scholarly journals Chronic musculoskeletal pain in neurological practice

2021 ◽  
pp. 22-28
Author(s):  
D. Kh. Khaibullina ◽  
Yu. N. Maksimov ◽  
F. I. Devlikamova
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Muscle Relaxant ◽  
Clinical Case ◽  
Pain Treatment ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Pain Syndrome ◽  
Chronic Musculoskeletal Pain ◽  
Herniated Disc

Treatment of musculoskeletal back pain is an essential problem for doctors of many specialties, including neurologists. In some cases, the chronic course of the pain syndrome is accompanied with complaints and clinical manifestations characteristic of neuropathic pain in the absence of significant damage to the neural structures, which is explained by the mechanism of central sensitization. In this case, there may be diagnostic errors in determining the nature of the pain, which entails inadequate therapy that does not lead to the desired result.The presented clinical case is devoted to the treatment of exacerbation of chronic musculoskeletal pain. Treatment of the patient for a herniated disc complicated by radiculopathy, carried out earlier, did not lead to the desired result due to the inconsistency of the diagnosis, inadequacy and lack of systematic therapy. Based on the analysis of the physical and paraclinical studies, the diagnosis was changed to « Lower back pain. Myofascial pain syndrome. Toxic polyneuropathy. Herniated disc LV-SI. Residual radiculopathy S1». Therapeutic measures were adjusted in accordance with the diagnosis. In order to relieve the pain syndrome at the first stage, a combined drug Neurodiclovit, a muscle relaxant, a drug of the SYSADOA group, soft tissue techniques of manual therapy, phonophoresis with glucocorticosteroids, and cognitive behavioral therapy were used. The assessment of the patient’s condition carried out after 7 days showed the effectiveness of the treatment, which allowed to cancel the use of a nonsteroidal anti-inflammatory drug, a muscle relaxant and a glucocorticosteroid. At the post-treatment stage, the patient was prescribed a combination of B vitamins (Neuromultivitis) and therapeutic gymnastics, as well as continued therapy with a slowacting symptomatic agent and non-drug treatment methods. Relief of the pain syndrome in the absence of adverse events confirmed the adequacy and effectiveness of the therapy.The presented clinical case demonstrates the importance of placing emphasis at the stage of diagnosis, taking into account the data of clinical and paraclinical research methods, and also illustrates the possibility of successful conservative therapy for exacerbation of chronic musculoskeletal pain in the practice of a neurologist.

scholarly journals Algorithm of Radiological Diagnostics of Dystrophic Damage to Ligaments of the Lumbosacral Spine in the Lower Back Pain Syndrome: the Potential of Sonography

2018 ◽  
pp. 109-114
Author(s):  
A. N. Mihailov ◽  
A. M. Yurkovskiy ◽  
I. V. Nazarenko
Keyword(s):  
Back Pain ◽  
Lower Back Pain ◽  
Structural Changes ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Diagnostic Algorithm ◽  
Pain Syndrome ◽  
Lumbosacral Spine ◽  
Lower Back ◽  
Magnetic Resonance Imaging Mri

Objective: to formulate the main points of the diagnostic algorithm in the lower back pain syndrome caused by pathology of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments based on the limits and potential of visualization methods. Material. Data of X-ray, multispiral computer tomography (MSCT), magnetic resonance imaging (MRI) and sonography of 184 patients aged 19-79 with clinical manifestations of the lower back pain syndrome caused by pathology of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments were analyzed. Results. The potential of the visualization methods in the assessment of structural changes of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments has been identified. The main points of the algorithm which makes it possible to diagnose the lower back pain syndrome, caused by pathology of ilio-lumbar, posterior long sacroiliac and sacrotuberal ligaments have been formulated. Conclusion. The choice of the visualization method in the lower back pain syndrome, caused by ligamentosis of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments must be made taking into account the limits and potential of MSCT, MRI and sonography, which will shorten the time of diagnostic search and reduce the risk of diagnostic errors.

scholarly journals Low back pain: a case study

2021 ◽  
pp. 384-390
Author(s):  
D. Kh. Khaibullina ◽  
Yu. N. Maksimov ◽  
F. I. Devlikamova
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Case ◽  
Muscle Tension ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Intervertebral Discs ◽  
Lower Limbs ◽  
Low Back ◽  
Medical Opinion

