ISSN:
2181-3906
2023
International scientific journal
«MODERN SCIENCE АND RESEARCH»
VOLUME 2 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
566
THE SIGNIFICANCE OF COMPUTERIZED THERMOGRAPHY IN EVALUATING
THE EFFICACY OF TREATING INFLAMMATORY BACK PAIN
Khodjaeva Zulfiya Amangeldievna
PhD, Department of Neurology and Pediatric Neurology, Medical Genetics, TPMI.
Khodjaev Amangeldi
PhD, “Shahlo shifo” Medical Clinic.
https://doi.org/10.5281/zenodo.10138379
Abstract.
Medical thermography (thermal imaging): “...a method of recording the natural
thermal radiation of the human div in the invisible infrared region of the electromagnetic
spectrum of div temperature - one of the most important indicators of human health, based on
the fact that any pathological condition locally or generally affects the processes of heat
production and heat exchange in the div Thus, during inflammation, the rate of biochemical
processes decreases, but the process of uncoupling respiration and phosphorylation intensifies, as
a result of which the temperature of the inflamed area will be higher than the temperature of the
surrounding tissues” [1].
Key words:
cervical dorsalgia, lumbosacral dorsalgia, quality of life.
ЗНАЧЕНИЕ КОМПЬЮТЕРНОЙ ТЕРМОГРАФИИ В ОЦЕНКЕ
ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ВОСПАЛИТЕЛЬНЫХ БОЛЕЙ В СПИНЕ
Аннотация.
Медицинская термография (тепловизионное изображение): “...метод
регистрации естественного теплового излучения человеческого тела в невидимой
инфракрасной области электромагнитного спектра температуры тела - один из
важнейших показателей здоровья человека, основанный на том факте, что любое
патологическое состояние локально или в целом влияет на процессы теплопродукции и
теплообмена в организме Таким образом, во время воспаления скорость биохимических
процессов снижается, но усиливается процесс разобщения дыхания и фосфорилирования,
в результате чего температура воспаленного участка будет выше, чем температура
окружающих тканей” [1].
Ключевые слова:
шейная дорсалгия, пояснично-крестцовая дорсалгия, качество
жизни.
Thermography normally has a certain thermal div, and in a healthy individual it
practically does not change, but pathology changes it. Thermography is absolutely safe for any
duration and duration of use; it is used in pregnant women and children, since it has absolutely no
radiation exposure - since it registers human electromagnetic radiation, unlike CT and X-ray
studies [1, 2, 4, 6]. It is much cheaper than magnetic resonance imaging, it can be used for long-
term monitoring of patients, it has a high speed of obtaining and processing information, easy
storage and access to research results [5].
Thermography is a non-contact method that works at a distance, which is not unimportant
from the point of view of the epidemiology of contact infectious pathologies [14], it allows “... to
examine the entire div at once and within the framework of one patient visit, which is also a
significant advantage in the thermography method” [5].
ISSN:
2181-3906
2023
International scientific journal
«MODERN SCIENCE АND RESEARCH»
VOLUME 2 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
567
The basis of dorsalgia is severe pain caused by irritation of the nerve endings of the soft
tissues around the spine: “... muscles, ligaments, fascia; facet joints, nerves and spinal ganglia;
intervertebral disc, vertebrae, dura mater" [3].
The causes of back pain are varied. Typically, back pain is associated with pathology of
the muscles, nerves, bones, joints or other structures of the spine [7].
Lumbar dorsalgia often occurs at the age of 20-50 years, the maximum pain syndrome
occurs at 50-64 years; at 20-64 years old, 24% of men and 32% of women report back pain [8, 9].
The most interesting thing is that 12–26% of children and adolescents also report the presence of
lower back pain [11, 12]. Up to 67% of women in the population felt pain in the lower back, and
the peak of pain is observed at 35–45 years of age [10, 13].
Purpose of the study:
to evaluate the role of computed thermography in assessing the
effectiveness of treatment for back pain.
Material and methods.
