Formation of a comprehensive rehabilitation program for patients considering the clinical and diagnostic features of the course of vertebral thoracic pain due to degenerative-dystrophic pathology of the thoracic spine
DOI:
https://doi.org/10.14739/2409-2932.2025.1.319687Keywords:
degenerative-dystrophic pathology of the spine, osteochondrosis, quality of life, myofascial pain syndrome, dorsalgia, rehabilitation, kinesiotherapyAbstract
Aim. To determine the clinical and diagnostic features of the course of thoracic back pain syndrome, to investigate life quality data in patients with degenerative-dystrophic pathology of the thoracic spine (DDPS) depending on the indicators of vertebrodynamics in order to conduct differentiated kinesiotherapy technique.
Materials and methods. Rehabilitation measures were conducted for 124 patients with DDPS complicated by thoracalgia syndrome at the post-acute stage. All patients had a functional block of the 2nd degree in the thoracic spine. They were divided into two groups. The first group (n = 56) received basic rehabilitation, including drug therapy, massage, personalized therapeutic exercises, and physical therapy. The second group (n = 68) additionally underwent post-isometric and post-reciprocal muscle relaxation, mobilization techniques (K. Lewit, R. Maigne, V. Gubenko), and original kinesiotherapy methods tailored to vertebrodynamics indicators. The outpatient rehabilitation cycle lasted 14 days.
Results. Assessment of the effectiveness of patients treatment in the study groups before and after the rehabilitation measures according to the visual analogue scale for measuring pain intensity, the PainDETECT and LANSS scales for screening components of neuropathic pain in people with chronic pain, the Roland-Morris quality of life questionnaire and EQ-5D (EQ-5D-3L) indicate a statistically significant intergroup difference (p < 0.05) with higher quality of life and lower intensity of pain manifestations in patients of the 2nd group compared to patients of the 1st group. According to the results of the Spearman correlation analysis the progression of signs of mental disorders is directly proportionally associated with the intensity of manifestations of myofascial syndromes due to DDPS, as showed statistically significant relationships between the values of the results of the Spielberger anxiety and Montgomery–Asberg depression rating scales, on the one hand, and the integral indicator of the cumulative thoracic vertebral-mechanical index (Rs = +0.69 and +0.78 at p < 0.01 for all cases), confirming the important pathogenetic relationship between these pathological processes, which indicates the urgent need for rehabilitation measures according to generally accepted (A. Stoddard, K. Lewit) and optimized methods proposed by us to reduce anxiety-depressive disorders and normalize the mental state in general. According to the Pearson agreement criterion, patients with DDPS in the comparison group had significantly more frequently registered values of the five-component EuroQOL-5D system of more than 4 points (χ2 = 11.63; p < 0.01).
Conclusions. Against the background of the course treatment, more than 90 % of patients with clinical manifestations of DDPS at the thoracic level achieved reliable positive results (significant reduction in pain syndrome, increased range of motion in blocked vertebral-motor segments, improved quality of life indicators).
References
Knezevic NN, Candido KD, Vlaeyen JW, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92. doi: https://doi.org/10.1016/S0140-6736(21)00733-9
Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021;25(2):275-95. doi: https://doi.org/10.1002/ejp.1679
Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):998. doi: https://doi.org/10.1186/s12891-021-04858-6
Kabeer AS, Osmani HT, Patel J, Robinson P, Ahmed N. The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond). 2023;84(10):1-9. doi: https://doi.org/10.12968/hmed.2023.0063
Lara-Palomo IC, Gil-Martínez E, Antequera-Soler E, Castro-Sánchez AM, Fernández-Sánchez M, García-López H. Electrical dry needling versus conventional physiotherapy in the treatment of active and latent myofascial trigger points in patients with nonspecific chronic low back pain. Trials. 2022;23(1):238. doi: https://doi.org/10.1186/s13063-022-06179-y
Gibbs D, McGahan BG, Ropper AE, Xu DS. Back Pain: Differential Diagnosis and Management. Neurol Clin. 2023;41(1):61-76. doi: https://doi.org/10.1016/j.ncl.2022.07.002
