Scoliosis pain

Gradually developing scoliotic spinal deformity is manifested by a number of symptoms, and pain with scoliosis - of various localization and intensity - is part of the clinical picture of this disease. However, pain does not occur in everyone.

Further, what pains in scoliosis are most often complained by patients, and why they arise.

Causes of the pain in scoliosis

Calling the main causes of pain during scoliotic deformity of the  spinal column , experts emphasize their vertebrogenic nature associated with the peculiarities of scoliosis: torsion displacement of part of the vertebrae relative to their axis with significant violations of the anatomical structure of the vertebral joints. This leads to frontal curvature of the spine and the formation of the pathological position of the body in space - scoliotic posture.

And pain in scoliosis is a symptom caused by various pathological skeletal changes that affect the vertebrae themselves (facet intervertebral and bone-transverse joints, spinous processes and intervertebral discs), and muscles, and part of the internal thoracic organs (due to a violation of their anatomical position with a strong bend of the spine in the frontal plane), and motor and sensory nerve fibers innervating the spine and their ends (which, when it is deformed, undergo compression at the entrance to the intervertebral s holes).

Risk factors

Key factors that increase the risk of pain in scoliosis are: progressive curvature; high (3-4th) degree of scoliotic deformation; S-shaped scoliosis , in which there may be pain with scoliosis of the 2nd degree (that is, when the Cobb angle is 10-25 °); the presence of lumbar or lumbar  dysplastic scoliosis .

Pathogenesis

To explain the pathogenesis of pain experienced by specific patients with scoliosis, its localization and nature often helps. Pain sensations - from mild to debilitating vertebral pain syndrome - can come from the place of the main curvature of the spine (bulge) or below the arch of deformation, from the concavity of the spine or from adjacent areas. In the first case, the pain occurs due to lateral spondylolisthesis (lateral displacement) of the vertebral bodies, spinal stenosis, compression and irritation of the dorsal roots of the spinal nerves innervating the peripheral structures.

In the second case,  pains in the spine  usually appear over time - due to excessive mechanical (compressive) stresses on the affected vertebral joints and intervertebral discs, in which degenerative changes occurred that caused the instability of the spinal column.

Muscle-fascial pains are the result of constant overstrain (hypertonicity) and functional imbalance of the paravertebral muscles with a change in posture.

Scoliosis-related headaches (which sometimes reach the level of migraine) can be tension headaches, occur with partial compression of the vertebral artery and worsening of cerebral blood supply, as well as with a decrease in cerebrospinal fluid pressure.

Epidemiology

According to clinical statistics, back pain most often occurs in the lumbar spine, followed by the thoracic region, that is, pain with scoliosis of the thoracic spine.

And muscle pains - from minor to moderately intense - are experienced by almost 20% of adolescents with idiopathic scoliosis of any location. 58.8% of the prevalence of back pain in patients with scoliotic disease is reported, compared with 33% in patients not suffering from coliotic disease. [1]

Symptoms

The most common are back pain with scoliosis, which develops due to the load on the vertebral joints, stretching of the muscles with a bulging scapula (with pain radiating to the shoulder in the scapular region), compression of nerve fibers; in adults - with wear of the intervertebral discs. Read more in publications:

• Scoliosis as a factor in the development of back pain
• Symptoms of spinal pain

Severe lower back pain with scoliosis and stiffness, as well as pain in the pelvic area (when it is skewed at 3-4 degrees of scoliotic deformity) are the result of torsion  displacement of the lumbar vertebrae , increased postural tension and sprains of the iliopsoas and sacroiliac ligaments. When the pelvis is inclined in adults with a high degree of dysplastic or degenerative scoliosis of the lumbar spine, one of the thighs (its muscles and tendons) is loaded more, which ultimately causes pain in the leg that gives off to the groin with scoliosis (often with severe lameness while walking). If the pelvis is not skewed, then the pain in the lower extremities is neurological in nature, due to narrowing of the spinal canal. [2]

Chest pain with scoliosis -  pain in the thoracic spine  due to its progressive deformation - can accompany the active process of changing the shape of the chest, inflammation of the sternocostal cartilage, as well as the formation of a hump when the ribs on one side of the back move and begin to bulge. At the same time, the sternum decreases, which leads to muscle spasms and compression of the lungs and heart. So, when a chest pain occurs in scoliosis with a curvature of more than 45 °, this can be a manifestation of somatic disorders in the lung area on the affected side (with a deterioration in its respiratory function due to volume reduction) and in the heart region with left-sided scoliosis - with pain in heart resembling angina pectoris.

If the ribs hurt with scoliosis of the cervicothoracic or thoracic spine, then the whole thing is intercostal neuralgia associated with irritation and compression of the  intercostal nerves  due to deformation of the rib-vertebral and sternocostal joints and synchodrosis (joints of the ribs with the sternum) - with a decrease the space between the costal bones on the concave side of the curvature.

In addition to periodic dull and aching pains in the upper part of the neck (turning into acute pains with head movements), headaches with scoliosis of the cervical spine are not uncommon  .

Diagnostics of the pain in scoliosis

The issues of diagnosis of scoliotic deformities of the spinal column are devoted to the publication:

• Diagnosis of scoliosis
• Spinal Examination Methods

Treatment of the pain in scoliosis

The best way to treat pain in scoliosis is to treat scoliosis , however, reducing the curvature (Cobb angle) does not always lead to a decrease in pain. [3]

Medications for relieving severe pain include periodic spinal injections of corticosteroids, painkillers for oral administration -  Effective pills for back pain .

Non-steroidal anti-inflammatory drugs can also be used (although they can have side effects on the digestive tract and blood circulation), more in the article -  Non-steroidal anti-inflammatory drugs and back pain.

Prescribed drugs for muscle relaxation (muscle relaxants Tizanidine, Tolperisone, Baclofen), tricyclic antidepressants, drugs to improve peripheral blood supply, B vitamins (thiamine, pyridoxine and cyancobalamin).

Painful muscle cramps are relieved by the drug of the group of anticonvulsants  Gabapentin  (other trade names: Gabalept, Gabantin, Gabagama).

Also see -  Treatment of muscle pain

Physiotherapeutic treatment of pain involves the appointment of hardware physiotherapy: iontophoresis, ultrasound phonophoresis, EHF-therapy, low-frequency magnetotherapy, electrical stimulation. To relax the muscles, massage, water and mud therapy are used, and to strengthen them and improve joint mobility - exercise therapy, yoga, swimming. [4]

Surgical treatment of scoliosis is  indicated when the Cobb angle exceeds 45-50 °; but surgical intervention in adults is associated with a high risk, and its long-term effectiveness has not been proven.

Complications and consequences

Back pain with scoliosis negatively affects the quality of life of patients. The consequences of a severe degree of scoliotic deformity include limitation of mobility, disability, disability.

Prevention

In the absence of specific measures to prevent the occurrence of scoliosis, the prevention of its complications in the form of pain consists in diagnosing the disease at an early stage and treating it.

Forecast

Unfortunately, the prognosis for many patients experiencing pain in scoliosis with a significant degree of spinal deformity lies in its long-term nature. And treatment often can not completely relieve the pain caused by permanent damage to tissues and nerve fibers.