed method of treatment of acute and chronic myofascial pain of the lumbar-sacral spine contains the following essential features: surface massage, metered manual therapy, subcutaneous administration of BPA in the area of the projection of each trigger points that differ from the prototype and allows you to get a therapeutic result in the complete restoration of the mobility of the muscles, the disappearance of muscle fibers and pain, which leads to full health, labour and social rehabilitation of patients.

The method is as follows. Sick visiting, then laid down on the couch on his stomach, arms along the body, the head on the side. Explore straight back muscles, define the zone of pain and trigger points. Produce light surface skin massage painful areas. Then carried out manually without the produce pressure up to 20 kg - until you feel the heat beneath his fingers and relaxing the muscle strand. A pressure perpendicular to the surface of the body, lasts 30-40 C. For one session spend 3-4 pressing each trigger points, with a break of 15-20 with between them. Then subcutaneously injected WITHIN the Central area of the projection of each trigger point.

The entire course of treatment is 5 sessions with an interval between them 2 days. KL ACC impose a dilution of 1:10, subcutaneously, in ascending doses: 0,1 - 0,2 - 0,3 - 0,4 - 0,5 Jr.

Example 1. Patient C s, 45 years old (case history N 1876, Protocol N 37) were hospitalized for chronic pain in the lumbar-sacral area, vibration disease, peripheral vegetative-vascular disorders.

Was admitted with complaints of a burning pain in the lumbar-sacral area, coldness in the extremities, hands and feet.

Neurological status: limitation of range of motion in the lumbar-sacral area, the smoothness of the lumbar lordosis, the tension of the back muscles, their pain on palpation.

On the radiograph of the lumbosacral spine is not modified.

Data capillaroscopy skin folds of the nail bed before treatment: the background is murky, Ney is Rohani, tortuous, microvessels in a state of spasm, is stagnant; the blood flow slowed down, inhomogeneous. Conclusion: the change of capillary blood flow by spastic type.

The patient was conducted 5 sessions of treatment by the present method. Before treatment was determined the sensitivity of the patient to WITHIN - staged skin sample diluted 1:100 KL ACC (0.1 ml). Injection was performed in the flexor surface of the forearm, intradermally, and watched the reaction for 20 minutes, the Sample is considered negative if the pimple diameter of not more than 0.9 cm and around is not limited. The sample is considered positive if the pimple with a diameter of 1 cm or more, and surrounded by a large area of redness. Reaction to the vaccine, the patient was negative.

Then the patient has to lie down on the couch face down. Spent light surface back massage. After finding trigger points in the muscles of the lumbosacral region was applied manual therapy on them. The pressure lasted 30-40 C. For one session was conducted 3-4 pressure with a break of 15-20 with between them. Under the fingers appeared warmth, muscle strand became softer, the tension in the muscles fell, heavy relaxed.

Diluted 10 times WITHIN was administered subcutaneously, in the centre Oal of 5 injections with a two-day break between them.

After treatment the patient's condition has improved. Pain disappeared, the roughness of the muscles, increased range of motion of limbs and disappeared in them a sense of numbness and cold.

Data capillaroscopy after treatment: background pink, clear, in the first linear millimeter - 8-10 capillaries, secondary branches, no spasm; the calm flow, homogeneous, i.e., in a capillary current spasm is not observed. After treatment in the peripheral circulation occurred normalization of capillary blood flow.

Example 2. Patient W s, 47 years old (case history N 748, minutes No. 19) was in the clinic for chronic pain lumbosacral spine region, vibration disease, peripheral vegetative-vascular disorders. Was admitted with complaints of pain in the lumbar-sacral area burning character without irradiation.

Neurological status: limited range of motion in the lumbar-sacral region, lumbar lordosis smoothed, palpation of the painful muscles of the lumbar region, dryness of the skin, atrophy of the muscles of the hands, on the radiograph of the lumbosacral spine intact.

Rheovasography lower konechno which begins: arterial vascular tone increased.

The patient was conducted 5 sessions of treatment by the proposed method. Before treatment was determined by the sensitivity of the patient to horse protein. Was put skin sample with a dilution of 1:100 KL ACC. Injection was carried out in the flexor region of the forearm. Reaction to the vaccine - negative.