The study is based on examination data of 175 patients with
dorsalgia with inflammatory origin of dorsalgia, of which 52 patients with CD and 123 patients
with PCD, aged 21-66 years (36.2±6.7 years).
We conducted a comprehensive clinical and neurological examination with active
identification of complaints and medical history. Radiological research methods were also used -
CT and MRI.
All patients received treatment in a physiotherapy private clinic for a minimum of 10 days.
Depending on the severity of the disease, duration of the disease, contraindications, a
complex of treatment was prescribed: massage of the diseased area No. 10; traction of the cervical
or lumbar region immediately after massage No. 10; ultrasound therapy No. 5-10 on the diseased
area with indomethacin, laser therapy No. 5-10; electrophoresis No. 5-10, UVT 1-2 units No. 3-5.
In addition to shock wave therapy, all physiotherapeutic procedures were carried out
regardless of inflammation, at least 4 different procedures per day of treatment.
In the presence of an inflammatory process, anti-inflammatory therapy was performed first:
For mild inflammation (CRP is 1.5-2 times higher): rheumoxicam 7.5 mg 1 tablet x 1 time
in the evening after meals for 10 days, on days 3-4 - UVT
For moderate inflammation (CRP higher than 2-3 times, ESR-25-35): xefocam 8.0 mg +
Phys. solution 100.0 = IV drip No. 5, (or Ketonal 2.0), then rheumoxicam 15 mg 1 tablet x 1 time
in the evening after meals for 10-20 days; mydocalm 1.0 i/m No. 5; after 3-5 days - shockwave
therapy, after 10 days of treatment, shockwave therapy was carried out once every 3-5 days, 3-5
times.
For severe inflammation (CRP is higher than 3 times, RF is increased by 2 times, ESR is
higher than 35 mm/h): physical solution 100.0 + Dexamethasone 2.0-2.0-1.0-1.0- 0.5 + Analgin
50% -2.0 + No-spa 2.0 = intravenous drip No. 5; xefocam 8mg++Physical solution 100.0=IV drops
No. 5 (or Ketonal 2.0), then rheumoxicam 15mg 1 tablet x 1 time in the evening after meals for
10-20 days; L-lysine 5.0-1.0 + Phys. solution 100.0 = IV drip No. 5; mydocalm 1.0 i/m No. 5;
after 5 days, shock wave therapy is added; after 10 days of treatment, shock wave therapy was
carried out once every 3-5 days, 3-5 times.
Determining the presence or absence of an active inflammatory component of dorsalgia
allowed us to make a decision on treatment tactics and its components.
ISSN:
2181-3906
2023
International scientific journal
«MODERN SCIENCE АND RESEARCH»
VOLUME 2 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
568
In turn, this group was divided into 3 subgroups using a blind sampling method:
Group 1A - differentiated therapy of dorsalgia of inflammatory origin with subsequent
administration of shock wave therapy - 58 patients (16 - CD and 42 - PCD);
Group 1B - differentiated therapy of dorsalgia of inflammatory origin without the inclusion
of shock wave therapy - 58 patients (17 - CD and 41 - PKD)
Group 1C – differentiated therapy of dorsalgia of inflammatory origin with subsequent
administration of shockwave therapy and vitamin D in therapeutic and prophylactic doses – 59
patients (19 – CD and 40 – PCD);
Statistical data processing was carried out using Microsoft Office Excel-2019, including
the use of built-in statistical processing functions.
The results of the study: the dynamics of pain in patients with CD group 1A are leveled out
and persist throughout 12 months of observation. So, if initially among patients in this group the
average scores were 8.4 ± 1.2 points, then after 14 days of observation they significantly decreased
to 5.5 ± 1.2 points (P < 0.05), after 3 months to - 4 .9±1.1 points (P<0.01), and after 12 months to
2.8±0.6 points (P<0.001). The data obtained indicate that the use of shockwave therapy in the
complex therapy of CD has a positive effect that lasts up to 12 months.
