[PAIN SYNDROMES CAUSED BY DEGENERATIVE-DYSTROPHIC SPINE DAMAGE (REVIEW)].

The aim of the study was to explore different treatment approaches for degenerative-dystrophic damage of the spine and define the most effective treatment methods, their stages regarding the pathogenetic basis of pain syndromes. Diverse treatments for degenerative-dystrophic damage of the spine do not facilitate but even complicate general practitioner's work due to the fact that information on clinical benefits of various drugs and techniques as well as various types of surgery is too contradictory; there is no single method of consistent combined therapy for vertebrogenic pain. There is no universal therapy or surgery that would provide sustainable relief of symptoms of nonspecific back pain and/or radicular syndrome. The pathogenesis of specific clinical manifestations of the disease and the ratio of clinical manifestations and pathomorphological changes are crucial in choosing the treatment. The general principles of treatment are unchanged: rest, analgesics and movement should be combined in appropriate sanogenic proportions in each case. Reduction of oedema and swelling of the intervertebral disc and the spinal nerve root, nerve endings are crucial in relief of pain syndrome. There is no doubt that nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective in relieving lumbar and radicular pain at the beginning of treatment. In the absence of significant improvement after the use of NSAIDs and the essential sanogenic movement loads, a more dynamic treatment should be used. First of all, different methods of local administration of pharmacological drugs should be used: starting with the simple subcutaneous injection of painful areas and finishing with ultrasound and MRI-controlled injections directly into the area around the damaged nerve root, the epidural space, or the facet joint. In most cases, epidural injections can reach areas of disc-radicular conflict - injection of the drug into the epidural space facilitates diffusion of glucocorticoids (or other pharmacological agents) into surrounding tissues as well as the nerve root regardless of its compression or irritation. Only after the ineffectiveness of NSAIDs and puncture treatments as well as epidural injection and in cases of persistent mechanical compression of the nerve roots taking into account the clinical manifestations, appropriate surgical treatments, both minimally invasive and open, are necessary.