Among pain syndrome (BS) of different origin the most common among the patients in our clinics is the one main area where the localization of pain - lumbar region. In the diagnosis of the causes of back pain we are based on a thorough analysis of patient complaints, anamnesis, results nevroortopedicheskogo and additional methods of examination. To select the correct tactics of patient we strive to accurately determine the pathogenic variety and source of pain. In our practice, nonspecific musculoskeletal pain syndromes are detected in approximately 80% -90% of patients; pain caused by lesion of the spinal cord (radiculopathy) 10-15%; and specific pain caused by infectious, tumor or other lesion of the spinal structures or internal diseases - from 4 to 5%.
Neuroscience
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line drugs in the treatment of back pain of any origin, and among these funds, we make extensive use of diclofenac . The advantages of this drug, in our experience and data from a number of clinical studies are well defined anti-inflammatory and analgesic effects and rapid onset of action . However, the use of NSAIDs can cause so-called class-side effects from the gastrointestinal tract and the SSA in varying degrees, common to all drugs in this group . Therefore, in recent years we often prescribed to patients Neurodiclovit drug, which is a combination in one dosage form of diclofenac with neurotropic vitamins B1, B6 and B12, are widely used in the treatment of backache . Due to such a combination has not only enhanced analgesic and protivovospalite & gt; Flax action of diclofenac, and opens the possibility to reduce its dose, and thus reduce the side effects that are dose-related in the majority .
Treating back pain is more expedient to carry out the principle of step-up, t . e . Intensive therapy first amplified to achieve meaningful clinical benefit, then the treatment continues on the principle of step-down, that is, its intensity gradually decreases . At the first stage we prescribe to our patients Neurodiclovit . T . to . 1 in its capsule contains 50 mg of diclofenac - is convenient to choose an effective dose, assigning 1 to 3 capsules to achieve analgesia . When reducing the symptoms and especially the intensity of pain dosage of NSAIDs initially decreases, then these drugs altogether canceled and we move to the second stage of therapy - neurotropic B vitamins (Neyromultivit) . With this two-step regimen use of combination therapy in the first stage allows us to reduce the time of treatment, to reduce the number of complications typical of NSAIDs by reducing doses of these drugs and the duration of use . And, by receiving fewer pills increases patients' adherence to treatment and reduces the cost of it . Appointment to the second stage of the complex of B vitamins - Neyromultivita - increases the effectiveness of treatment of NSAID, to extend the period of remission, directed by neurotrophic effect of vitamins, their ability to soothe "irritated" the nerves and improve trophism and function of the nervous tissue . Here's an example of a clinical case from our practice .
Patient B, 57 years old, diagnosed lumbodynia on the background of osteochondrosis of the lumbar spine (LIII-LV) with moderate to severe pain, chronic remitting course with exacerbations of moderate frequency, the phase of incomplete remission . Sick for 8 years, during exacerbations, advancing 3-4 times a year, taking diclofenac at a dose of 150 mg per day in tablets, courses of 2-3 weeks, according to the patient because it helps her better than other NSAIDs . During the recent aggravation in the end of the second week of receiving Diclofenac felt discomfort in the epigastric area, heartburn, nausea . After consultation with a gastroenterologist to reduce the dose of Diclofenac 50 mg per day, but soon increased back pain . In the event of last exacerbation lumbodynia had an appointment Neyrodiklovita 1 capsule 3 times daily The decrease in pain intensity and an increase in locomotor activity occurred after 3 days and the total dose of diclofenac reduced to 2 capsules per day (t . e . 100 mg), and after 7 days of treatment, the pain is almost gone, and no symptoms of the gastrointestinal tract does not appear . Within 7 days of receiving more Neurodiclovit 1 capsule per day, and then he was appointed Neyromultivit 1 tablet 3 times a day for 1 month . As a result, occurred disease remission .
Neurologist of higher category clinic "ASTER-Med" Alexander Popov Emmanuilovna
Treatment and prevention
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