In group 1B, after 14 days of observation, positive dynamics were noted, there was a
significant decrease in average scores on the VAS scale from 7.9 ± 1.1 to 5.5 ± 1.0 points (P <
0.05), however, in long-term periods (3 months and year) found an increase in average scores after
1 year to the initial ones, which demonstrates the short-term effectiveness of traditional treatment,
the maximum of which occurs in the first 2 weeks and lasts up to 3 months.
In group 1C, a statistically significant reduction in pain was observed relative to groups 1A
(P<0.05) and 1B groups (P<0.01), which confirms the long-term effectiveness of the combined
use of shockwave therapy and vitamin D, the peak effectiveness of which occurs at 12 months
(P<0 .01) in relation to group 1A (1.8±0.5 versus 2.8±0.6 points) and to group 1B (1.8±0.5 versus
7.3±1.5 points (P< 0.001).
When analyzing the effectiveness of prescribing shockwave therapy and vitamin D in the
complex treatment of patients with PCD, we also noted significant relief of pain. Thus, in group
1A, the initial average scores were 9.2±1.3 points; we noted a significant decrease in VAS scores
already on the 14th day of treatment; after 3 months and 12 months, the positive effect persisted,
which was confirmed by a persistent decrease in average scores (4. 3±0.9 and 3.2±0.5 points,
respectively).
In group 1B, regression of the pain symptom was observed during the first 14 days of
treatment (8.9±1.4 versus 6.9±1.2 points; P<0.01), while in the long-term period after 3 months
and 12 months there was an increase in average points on the VAS scale (7.3±1.6 and 7.8±1.5
points).
In group 1C of patients with PCD, after 14 days of treatment there was an almost 2-fold
decrease in average VAS scores (9.1±1.7 versus 4.2±1.3 points; P<0.05), in the long-term period
after At 3 and 12 months, pain relief was observed in all patients, with the average scores
significantly decreasing compared to the initial data (2.8±0.7, 1.5±0.4 points versus 9.1±1.7 points;
P<0.001). A study of the long-term period showed persistent positive dynamics among patients
with PCD when prescribed in combination therapy with UVT and vitamin D.
ISSN:
2181-3906
2023
International scientific journal
«MODERN SCIENCE АND RESEARCH»
VOLUME 2 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
569
The degree of muscle disorders in the dynamics of observation among patients with CD
and PCD also underwent changes and had a positive trend, so if before treatment the average score
on the IMS scale in the groups was on average 12.9 ± 0.18 points for CD, and 9 for PCD .8±±0.32
points, then after treatment there was a decrease in the average score by an average of 3.5 times, a
particularly pronounced decrease was observed in groups 1A and 1C (Table 1).
The most pronounced relief of muscular-tonic syndrome was observed in group 1C in
patients with CD and PCD, i.e. in patients whose treatment complex was prescribed shockwave
therapy and vitamin D. When analyzing the initial indicators of IMS in group 1A, both in CD and
PCD corresponded to grade III severity, whereas after treatment it was grade I (mild).
Thus, the average scores on the IMS scale on day 14 in group 1A in patients with CD
significantly decreased (12.2±0.12 versus 8.5±0.21 points). In the long-term period, symptom
relief in this group reached 3.2±0.11 points. With PCD in group 1A, the average IMS score after
14 days of treatment was 8.5±1.5 points, which is significantly lower than the initial data. After 3
and 12 months, stable relief of muscular-tonic syndrome was observed (5.1±1.3 and 3.9±0.14
compared to 11.6±1.3 points; P<0.05).
In group 1B, in patients with CD, positive dynamics of IMS indicators were noted on day
14; in the long-term period, the average IMS indicators increased and in most patients they reached
the initial data or higher. Among patients with PCD in group 1B, a similar picture is observed. The
data obtained in group 1B indicate that the relief of muscular-tonic syndrome is unstable and in
the long term, in most patients, repeated cases of the disease are observed.
In group 1C, the most pronounced positive dynamics of relief of muscular-tonic syndrome
were recorded with a persistent effect maintained in the long-term period compared with the
indicators of groups 1A and 1B. Thus, 14 days after treatment, there was an almost 2-fold decrease
in average scores (P<0.05) on the IMS, while after 3 months a decrease in average scores was
noted by 2.5 times (P<0.05), and after 12 months 4.3 times (P<0.01) relative to the original data.
