الفهرس | Only 14 pages are availabe for public view |
Abstract Low back pain is a common musculoskeletal disorder affecting ٨٠٪ of people at some point in their lives. It accounts for more sick leave and disability than any other medical condition. It can be acute, subacute , or chronic in duration. Several lines of treatment have been used and there are recent advances in the tools of management of low back pain. Various new trends have been proposed; including intradiscal electro thermal therapy. It works by heating the outer layer of the disc where pain receptors are located. The heat theoretically alters the collagen within the disc and also destroys pain receptors located there. Pain reduction has been reported within a few days and up to six months following the procedure. Recently attention has been given to the use of mesenchymal stem cells derived from adult bone marrow and on the feasibility of constructing cells through tissueengineering .The cells have the ability of self –renewal and proliferation and the multilineage potential to differentiate . The intradiscal ozone therapy(Chemonucleolysis) is a novel technique for management of low back pain due to compression of nerve roots by the intervertebral disces.It is based on the use of oxygen atom liberated from breaking down of oxygen molecule when it is injected into the disc .The active oxygen atom attaches with proteo-glycan bridges in the nucleus pulposus which are broken down and become no longer capable of holding water .As a result the disc shrinks and becomes mummified and decompression of the nerve root occurs . It is equivalent to surgical discectomy. It has also anti inflammatory action and tissue oxygenation is increased.Chemonucleolysis uses an enzyme called chymopapain (derived from papaya), which is injected into the disc space. Local anesthesia or general anesthesia may be used to control pain during the injection. Chymopapain speeds up the breakdown of the jellylike substance inside the disc (nucleus), releasing water. As a result, the bulging disc may shrink and relieve pressure on the nerve root. Pulsed radiofrequency is a another new technique where strong electromagnetic field is produced around the nerve .It acts to stop pain signal transmission .Here the normal function of nerve is maintained and only abnormal pain is stopped. Patients with chronic discogenic LBP can also benefit from injection of methylene blue into painful discs which may be a very effective alternative for surgical treatment .Methylene blue neurotropic effect enables it to block nerve conduction or destroy nerve endings. Lumbar facet joint injection involves injecting a small amount of local anesthetic and/or steroid medication, which can anesthetise the facet joints and block the pain. Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief . The medial branch nerve block is designed to interrupt the pain signal being carried by the medial branch nerves that supply a specific facet joint. A sacroiliac joint injection - also called a sacroiliac joint block - is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction. Spinal steroid injection is a low risk and rapid treatment option. It is more effective in patients with MRI finding of discogenic inflammation, specifically adjacent inflammatory end plate changes Steroid injection interrupts the pain spasm cycle and nociceptor transmission by the local analgesic and reducing inflammation induced by corticosteroids .It is contraindicated in cases as in diabetes, malignancy and relatively with allergy to the injected substance ,history of steroid psychosis ,congestive heart failure, pregnancy. Prolotherapy is an injection procedure used to treat connective tissue injuries of the musculoskeletal system that have not healed by either rest or other conservative therapies in order to relieve back pain. The injections promote a healing. It works by causing a temporary, low grade inflammation at the injection site, activating fibroblasts to the area, which, in turn, synthesize precursors to mature collagen and thus reinforce connective tissue. The substance used in prolotherapy injection is a natural irritant agent as sugar(dextrose or glucose) alone or in combination with glycerine and phenol. Hydroelectrophoresis is a novel method of driving drugs through the dermal tissue, which has been proposed for muscle pain treatment.It allows the active agent to penetrate about ٠٫٥-١٠cm in tissue avoiding dispersion and creating a directional flow allowing local regional therapy .It permits management of pain with applications lasting for ١٥- ٣٠minutes with a possibility to focus therapy to involved regions.A treatment protocol based on ٣ hydrofor applications of water solution containing sodium diclofenac and mesilate pridinole(added in order to enhance drug molecule transport). Injection of Botox directly into the target muscles could have the advantage of reducing muscle spasm without producing sedation. This is in contrast to systemic muscle relaxants. This has a benefit in the treatment of muscle spasm associated with chronic low back pain. Botox® may produce a prolonged reduction of spasm by producing a partial, reversible denervation of the muscles. selective weakening of painful muscles in spasm may interrupt the pain-spasm-pain cycle, and facilitate rehabilitation. Biochemical treatment options including attempts at intervertebral disc restoration are desirable for the physiologic treatment of degenerative disc disease without herniation Lumbar intervertebral discs can be injected with a solution of glucosamine and chondroitin sulfate combined with hypertonic dextrose and dimethlysulfoxide (DMSO) which has chemoneuromodulatory potential. They contribute to the biosynthesis of proteoglycans. Proteoglycans and collagens constitute the two major classes of macromolecules in the nucleus pulposus and annulus fibrosus . Degenerative discs are thought to produce nerve root pain mechanically or chemically. Exposure of irritated nerves to hypertonic dextrose is thought to have a chemoneuromodulatory potential and reduce sustained pain .It involves injection of a combination of dextrose, glucosamine, chondroitin and dimethylsulfoxid. Piriformis Syndrome Is a condition in which the piriformis muscle, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain). There is no simple diagnostic test for piriformis syndrome.The condition is diagnosed on basis of the patient’s symptoms and on aphysical examination, and after excluding other possible causes of the patient’s pain. Treatment include a combination of ice pack or heat pack, medications (NSAIDs), injections (eg. Botox) and electrotherapy. After an episode of low back pain has lasted between two to six weeks, or if there are frequent recurrences of low back pain, it is reasonable to consider physical therapy for back treatment. In general, the goals of back pain exercises and physical therapy are to decrease back pain, increase range of motion, and provide education on a maintenance program to prevent further recurrences .Physical therapy includes Passive Physical Therapy eg; Heat/ice packs, TENS units, Iontophoresis and, Ultrasound and Active Physical Therapy eg: Stretching exercise, Strengthening exercise ,Low-impact aerobic conditioning , Core strengthening exercises and, Exercise balls. Yoga is approximately ٤٬٠٠٠ years old and is a scientific methodology aimed at uniting the mind, body, and spirit. This bonding that occurs through yoga is said to bring about not only physical benefits, but mental benefits as well, taking the individual to a level that could not be reached by manipulating one factor alone. |