ДИСКОГЕННА БОЛКА В КРЪСТА – ПАТОФИЗИОЛОГИЧНИ ОСОБЕНОСТИ И ТЕРАПЕВТИЧНИ ПОДХОДИ.

Low back pain is a global public and occupational health problem. Approximately 80% of the general population experiences low back pain of varying intensity at some point in their lives. Intervertebral disc degeneration is the main pathology in 42% of patients suffering from low back pain. The intervertebral disc is composed of three separate elements: a central part - nucleus pulposus, an outer part - annulus fibrosus and two cartilaginous endplates covering the upper and lower surfaces of the vertebral bodies. The degenerative process consists of 4 stages: dehydration, cracking, neovascularization and bone changes. As a result of these changes, the biomechanics of the lumbar compartment is disturbed and local and, in some patients, radicular pain occurs. The proven therapeutic approaches for discogenic lumbalgia are divided in conservative (pharmacological and non-pharmacological) and surgical methods for the treatment of this disease. New therapeutic strategies that are being actively investigated include gene therapy, growth factor therapy and inhibition of chemical mediators of pain. Biological therapies that stimulate the recovery processes in the intervertebral discs are still in the experimental stage and more studies are needed to establish their effectiveness in cases of severe degenerative changes. Knowing the pathophysiologic mechanisms of low back pain enables the clinician to differentiate the mechanism that plays the dominant role in the onset of pain and to conduct targeted treatment with optimal results. The aim of this review is to reveal the pathophysiological mechanisms of pain symptomatology in the lumbar spine and to discuss the main therapeutic approaches to address the problem. [ABSTRACT FROM AUTHOR]