The most common mechanism of pain caused by disease of the spine, may be prolonged compression of the nerve roots or the development of local areas of functional and morphological changes in the muscle (trigger zones), also causing pain - miodystrophic syndrome or MFBS. Often, it is spastic muscles themselves are the cause of pain, starting secondary "circle of pain" that lasts for a long time due to neural mechanisms (through the activation of neural pathways in the periphery).
Physiological muscle tension that follows any pain, is to immobilize the affected area of the body and the creation of the muscular system. However, skeletal muscle is often the cause of pain syndromes. It is well known tonic muscle tension (muscle spasm protective), arising in response to pain impulses emanating from different sources (internal organs, spine and associated structures, joints, ligaments, etc..). In turn, muscle spasm leads to increased stimulation of pain receptors in the muscles, and there is a "vicious circle": the pain - muscle spasm - enhanced pain - painful muscle spasm. However, along with the secondary muscle reflex response in the form of tonic muscle reaction may suffer initially, being the only source of pain.
Nociceptive impulses affected motor segment activates the motor neurons of the anterior horns of the spinal cord, which leads to a spasm of the muscles innervated by that segment of the spinal cord. When muscle spasm is a stimulation of nociceptors most muscle. In spastic muscles develop pockets of local ischemia, which causes vasomotor and dystrophic changes in the tissues, increasing even more the activation of nociceptors in muscle fibers.
For the relief of pain used analgesics, NSAIDs, and muscle relaxants. Standard treatment includes MFBS: NSAIDs, muscle relaxants, the impact on the TT, therapy aimed at restoring the normal functioning of muscle tissue: the reduction of muscle tension, strengthen muscular frame, a lifestyle change.
For the treatment of painful muscle spasms, muscle relaxants are used orally or parenterally. Muscle relaxants relieve pain, reduce reflex muscle tension, improve motor function and facilitate the implementation of physical therapy. Treatment of muscle relaxants begin with the usual therapeutic dose and continue throughout the retention period pain. Generally, treatment is several weeks.
One of the most effective and safe drugs of this group is Sirdalud, the international non-proprietary name - Tizanidine. It is proved that the painful muscle spasm addition to standard therapy (NSAIDs, physiotherapy) relaxants leads to more rapid regression of pain, muscle tension and improve mobility of the spine. Clinical studies comparing monotherapy with combination therapy of NSAIDs NSAIDs and tizanidine 4 mg, demonstrated the superiority of the latter in efficiency. Data were obtained on a high performance integrated use of tizanidine 4 mg and diclofenac in the treatment of patients with rheumatological profile.
Tizanidine 4 mg is a centrally acting muscle relaxant - the main point of application of its action is in the spinal cord and relates to imidazoline being selective a2-agonist, thereby demonstrating selective action on muscle tone. Muscle relaxant effect of the drug is associated with its effect on a2-adrenergic receptors in the brain and spinal cord. Sirdalud reduces the release of excitatory neurotransmitters, particularly noradrenaline and aspartate at "blue stain - locus ceruleus», thus reducing their effect on the receptors, which correspondingly leads to a decrease of excitability and a- g-motoneurons in the spinal cord. Stimulating the presynaptic a2-receptors, Tizanidine 4mg suppresses the release of excitatory amino acids to stimulate the receptors sensitive to N-methyl-D-aspartate (NMDA-receptors). Consequently, at the intermediate spinal cord neurons are suppressed polysynaptic transmit excitation. Since this mechanism is responsible for the excessive muscle tone, then when suppressing muscle tone decreases. In addition to the muscle relaxant characteristics Sirdalud (tizanidine) also provides central Moderate analgesic effect.