Неврология, нейропсихиатрия, психосоматика (Nov 2019)
Treatment of patients with acute and subacute lumbodynia and lumbar ischialgia
Abstract
No effect of outpatient treatment is observed in some patients with acute nonspecific lumbodynia and lumbar ischialgia; therefore they are referred to pain management departments or centers for specialized examination and treatment.Objective: to study of the anatomical causes of pain and the efficiency of celecoxib (Dilaxa) treatment in patients with acute and subacute lumbodynia and lumbar ischialgia in the inpatient setting.Patients and methods. Eighty patients (47 women and 33 men; mean age, 51.0±15.3 years) with acute and subacute lumbodynia (n=11) or lumbar ischialgia (n=69) were followed up. Pain intensity was assessed using a visual analogue scale (VAS); functional limitation was rated according to the Roland–Morris scale (RMS). To reduce the intensity of pain syndrome, patients took oral celecoxib (Dilaxa) 200 mg twice daily. Therapeutic blockades with anesthetics and glucocorticoids were used in some cases of damage to the sacroiliac joint (SIJ) or facet joints (FJ). Patients were informed of the benign nature of the disease; they did therapeutic exercises.Results and discussion. The causes of pain were ascertained to be injuries of SIJ (48,8%), FJ and SIJ (18,8%), FJ (17,5%), herniated disc (10%), piriformis syndrome (2.5%), and piriformis syndrome and SIJ injury (2.5%). The duration of treatment averaged 11.0±2.4 days. By the end of the study, there was a clinically significant reduction in pain in 86% of patients. The treatment resulted in a 2.4-fold average reduction in pain intensity (from 7.0 to 2.9 VAS scores): a 4-fold reduction in patients with lumbodynia (from 6.4 to 1.6 scores) and a 2.3-fold one in those with lumbar ischialgia (from 7.1 to 3.1. scores); the degree of disability reduced by an average of 1.9 times (from 8.1 to 4.3 RMS scores): by 3.6 times (from 6.8 to 1.9 scores) and 1.9 (from 8,3 to 4,7 scores) times in patients with lumbodynia and in those with lumbar ischialgia, respectively. No adverse events were observed during the treatment period.Conclusion. There were high SIJ and FJ injury rates in subacute lumbar ischialgia. Celecoxib was noted to be highly effective and safe in treating acute and subacute lumbar ischialgia and lumbodynia.
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