Mohd Isa IL, Teoh SL, Mohd Nor NH, Mokhtar SA. Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. Int J Mol Sci. 2022;24(1):208. doi: https://doi.org/10.3390/ijms24010208
O'Sullivan PB, Caneiro JP, O'Sullivan K, Lin I, Bunzli S, Wernli K, et al. Back to basics: 10 facts every person should know about back pain. Br J Sports Med. 2020;54(12):698-9. doi: https://doi.org/10.1136/bjsports-2019-101611
Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi: https://doi.org/10.1002/14651858.CD009790.pub2
Penchev R, Scheuring RA, Soto AT, Miletich DM, Kerstman E, Cohen SP. Back Pain in Outer Space. Anesthesiology. 2021;135(3):384-95. doi: https://doi.org/10.1097/ALN.0000000000003812
Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach?. Disabil Rehabil. 2022;44(13):3270-84. doi: https://doi.org/10.1080/09638288.2020.1851783
Kongsted A, Ris I, Kjaer P, Hartvigsen J. Self-management at the core of back pain care: 10 key points for clinicians. Braz J Phys Ther. 2021;25(4):396-406. doi: https://doi.org/10.1016/j.bjpt.2021.05.002
Maschke M, Diener HC. Chronische Rückenschmerzen [Chronic Back Pain]. Fortschr Neurol Psychiatr. 2023;91(7-08):326-39. doi: https://doi.org/10.1055/a-2055-5322
Ross R, Han J, Slover J. Chronic Lower Back Pain in Weight Lifters: Epidemiology, Evaluation, and Management. JBJS Rev. 2023;11(6):e22.00228. doi: https://doi.org/10.2106/JBJS.RVW.22.00228
Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Traumatol. 2021;22(1):51. doi: https://doi.org/10.1186/s10195-021-00616-5
Ríos-León M, Taylor J, Segura-Fragoso A, Barriga-Martín A. Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study. Pain Med. 2024;25(5):344-51. doi: https://doi.org/10.1093/pm/pnad165
Takada C, Kim K, Kokubo R, Ideguchi M, Mihara R, Koketsu K, et al. Reliability of PainDETECT for Evaluating Low Back Pain Caused by Cluneal Nerve Entrapment. J Nippon Med Sch. 2024;91(3):328-32. doi: https://doi.org/10.1272/jnms.JNMS.2024_91-312
Cheng LJ, Pan T, Chen LA, Cheng JY, Mulhern B, Devlin N, et al. The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-Analysis. Value Health. 2024;27(7):986-97. doi: https://doi.org/10.1016/j.jval.2024.02.018
Garratt AM, Engen K, Kjeldberg IR, Nordvik JE, Ringheim I, Westskogen L, et al. Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation. Arch Phys Med Rehabil. 2024;105(1):40-8. doi: https://doi.org/10.1016/j.apmr.2023.04.026
Cahueque M, Ardebol J, Armas J, Azmitia E. Dolor sacroilíaco: diagnóstico y tratamiento [Sacroiliac pain: diagnosis and treatment]. Acta Ortop Mex. 2021;35(1):85-91.
Sipaviciene S, Kliziene I. Effect of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work. Clin Biomech (Bristol). 2020;73:17-27. doi: https://doi.org/10.1016/j.clinbiomech.2019.12.028
Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain. 2024;28(2):181-98. doi: https://doi.org/10.1002/ejp.2190
Carman MJ. CE: Assessing Back Pain in Patients Presenting to the ED. Am J Nurs. 2021;121(7):26-30. doi: https://doi.org/10.1097/01.NAJ.0000756520.85864.c0
Passalent L, Inman RD, Haroon N. Nonspecific Low Back Pain. N Engl J Med. 2022;387(5):478-9. doi: https://doi.org/10.1056/NEJMc2207597
Vemuri A, Goto KK. Osteopathic Manipulative Treatment: Counterstrain/FPR Procedure - Thoracic Vertebrae. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 19, 2022.
Carassiti M, Pascarella G, Strumia A, et al. Epidural Steroid Injections for Low Back Pain: A Narrative Review. Int J Environ Res Public Health. 2021;19(1):231. doi: https://doi.org/10.3390/ijerph19010231
Braunschweig R, Janka R, Spahn G, Tiemann A. Rückenschmerz: Aktuelle Entwicklungen und Leitlinien [Back pain: State of the art and guidelines]. Radiologe. 2020;60(2):123-31. doi: https://doi.org/10.1007/s00117-019-00623-y
Alizadeh R, Sharifzadeh SR. Pathogenesis, etiology and treatment of failed back surgery syndrome. Neurochirurgie. 2022;68(4):426-31. doi: https://doi.org/10.1016/j.neuchi.2021.09.005
Manigold T, Gantschnig BE, Streitberger K. Multiprofessioneller Behandlungsansatz bei chronischen Rückenschmerzen [Multiprofessional treatment approach in chronic back pain]. Z Rheumatol. 2023;82(1):31-7. German. doi: https://doi.org/10.1007/s00393-022-01258-6
Schwill C. Rückenschmerzen in der Hausarztpraxis: Der spezifische Rückenschmerz [Back pain in the primary care setting: Specific back pain]. Internist (Berl). 2021;62(1):34-46. German. doi: https://doi.org/10.1007/s00108-020-00919-5
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