Scoliosis pain

Gradually developing scoliotic deformation of the spine manifests itself in a number of symptoms, and pain in scoliosis - of varying localization and intensity - is part of the clinical picture of this disease. However, not everyone experiences pain.

Next, we will talk about what kind of pain patients with scoliosis most often complain about, and why it occurs.

Causes scoliosis pain

When naming the main causes of pain in scoliotic deformation of the spinal column, specialists emphasize their vertebrogenic nature, associated with the features of scoliosis: torsional 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 a 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 the violation of their anatomical position with a strong curvature of the spine in the frontal plane), and the motor and sensory nerve fibers innervating the spine and their endings (which, when it is deformed, are subject to compression at the entrance to the intervertebral openings).

Risk factors

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

Pathogenesis

The pathogenesis of pain experienced by specific patients with scoliosis is often explained by its location and nature. Pain sensations – from mild to debilitating vertebrogenic pain syndrome – can originate from the site of the main curvature of the spine (convexity) or below the arc of deformation, from the concavity of the spine or from adjacent areas. In the first case, pain occurs due to lateral spondylolisthesis (sideways displacement) of the vertebral bodies, spinal stenosis, compression and irritation of the dorsal roots of the spinal nerves innervating peripheral structures.

In the second case, spinal pain usually appears over time – due to excessive mechanical (compressive) loads on the affected vertebral joints and intervertebral discs, in which degenerative changes have occurred, causing instability of the spinal column.

Muscle-fascial pain is the result of constant overstrain (hypertonicity) and functional imbalance of the paravertebral muscles when changing posture.

Headaches associated with scoliosis (which sometimes reach the level of migraine) can be tension headaches, occurring with partial compression of the vertebral artery and deterioration of cerebral blood supply, as well as with a decrease in cerebrospinal fluid pressure in the brain.

Epidemiology

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

And muscle pain – from minor to moderate – is experienced by almost 20% of adolescents with idiopathic scoliosis of any localization. A 58.8% prevalence of back pain is reported in patients with scoliosis compared to 33% in patients without scoliosis. [ 1 ]

Symptoms

The most common back pain is considered to be scoliosis, developing due to the load on the vertebral joints, stretching of the muscles by a protruding shoulder blade (with pain in the shoulder blade area radiating to the shoulder), compression of nerve fibers; in adults - with wear of the intervertebral discs. Read more in the publications:

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

Severe lower back pain and stiffness in scoliosis, as well as pain in the pelvic area (when it is tilted in grades 3-4 scoliotic deformation) are the result of torsional displacement of the lumbar vertebrae, increased postural tension and stretching of the iliopsoas and sacroiliac ligaments. With an inclined position of the pelvis in adults with a high degree of dysplastic or degenerative scoliosis of the lumbar spine, one of the hips (its muscles and tendons) is loaded more, which ultimately causes pain in the leg in scoliosis radiating to the groin area (often with pronounced limping while walking). If the pelvis is not tilted, then the pain in the lower limbs is neurological in nature, caused by a narrowing of the spinal canal. [ 2 ]

Chest pain in 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 cartilages, and the formation of a hump, when the ribs on one side of the back shift and begin to protrude. In this case, the retrosternal space decreases, which leads to muscle spasms and compression of the lungs and heart. So, when the chest hurts with scoliosis with a curvature of more than 45 °, this may be a manifestation of somatic disorders in the lung area on the affected side (with deterioration of its respiratory function due to a decrease in volume) and in the heart area with left-sided scoliosis – with pain in the heart, reminiscent of angina.

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

In addition to periodic dull and aching pain in the upper part of the neck (which becomes sharp when moving the head), headaches are also common with scoliosis of the cervical spine.

Diagnostics scoliosis pain

The following publications are devoted to the issues of diagnostics of scoliotic deformities of the spinal column:

• Diagnosis of scoliosis
• Methods of examination of the spine

Treatment scoliosis pain

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

Medications for relieving severe pain include periodic spinal corticosteroid injections, oral painkillers - Effective Back Pain Pills.

Non-steroidal anti-inflammatory drugs (NSAIDs) may also be used (although they may have gastrointestinal and circulatory side effects), for more details see the article - Non-steroidal anti-inflammatory drugs and back pain.

Prescribed medications include muscle relaxants (muscle relaxants Tizanidine, Tolperisone, Baclofen), tricyclic antidepressants, agents to improve peripheral blood supply, and B vitamins (thiamine, pyridoxine, and cyanocobalamin).

Painful muscle spasms are relieved by the anticonvulsant drug Gabapentin (other trade names: Gabalept, Gabantin, Gabagama).

See also – Muscle Pain Treatment

Physiotherapeutic treatment of pain involves the use of hardware physiotherapy procedures: iontophoresis, ultrasound phonophoresis, UHF therapy, low-frequency magnetic therapy, electrical stimulation. Massage, water and mud therapy are used to relax muscles, and exercise therapy, yoga, and swimming are used to strengthen them and improve joint mobility. [ 4 ]

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

Complications and consequences

Back pain in scoliosis negatively affects the quality of life of patients. The consequences of severe scoliotic deformation include limited mobility, loss of ability to work, and disability.

Prevention

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

Forecast

Unfortunately, the prognosis for many patients experiencing scoliosis pain with a significant degree of spinal deformity is that it is long-term. And treatment often cannot completely relieve the pain caused by constant damage to tissues and nerve fibers.