Durerea vertebrogenă, musculo-scheletală

VARIANTE DE TRATAMENT:
1. EDUCARE ÎN NEUROŞTIINŢA DURERII:
a. în cazul afecţiunilor musculo-scheletale cronice – ameliorează durerea, funcţia şi
reduce dizabilitatea; influenţează factorii psiho+sociali, ameliorează mobilitatea,
reduce costurile de tratament. https://www.ncbi.nlm.nih.gov/pubmed/27351541
b. full durerea lombară cronică este caracterizată şi de modificări la nivel cerebral
(including functional connectivity reorganisation in several brain regions and
increased activation in brain regions of the so-called 'pain matrix' (or 'pain
connectome'). This approach includes cognitively preparing patients for exercise
therapy using (therapeutic) pain neuroscience education, followed by cognition-
targeted functional exercise therapy.
https://www.ncbi.nlm.nih.gov/pubmed/28967357
c. ascultarea - model biopsihosocial – explicarea teoriilor biomecanice utile în
tratament acut, subacut si postoperator. Pt cronic – momentul anamnezei – optim
pentru aplicarea educaţiei cu privire la neuroştiinţa durerii – screening, identificarea
barierelor psihosociale în ameliorare, evaluarea mecanismului durerii.
https://www.ncbi.nlm.nih.gov/pubmed/27351690
2. FREE MODULAREA DESCENDENTĂ A DURERII ŞI CRONICIZAREA DURERII Descending pain
facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms
that can be engaged to promote or protect against pain 'chronification'. These systems
interact with higher centres, thus providing a means through which exogenous factors can
influence the risk of pain chronification. A greater understanding of the role of descending
pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant
processes that can lead to chronic pain. https://www.ncbi.nlm.nih.gov/pubmed/24752199
3. INJECŢII EPIDURALE pt durerea spinală cronică: rezultate controversate
https://www.ncbi.nlm.nih.gov/pubmed/26606031
4. INFILTRAŢII – PT COLOANA CERVICALĂ ŞI LOMBARĂ: eficiente, dacă tehnica de injectare
este corectă. https://www.ncbi.nlm.nih.gov/pubmed/28108775 Level II evidence for the
efficacy of cervical interlaminar epidural injections with local anesthetic with or without
steroids, based on at least one high-quality relevant randomized control trial in each
category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis,
and post surgery syndrome. https://www.ncbi.nlm.nih.gov/pubmed Based on the present
assessment for the management of spinal facet joint pain, the evidence for long-term
improvement is Level II for lumbar and cervical radiofrequency neurotomy, and therapeutic
facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar
intraarticular injections; and Level IV for cervical intraarticular injections and thoracic
radiofrequency neurotomy. https://www.ncbi.nlm.nih.gov/pubmed/26218948

REGIUNI DE TRATAT:

COLOANA CERVICALĂ
- INTERESANT DE DOWNLOADAT Twelve recommendations were based on evidence and nine
on consensus. Management should include information about prognosis, warning signs, and
advise to remain active. For treatment, guidelines suggest different types of supervised
 exercise and manual therapy; combinations of exercise and manual therapy before medicine
for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and
Tramadol after careful consideration for NP and CR.
https://www.ncbi.nlm.nih.gov/pubmed/28523381
- Free NCB - TRAT CONSERVATOR Nonoperative treatment includes physical therapy involving
strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory
drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have
higher risks of serious complications. In patients with red flag symptoms or persistent
symptoms after four to six weeks of treatment, magnetic resonance imaging can identify
pathology amenable to epidural steroid injections or surgery
https://www.ncbi.nlm.nih.gov/pubmed/27175952
- FREE VERTIJUL DE ORIGINE CERVICALĂ reatment for cervical vertigo is challenging. Manual
therapy is recommended for treatment of proprioceptive cervical vertigo. Anterior cervical
surgery and percutaneous laser disc decompression are effective for the cervical spondylosis
patients accompanied with Barré-Liéou syndrome. As to rotational vertebral artery vertigo, a
rare entity, when the exact area of the arterial compression is identified through appropriate
tests such as magnetic resonance angiography (MRA), computed tomography angiography
(CTA) or digital subtraction angiography (DSA) decompressive surgery should be the chosen
treatment.
COLOANA TORACICĂ
- DUREREA NEUROPATĂ POST TVM: DE CĂUTAT – GHID DE DGS ŞI TRATAMENT
https://www.ncbi.nlm.nih.gov/pubmed/29249383
COLOANA LOMBO-SACRATĂ
- STENOZĂ DE CANAL LOMBAR: chiru vs conservator: high rate of effects reported in three of
five surgical groups, ranging from 10% to 24%. No side effects were reported for any of the
conservative treatment options. LEVEL OF EVIDENCE:1.
https://www.ncbi.nlm.nih.gov/pubmed/27128388 ; Given that rapid deterioration is rare and
that symptoms often wax and wane or gradually improve, surgery is almost always elective
and considered only if sufficiently bothersome symptoms persist despite trials of less
invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than
for non-operative treatment, but the evidence is heterogeneous and often of limited quality.
https://www.ncbi.nlm.nih.gov/pubmed/26727925
- LOMBALGIE NESPECIFICĂ: Thus, spinal fusion and disc replacement will no longer be routine
forms of treatment for patients with low back pain. !!! FĂRĂ CHIRU
https://www.ncbi.nlm.nih.gov/pubmed/28768775
- IMPORTANT “Spinal low back pain,” which describes the evidence regarding diagnostics and
invasive treatment of the most common spinal low back pain syndromes, that is, facet joint
pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and
failed back surgery syndrome. TRATAMENT INVAZIV VS CONSERVATOR
https://www.ncbi.nlm.nih.gov/pubmed/26032119
- denervare cu radiofrecvenţă: Conventional radiofrequency denervation resulted in
significant reductions in low back pain originating from the facet joints in patients showing
the best response to diagnostic block over the first 12 months when compared with sham
procedures or epidural nerve blocks. https://www.ncbi.nlm.nih.gov/pubmed/28576500
- FIZIOTERAPIE: in HDL – influenţează fiziologia discului, prin difuzia apei şi transportul
molecular – importante pentru sănătatea şi integritatea lui.
https://www.ncbi.nlm.nih.gov/pubmed/28715273
-
 - durere acută: excludere red flags şi investigare yellow flags:
https://www.ncbi.nlm.nih.gov/pubmed/27120496

