Abstract
icalgia in the MM of the AFU. Materials and Methods: 45 male MM of the AFU aged 27-62 years, average age 42.3 ± 5.8 years, with pain in the cervical spine were examined. The effectiveness of drug and combined drug and complex physiotherapeutic treatment of cervical pain was evaluated according to the indicators of the NPAD scales, NDI and VAS. Results: Cervicocranial pain (37.8%) and cervicobrachial pain (33.3%) prevailed in the structure of the pain syndrome in the MM of the AFU. Against the background of the treatment, a significant decrease in the severity of the pain syndrome and complaints was observed in a significant majority of patients. There was a statistically significant decrease in the intensity of the pain syndrome according to the VAS (from 6.8±0.8 points to 5.2±0.5 points in group 1, and from 6.2±0.4 points to 4.8±0, 6 points in group 2. There was also a trend towards normalization of indicators on the NPAD scales (from 61.8 ± 3.6 points to 57.3 ± 4.1 points in group 1 and from 62.2 ± 4.1 points to 50, 2±3.8 points in group 2) and NDI (from 36.7±3.2 points to 29.1±4.3 points in group 1 and from 37.5±3.8 points to 25.3±3.2 points in the 2nd group). Conclusions: 1. Cervical pain syndrome of the spine in MM of the AFU most often manifests itself in the form of cervicocranialgia and cervicobrachialgia. 2. Drug treatment of cervicalgia demonstrates an effective reduction in pain intensity according to VAS, especially when combined with physiotherapeutic treatment. 3. Complex physiotherapeutic treatment in combination with drug therapy in MM of the AFU leads to regression of pain syndrome and improvement of quality of life and
AFU most often manifests itself in the form of cervicocranialgia and cervicobrachialgia. 2. Drug treatment of cervicalgia demonstrates an effective reduction in pain intensity according to VAS, especially when combined with physiotherapeutic treatment. 3. Complex physiotherapeutic treatment in combination with drug therapy in MM of the AFU leads to regression of pain syndrome and improvement of quality of life and reduction of disability according to the diagnostic scales of NPAD and NDI. KEY WORDS: cervicalgia , physiotherapy, military men, VAS, NPAD , NDI Acta Balneol. 2024;66(5):303-307. doi: 10.36740/ABAL202405101 INTRODUCTION The issue of diagnosis and treatment of pain syndromes caused by spine pathology is one of the most common problems of modern medicine. This issue became extremely acute precisely in the conditions of wartime, when almost every second patient turns to the doctor with complaints of back pain [1]. Pain is a kind of feeling that arises as a result of strong irritations of the nervous system and is one of the most common diseases in the world. Estimates of the prevalence of vertebrogenic pain syndromes in E urope vary from 32.9% to 70% [2, 3]. Dorsalgia is pain and a feeling of muscle tension or stiffness in the back. M ay involve the cervical, thoracic, or lumbar spine and radiate along one or both upper extremities to the trunk or along one or both lower extremities. Dorsalgia can be: vertebrogenic, which is associated with spine pathology, and non-vertebrogenic, which is caused by stretching of muscles and ligaments, psychogenic factors, somatic diseases. The cause of dorsalgia can be intervertebral hernias, osteoporosis, scoliosis, a sedentary lifestyle or working in the wrong position, physical exertion and overstretching of the back muscles, hypothermia, back injuries, deficiency of group B vitamins, etc. [1]. Degenerative – dystrophic lesions of the cervical spine (CS) initiate motor and sensory disorders, neurological deficits, pain syndrome, etc. [4]. The latter is a medical problem, actuality which progressively in recent years grows: in ten years it’s the frequency increased by 21% [5] and can reach 41% [6, 7]. Musculoskeletal and connective tissue disorders rank third in the incidence structure among the
dystrophic lesions of the cervical spine (CS) initiate motor and sensory disorders, neurological deficits, pain syndrome, etc. [4]. The latter is a medical problem, actuality which progressively in recent years grows: in ten years it’s the frequency increased by 21% [5] and can reach 41% [6, 7]. Musculoskeletal and connective tissue disorders rank third in the incidence structure among the adult population of Ukraine with a steady upward trend [8]. Up to 350, 000 cases of primary osteoarthritis are registered annually in Ukraine, of which more than 60% are of working age [8]. Primary disability due to diseases of the musculoskeletal system occupies the third place in the structure of primary disability of both the adult population (more than 11%) and the population of working age (13%) [9]. The incidence and prevalence of diseases of the musculoskeletal system increases with age [10]. Annually, 39 million people (0.5%) worldwide suffer from spondylolisthesis, 403 million (5.5%) people have symptomatic disc degeneration and 103 million (1.4%) people worldwide suffer from spinal canal stenosis [11]. In the case of degenerative-dystrophic changes in CS and in the clinical manifestation of the disease, complaints of varying degrees of pain prevail in patients. In fact,