As defined in the WHO Bulletin (1999), low back pain (LBP) is pain, muscle tension or stiffness localized in the back between the XII pair of ribs and the lower gluteal folds, with or without irradiation in lower limbs. The LBP syndrome is not a nosological unit, but due to its high prevalence, social and economic importance, it has a separate heading in ICD-10 – (M 54.5). Various structures can be the source of LBP: intervertebral discs, facet and sacroiliac joints, muscles, ligaments, tendons, fascia, spinal cord and its roots, peripheral nerves, etc. Depending on which structure the source of pain is, the nature of the pain can have a nociceptive, neuropathic or mixed character, which affects the tactics of patient management. The variety of clinical manifestations of LBP introduces certain difficulties in the process of making a diagnosis and may entail the appointment of treatment methods that are inadequate for the patient’s condition. In such cases, it is advisable to conduct an additional consultation in order to obtain a second medical opinion. The message is devoted to the analysis of a clinical case of LBP. During the examination of the patient, the nature of the pain, initially regarded as neuropathic, began to be interpreted as nociceptive. In accordance with this, a complex treatment was prescribed, which included pharmacological preparations and methods of non-drug therapy. In order to quickly relieve the pain syndrome, the drug dexketoprofen was used according to a stepwise scheme. Obtaining effective anesthesia within 5 days made it possible to abandon further NSAID intake and to continue follow-up treatment with a preparation of B vitamins, a muscle relaxant and SYSADOA in combination with non-drug methods of treatment. The considered clinical case illustrates both the difficulties arising in the diagnosis of LBP and the possibilities of successful conservative therapy of this disease. 

scholarly journals Chronic Musculoskeletal Pain, Self-Reported Health and Quality of Life among Older Populations in South Africa and Uganda

2018 ◽  
Vol 15 (12) ◽  
pp. 2806 ◽  
Author(s):  
Chao Wang ◽  
Run Pu ◽  
Bishwajit Ghose ◽  
Shangfeng Tang
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
South Africa ◽  
Back Pain ◽  
Musculoskeletal Pain ◽  
Chronic Musculoskeletal Pain ◽  
Self Rated Health ◽  
Reported Health ◽  
Older Populations

Chronic musculoskeletal pain (CMP) is a serious health concern especially among the elderly population and has significant bearing on health and quality of life. Not much is known about the relationship between chronic pain with self-reported health and quality of life among older populations in low-resource settings. Based on sub-national data from South Africa and Uganda, the present study aimed to explore whether the older population living with CMP report health and quality of life differently compared to those with no CMP complaints. This study was based on cross-sectional data on 1495 South African and Ugandan men and women collected from the SAGE Well-Being of Older People Study. Outcome variables were self-reported physical and mental health and quality of life (QoL). Mental health was assessed by self-reported depressive symptoms during the last 12 months. CMP was assessed by self-reported generalised pain as well as back pain. Multivariable logistic regression models were used to measure the association between health and QoL with CMP by adjusting for potential demographic and environmental confounders. The prevalence of poor self-rated health (61.2%, 95% CI = 51.7, 70.0), depression (37.2%, 95% CI = 34.8, 39.6) and QoL (80.5%, 95% CI = 70.8, 87.5) was considerably high in the study population. Mild/moderate and Severe/extreme generalised pain were reported respectively by 34.5% (95% CI = 28.9, 40.5) and 15.7% (95% CI = 12.2, 19.9) of the respondents, while back pain was reported by 53.3% (95% CI = 45.8, 60.4). The prevalence of both types was significantly higher among women than in men (p < 0.001). In the multivariate analysis, both generalised pain and back pain significantly predicted poor health, depression and QoL, however, it varied between the two different populations. Back pain was associated with higher odds of poor self-rated health [OR = 1.813, 95% CI = 1.308, 2.512], depression [1.640, 95% CI = 1.425, 3.964] and poor QoL [1.505, 95% CI = 1.028, 2.202] in South Africa, but not in Uganda. Compared to having no generalised pain, having Mild/Moderate [OR = 2.309, 95% CI = 1.219, 7.438] and Severe/Extreme [OR = 2.271, 95% CI = 1.447, 4.143] generalised pain was associated with significantly higher odds of poor self-rated health in South Africa. An overwhelmingly high proportion of the sample population reported poor health, quality of life and depression. Among older individuals, health interventions that address CMP may help promote subjective health and quality and life and improve psychological health.

scholarly journals Acute musculoskeletal neck and back pain

2021 ◽  
pp. 81-88
Author(s):  
Y. N. Maksimov ◽  
D. Kh. Khaibullina
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Clinical Manifestations ◽  
Intervertebral Discs ◽  
Economic Problem ◽  
Physical Work ◽  
Economic Losses ◽  
First Case ◽  
Working Age ◽  
Neurological Research