- durerea cronică discogenă: The intervertebral disk can be a common source of acute or
chronic low back pain; A thorough history and physical examination are needed to assess
patients with discogenic low back pain; Lifestyle modifications including smoking cessation,
proper lifting mechanics, ergonomics, and lower body mass index are helpful; Discogenic
pain results from changes in the nucleus pulposus and tears in the annulus fibrosis;
Psychological support, including treatment of underlying or coexistent depression, is highly
recommended; Conservative treatment, including home exercise for chronic lower back pain,
is recommended; Injection of corticosteroids for discogenic lower back pain shows mixed
efficacy and should be performed judiciously; Surgery for this condition should be reserved
for cases of significant refractory cases with profound disability and should be confirmed
with diskography https://www.ncbi.nlm.nih.gov/pubmed/24787335 thermal annular
procedures: The evidence is Level I, or strong, that percutaneous biacuplasty is efficacious in
the treatment of chronic, refractory discogenic pain. Biacuplasty may be considered as a
first-line treatment for chronic, refractory discogenic pain.
https://www.ncbi.nlm.nih.gov/pubmed/28934777 ; A literature review is presented on the
natural history, role of physical examination, timing of surgery, evidence-based treatment,
and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain
compared to conservative therapy, although the effect fades after a year. There is no
treatment modality better than the rest in terms of pain control and neurological recovery,
nor is there a surgical technique clearly superior to simple discectomy. The lack of sound
scientific evidence on the surgical indication may contribute to its great geographical
variability. Since LDH has a favourable natural history, neuroimaging and surgery should not
be considered until after a 6-week period. It is necessary to specify and respect the surgical
indications for LDH, avoiding conflicts of interests.
https://www.ncbi.nlm.nih.gov/pubmed/28130015
- The diagnostic workup should focus on evaluation for evidence of systemic or pathologic
causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for
a prolonged disability course. All patients with acute or chronic low back pain should be
advised to remain active. The treatment of chronic nonspecific low back pain involves a
multidisciplinary approach targeted at preserving function and preventing disability. Surgical
referral is indicated in the presence of severe or progressive neurologic deficits or signs and
symptoms of cauda equina syndrome. https://www.ncbi.nlm.nih.gov/pubmed/24758954
- Lombalgie şi nevralgie MI persistente – adezioliză percutanată – evidenţe de nivel I -
https://www.ncbi.nlm.nih.gov/pubmed/26815254
- kinetoterapie - ISOLATED LUMBAR EXTENSION RESISTANCE TRAINING – ameliorarea durerii,
disabilităţii https://www.ncbi.nlm.nih.gov/pubmed/25452128
COCCIS
- COCCIDINIA - Treatments may include the use of cushions, medications by mouth, topical
medications, local pain management injections, pelvic floor physical therapy, and (in rare
 cases) surgical removal of the coccyx (coccygectomy).
https://www.ncbi.nlm.nih.gov/pubmed/28676363
- https://ppch.pl/resources/html/article/details?id=152617&language=en DETALII – TERAPII
MANUALE!!
- Ablaţia cu radiofrecvenţă a nervilor sacrococcigieni în cazul eşecului tratamentului
conservator https://www.ncbi.nlm.nih.gov/pubmed/28034983