304 Valery Y. Kalashnikov et al. a similar clinical picture affects more than half of the world’s population, and its prevalence in industrialized countries is 60-80% [12]. Physiological cervical lordosis takes part in the process provides cushioning of the spine when walking and running processes chewing, breathing, vocalization, eye movements, etc. [13]. Its pathological deformation, especially at the level between segments C 5 , C 6 and C 7 , leads to significant clinical consequences: painful reflex phenomena disorders, paresis and paralysis upper and lower limbs [14, 15]. The above accompanied by a number of related diseases from violation blood supply to the brain, vegetative symptoms dysfunctions cervical and higher level [13, 16]. Back pain is currently one of the most common syndromes among military men (MM) of the Armed Forces of Ukraine (AFU). In the conditions of being at the front, back pain occurs in military personnel mostly as a result of increased physical load on the spine, in particular, as a result of wearing protective equipment. Almost half of the MM of the AFU, who sought neurological help for back pain, associated the occurrence of pain with wearing a body armor. This was especially true of men over 40 years of age, in whom the development of back pain syndrome is also associated with age-related changes in the body [3]. Among all cases of dorsalgia in the MM, cervical pain occupies a significant place not only due to its prevalence, but also due to the significant impact on the general condition of patients, in particular, on cerebral functions. The prevalence of cervical pain in the MM of the pain syndrome of the cervical spine requires the development of new methods of pain syndrome treatment. AIM Study of the effectiveness of complex physiotherapeutic treatment of cervicalgia in the MM of the AFU. MATERIALS AND METHODS On the basis of the Center of Physiotherapy and Rehabilitation in Tyachiv, 45 men of the MM of the AFU aged 27-62 years, average age 42.3 ± 5.8 years, with pain in the cervical spine were examined. Inclusion criteria: cervicalgia lasting more than 3
effectiveness of complex physiotherapeutic treatment of cervicalgia in the MM of the AFU. MATERIALS AND METHODS On the basis of the Center of Physiotherapy and Rehabilitation in Tyachiv, 45 men of the MM of the AFU aged 27-62 years, average age 42.3 ± 5.8 years, with pain in the cervical spine were examined. Inclusion criteria: cervicalgia lasting more than 3 months, consent to participate in the study. Exclusion criteria: presence of malignant neoplasms, acute infectious, rheumatological and neurodegenerative diseases, heart failure, allergies, presence of indications for neurosurgical intervention. All patients underwent a clinical and neurological examination and magnetic resonance imaging (MRI) of the cervical spine. Degenerative changes in the intervertebral discs (IVD), hypertrophy of the facet joints, stenosis of the spinal canal, herniated IVD and others were detected during MRI. Analysis of the intensity of the pain syndrome in dynamics was carried out according to the visual analog scale (VAS), as well as functional indicators according to the NPAD and NDI scales [17-19]. VAS is a horizontal line 10 cm long, anchored with word descriptors at each end (0: no pain, 10: most severe possible pain). P atients they ask paint vertical mark through the horizontal line, which is best, reflects pain level VAS is widely used a tool evaluations with proven reliability and validity. The NPAD consists of 20 items divided into 4 dimensions; neck problems; pain intensity; emotions and cognition; and interference with life activities. The item score ranges from 0 (no pain or limitation of activity) to 5 (extreme pain or maximum limitation). The overall NP AD score ranges from 0 to 100 points. The NDI consists of ten items: pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleep and rest. Each item contains six different statements expressing a progressive level of pain or activity limitation. The item score ranges from 0 (no pain or limitation) to 5 (as much pain as possible or maximum limitation). The total NDI score ranges from 0 to 50 points. All patients were treated according to the current clinical protocol “Guideline 00398. P ain in the neck and shoulder