Back and neck pain is widespread in the population. Preferably, patients of working age are sick, which leads to serious economic losses. The transition of pain from acute to chronic increases financial costs, so effective treatment of back pain is an important medical, social and economic problem. Musculoskeletal pain (MSP) prevails among all types of back pain. The source of the MSP can be various structures of the musculoskeletal system: bones, joints, muscles, fascia, tendons, ligaments, intervertebral discs. The provoking factors for the development of the MSP are static and dynamic overloads arising from physical work, long stay in a fixed posture, unprepared movements, hypothermia, vibrations. The leading diagnostic method for the MSP is a physical research of a patient which includes a detailed collection of complaints and anamnesis, inspection in statics and dynamics, carrying out global and special tests, neuroorthopedic and neurological research. In most cases, the analysis of the results obtained allows you to set a clinical diagnosis without appointing additional research methods. Two cases of acute MSP with different localization, clinical manifestations and flow are offered to the discussion. In the first case, the process was localized in the muscles of the law back. In the second patient, the muscular tonic syndrome developed in the muscles of the neck and shoulder belt and was supported by functional blockades of the vertebral motor segments. For the treatment of both patients, NSAID, muscle relaxant, glucocorticoid, as well as non-drug therapy methods were used. For local injection therapy, a drug group of glucocorticoids was used, having a sodium phosphate and betamethazone dipropionate as part of the sodium betamethasone. The combination of two betamethazone salts provides both the rapid and prolonged effect of the drug, which makes it reasonable to use it with acute musculoskeletal pain.

Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation

2019 ◽  
Vol 19 (4) ◽  
pp. 779-787
Author(s):  
Mostafa Allami ◽  
Elahe Faraji ◽  
Fatemeh Mohammadzadeh ◽  
Mohammad Reza Soroush
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Musculoskeletal Pain ◽  
Odds Ratio ◽  
Chronic Musculoskeletal Pain ◽  
Musculoskeletal Symptoms ◽  
Phantom Pain ◽  
Low Back ◽  
Knee Amputation ◽  
Stump Pain

Abstract Background and aims Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation. Methods The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain. Results Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19–4.17); p = 0.012] and the odds ratio of low back pain was higher in amputees with stump pain [OR = 3.06 (CI: 1.50–6.21); p = 0.002]. Conclusions This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments. Implications These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.

scholarly journals An unusual pediatric clinical case of atypical pyoderma gangrenosum

2020 ◽  
Vol 48 (4) ◽  
pp. 263-270
Author(s):  
T. G. Sedova ◽  
V. D. Elkin ◽  
A. A. Zhukova
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Oral Mucosa ◽  
Pyoderma Gangrenosum ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Unknown Etiology ◽  
Neutrophilic Dermatoses ◽  
Pyostomatitis Vegetans

Pyoderma gangrenosum (PG) belongs to the group of neutrophilic dermatoses with unknown etiology and poorly understood pathogenesis. In children, PG is primarily associated with inflammatory bowel diseases (Crohn's disease and ulcerative colitis). By now, about 355 PG cases have been described worldwide, including 15 children with the involvement of oral mucosa. Clinical manifestations of the disease are diverse and depend on the form, stage and associated conditions. Such a rare PG as pyodermatitis-pyostomatitis vegetans manifests by combined lesions of the oral mucosa and skin. The authors present historical data on the investigation of the disease, its etiology, pathogenesis, risk factors, and clinical picture. A description of a rare clinical case of severe form of atypical PG, namely, pyodermatitis-pyostomatitis vegetans in a 10-year-old child, is presented. The unique character of the case is related to the variety of clinical manifestations and the clinical course complicated by the development of keloid and partial scar-related flexion contracture of the upper and lower extremities, the formation of microstoma and cachexia. The association of pyodermatitis-pyostomatitis vegetans with Crohn's disease was found. The lack of awareness of the clinical symptoms of this rare disease has led to diagnostic errors and late diagnosis.

scholarly journals Rapidly progressive course of nonspecific aortoarteritis: a clinical case

2020 ◽  
Vol 11 (4) ◽  
pp. 83-89
Author(s):  
Marina V. Grushina ◽  
Ilya Sergeevich Grekov ◽  
Kseniya D. Arkhypova
Keyword(s):  
Cerebral Ischemia ◽  
Arterial Hypertension ◽  
Clinical Case ◽  
Carotid Arteries ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Practical Interest ◽  
Diagnostic Errors ◽  
Vascular Lesions ◽  
First Year