Then the patient has to lie down on the couch face down. Spent light surface back massage. After finding trigger points in the muscles of the lumbosacral region was applied manual therapy on them. The pressure lasted 30-40 C. For one session was conducted 3-4 pressure with a break of 15-20 with between them. Under the fingers appeared warmth, muscle strand became softer, the tension in the muscles fell, heavy relaxed.

Diluted 10 times WITHIN was administered subcutaneously, in the center of the projection of each trigger points in ascending doses: 0,1 - 0,2 - 0,3 - 0,4 - 0,5 Jr. the Course of treatment consisted of 5 injections with a two-day break between them.

After treatment the patient's condition has improved: disappeared muscle fibers, pain in the lumbar-sacral area, increased range of motion, decreased swelling tissue.

Rheovasography after treatment: vertex sharp waves, incisura deep log is 0,172 Ohms. Conclusion: arterial vascular tone returned to normal - in normal limits, no asymmetry. Analysis of rheovasography after treatment reliably shows the improvement of the condition of the patient.

To compare the effectiveness of treatment and claimed by known methods use complex criterion of efficiency (e), quantitatively equal to the ratio of estimating the probability of recovery (%) duration of treatment (in days). Then the effect of the application of the new method of treatment in comparison with traditional medical treatment is determined by the efficiency gains:

P = En- Et,

where enand et- the effectiveness of treatment of new and traditional ways.

Given the local nature of the disease, the probability of recovery will be assessed by the local criterion - pain syndrome. Baseline data for evaluating the effectiveness and results of calculation of efficiency gains for the comparison of treatment methods - metered manual therapy (prototype), the introduction of KL ACC (according to the method proposed method) and a combination of superficial massage, manual therapy and WITHIN (the inventive method are summarized in table.

The table shows (column 5) that when emeu amount increases efficiency:

1,029 + 1,031 = 2.06 to < 2,345,

that quantitatively confirms the expression "sverhsummarny effect" in the claimed method.

Comparison of the results of clinical observations and evaluations of the effectiveness of treatment allows you to specify the advantages of the proposed method in comparison with the known methods of treatment:

restoration of microcirculation;

earlier disappearance of pain syndrome;

ease of implementation;

no complications;

full rehabilitation of patients.

Sources of information

1. Travell J.G. Myofascial pain. - M, Medicine, 1989, S. 7.

2. Akimov, A. "Etiotropic and pathogenetic treatment of neurological pain syndromes peripheral Genesis". "Neuropathology and psychiatry, 1983, No. 3, S. 504-511.

3. Darbinian T. M., Buniatian A. A. Neuroleptanalgesia. AB-to anasthesiologie and resuscitation. M, Medicine, 1989, S. 157-159.

4. Travell J. He Myofascial pain. - M, Medicine, 1989, S. 53-57 (prototype).

1. A method of treating acute and chronic myofascial pain of the lumbar-sacral spine by determining the zone of pain and trigger points, characterized in that after determining the zone of pain spend W ill result immunostimulant, in this manual, the impact of each trigger points is carried out by deep finger pressure until you feel the heat beneath his fingers and relaxing the muscle strand.

2. The method according to p. 1, characterized in that the adjuvant is injected subcutaneously into the center area of the projection of each trigger point.

3. The method according to p. 1, characterized in that as immunostimulant use antireticulin cytotoxic serum by A. A. the Petitioner.

 

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FIELD: medicine, narcology.

SUBSTANCE: one should detect satisfaction insufficiency syndrome due to performing genetic analysis by the presence of, at least, one of the genes coding the exchange of neuromediators being the constituents of human satisfaction system. One should compensate satisfaction insufficiency due to performing, at least, one complex of physical exercises. Moreover, in case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture in patient one should apply the complex of physical exercises including those to provide sedative effect, and in case of availability of pathological gene allele of dopamine-beta-hydroxylase protein one should apply the complex of physical exercises including those that induce an activating effect. In case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture one should apply additional food biologically active additives based upon amino acids being the precursors of neuromediators, such as taurine, D-, L-phenylalanine in combination with 5-hydroxytryptophan, hypericin and vitamin B6, and in case of pathological gene allele of dopamine-beta-hydroxylase protein one should additionally apply food biologically active additives based upon amino acids being the precursors of neuromediators, such as: taurine, tyrosine and/or dimethylaminoethanol, lecithin and group B-vitamins. The present innovation enables to take into account pathological disease mechanism.

EFFECT: higher efficiency of prophylaxis.

14 cl, 5 ex

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