A study of the long-term period showed persistent positive dynamics among patients with PCD
when prescribed in combination therapy with UVT and vitamin D.
We also established the leveling of the inflammatory process during thermography. The
most typical thermographic manifestation of spinal pain syndrome was the identification of zones
with increased intensity of infrared (IR) radiation on the posterior surface of the div (Fig. 1).
ISSN:
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Before treatment
After treatment
Rice. 1. Pathological hyperthermia of the posterior surface of the neck in CD.
Thermogram (a) and pseudo-three-dimensional image (b) of the posterior surface of the
neck
Depending on the localization and severity of the pathological process, various variants of
disruption of normal thermotonography of the posterior surface of the div were diagnosed:
thermal asymmetry of the thermal pattern, zones of increased emission of infrared radiation in the
area of the skin projection of the spinous processes of the vertebrae (individually several or
throughout the entire spinal column), foci of confluent and spotted pathological hyperthermia in
paravertebral zones.
Having analyzed the changes in thermal imaging data before and after treatment, we can
say that after treatment, the values of absolute temperature in the neck area change unreliably in
the treatment groups.
However, in groups 1A and 1C in the neck region there was a decrease in maximum
temperature - on average by 1.8±0.01°C and 2.3±0.01°C (35.4±1.2°C and 35.8 ±1.1°C before
treatment and 33.6±1.3°C and 33.5±1.2°C after treatment, respectively) (Fig. 2).
Fig. 2. Thermometry indicators for CD in treatment groups during follow-up
In group 1B, temperature indicators before and after treatment changed by 0.8±0.01°C,
which is significantly lower in relation to groups 1A and 1C (P<0.01).
When studying thermographic indicators in the dynamics of treatment in patients with
PCD, we established the following temperature changes, so in patients of groups 1A and 1C we
35,4
35,2
35,8
33,6
34,4
33,6
32
32,5
33
33,5
34
34,5
35
35,5
36
1A
1B
1C
before treatment
after treatment
°
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found a statistically significant decrease in thermal asymmetry in all studied regions (p <0.05). In
the PCD region, the most pronounced decrease in thermal asymmetry was observed after treatment
(p <0.05).
Before treatment, the study groups did not differ in thermal asymmetry (p>0.05). In group
1B there was also a change in thermal asymmetry after treatment, but not as strong as in groups
1A and 1C (Fig. 3).
Fig.3. Thermometry indicators for CD in treatment groups during observation
dynamics
As can be seen from the diagram, in patients of group 1A, a decrease in temperature was
found on average by 2.2±0.05°C, while in group 1B it was only by an average of 0.8±0.01°C,
which is significantly lower (P< 0.05). However, in group 1C, the average deviations in the
dynamics of the study were 3.2±0.06°C, which was significantly higher in relation to groups 1A
and 1B (P<0.01) (Fig. 4).
Based on the results obtained, it can be argued that in case of dorsalgia, an informative
indicator of the level of pain is the severity of thermal asymmetry in the neck and lumbosacral
region. The criterion for improving the condition of patients can be not only a decrease in
maximum temperature, but also a decrease in thermal asymmetry.
37,8
36,3
36,8
35,6
35,5
33,6
31
32
33
34
35
36
37
38
39
1А
1B
1C
before treatment
after treatment
°
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Fig.4. Pathological hyperthermia of the spine during PCD. Thermogram (a) and (b)
after treatment; (c) before treatment
Based on this, we can talk about a decrease in inflammatory processes, irritation
phenomena and venous stagnation in patients who received shockwave therapy and vitamin D.
Conclusion: thermographic monitoring of such patients during the process of
rehabilitation treatment showed that in most cases, subjective normalization occurs earlier than
the ICTG indicators return to normal. This makes it possible to very reliably diagnose residual
effects of the inflammatory process and, if necessary, continue rehabilitation measures.
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