Background. Nonspecific aortoarteritis, or Takayasus disease, is one of the most complex and rare pathologies in modern clinical practice. It is the orphan nature of the disease, along with non-specific clinical manifestations, that causes a large number of clinical and diagnostic errors that lead to an unfavorable prognosis and early disability of patients. Despite the development of modern methods of treatment of nonspecific aortoarteritis, in some cases it is not possible to achieve a stable remission, which leads to a steady progression of the pathological process. Clinical case description. The article presents a case of a rapidly progressing course of Takayasu's disease in a young woman with multiple arterial vascular lesions that developed during the first year after the onset of arterial hypertension, while the narrowing of the carotid arteries (7585%) was not accompanied by signs of cerebral ischemia. The follow-up period was 10 years. Conclusion. Given the peculiarities of this nosology, each identified case of Takayasus disease is of great clinical and practical interest. The disease peculiarity in thise patient is that during the first year from the onset of arterial hypertension, the main occlusive lesions of the aorta and arterial vessels were identified. At the same time, the narrowing of the carotid arteries (7585%) was not accompanied by signs of cerebral ischemia. It should be noted that often the symptoms of non-specific aortoarteritis appear under the masks of other diseases, which requires a careful differential search. A correct diagnosis and timely treatment can prevent the development of complications and slow the progression of the disease.

Volume formation of the orbit in hemoblastosis

2021 ◽  
Vol 22 (1) ◽  
pp. 114-117
Author(s):  
M. N. Ponomareva ◽  
◽  
I. N. Pakhirko ◽  
I. A. Arefieva ◽  
E. S. Klimov ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Clinical Case ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Hodgkin's Lymphoma ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Hematology is the most important branch of practical medicine, thanks to significant advances in the diagnosis and treatment of hemoblastosis. The earlier the timely complex treatment is started, the better the vital prognosis and fewer complications. Aim.To present a clinical case of volumetric orbit formation in a 67-year-old man with hemoblastosis. Materials and methods. A retrospective analysis of the dynamics of the development of clinical manifestations and diagnostics of the volume formation of the orbit in a patient born in 1954 was carried out. Results. The patient suffers from diffuse non-Hodgkin’s lymphoma, unspecified, with lesions of the axillary lymph nodes on both sides, the soft tissues of the chest on the right, and the peritoneum. Chronic pain syndrome. The diagnosis was made in the oncological dispensary, where he was in 28.12.2020. Complaints from the organ of vision appeared on 09.01.2021, but the patient was not examined by an ophthalmologist. The immunohistochemical study of 15.01.2021 confirmed the morphological picture of the lymphoproliferative disease, but the patient did not receive specialized antitumor therapy, and therefore the ophthalmic symptoms continued to increase, vision loss and pain syndrome increased. Regarding the above complaints, the patient went to the emergency room of ophthalmological care. Computed tomography of the brain and orbits was performed in addition to standard ophthalmological examinations. The formation of the left orbit with exophthalmos was diagnosed. Conclusion. This clinical case shows that in male patients, aged 67 years, the ophthalmological manifestations of non-Hodgkin’s lymphoma may be metastasis to the orbit with a gradual increase in the clinical picture (displacement of the eyeball, movement restrictions, exophthalmos), for 2 weeks, while maintaining visual functions (visual acuity 0.7-0.8) and the occurrence of conjunctivitis.

The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity

1991 ◽  
Vol 69 (5) ◽  
pp. 683-694 ◽  
Author(s):  
James P. Lund ◽  
Revers Donga ◽  
Charles G. Widmer ◽  
Christian S. Stohler
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Lower Back Pain ◽  
Temporomandibular Disorders ◽  
Muscle Soreness ◽  
Muscle Tension ◽  
Chronic Musculoskeletal Pain ◽  
High Threshold ◽  
Chronic Lower Back Pain ◽  
Lower Back

Articles describing motor function in five chronic musculoskeletal pain conditions (temporomandibular disorders, muscle tension headache, fibromyalgia, chronic lower back pain, and postexercise muscle soreness) were reviewed. It was concluded that the data do not support the commonly held view that the pain of these conditions is maintained by some form of tonic muscular hyperactivity. Instead, it seems clear that in these conditions the activity of agonist muscles is often reduced by pain, even when this does not arise from the muscle itself. On the other hand, pain causes small increases in the level of activity of the antagonist. As a consequence of these changes, force production and the range and velocity of movement of the affected body part are often reduced. To explain how such changes in the behaviour come about, we propose a neuro-physiological model based on the phasic modulation of excitatory and inhibitory interneurons supplied by high-threshold sensory afferents. We suggest that the "dysfunction" that is characteristic of several types of chronic musculoskeletal pain is a normal protective adaptation and is not a cause of pain.Key words: pain, headache, temporomandibular disorders, fibromyalgia, chronic lower back pain, post-exercise muscle soreness.

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