{"id":13340,"date":"2008-11-13T20:00:00","date_gmt":"2008-11-13T20:00:00","guid":{"rendered":""},"modified":"2016-10-13T15:43:26","modified_gmt":"2016-10-13T15:43:26","slug":"klausimai-ir-atsakymai-apie-umini-juosmens-skausma","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/klausimai-ir-atsakymai-apie-umini-juosmens-skausma\/13340\/","title":{"rendered":"Klausimai ir atsakymai apie \u016bmin\u012f juosmens skausm\u0105"},"content":{"rendered":"<p class=\"Pa2\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Straipsnyje apra\u0161omi \u016bminio ir l\u0117tinio juosmens skausmo skirtumai, nurodomos pagrindin\u0117s \u016bminio juosmens skausmo prie\u017eastys, b\u016bdinga nespecifinio mechaninio, \u0161aknelinio skausmo ir spinalin\u0117s stenoz\u0117s klinika. Aptariamas tyrim\u0173 planas, rekomenduojamas \u012frodymais pagr\u012fstas \u016bminio juosmens skausmo gydymas.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Default\" style=\"margin: 0cm 0cm 0pt; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u00a0<\/span><\/b><\/span><\/p>\n<p class=\"Default\" style=\"margin: 0cm 0cm 0pt; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Ar reikia atskirti \u016bmin\u012f juosmens skausm\u0105 nuo l\u0117tinio?<\/span><\/b><\/span><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa4\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa4\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Taip. Nors \u016bminis ir l\u0117tinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/juosmens-skausmas\/53594\">juosmens skausmas<\/a> yra tos pa\u010dios arba pana\u0161ios etiologijos, ligos ir gydymo efektyvumo prognoz\u0117s skiriasi. Per gyvenim\u0105 bent vien\u0105 \u016bminio juosmens skausmo epizod\u0105 patiria iki 85% \u017emoni\u0173. Da\u017eniau serga auk\u0161tesni asmenys, moterims skausmus didina antsvoris, n\u0117\u0161tumas, jauniems t\u0117vams \u2013 vaik\u0173 prie\u017ei\u016bra. Da\u017eniau ken\u010dia dirbantys s\u0117dim\u0105 darb\u0105, vairuojantys arba, prie\u0161ingai, \u2013 sunkiai fizi\u0161kai dirbantys,atliekantys stereotipinius kilnojimo,lankstymosi judesius. Manoma, kad skausm\u0105 suk\u0117l\u0119s jungiamojo, raumeninio ar nervinio audinio pa\u017eeidimas turi sugyti savaime per 6\u201312 savai\u010di\u0173, tod\u0117l \u016bminiu juosmens +\/- kojos skausmu vadinamas skausmas, trunkantis trumpiau nei 3 m\u0117nesius. Ma\u017edaug 10% ligoni\u0173 skausmas nepraeina per 3 m\u0117nesius ir tampa l\u0117tinis. \u0160is l\u0117tinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/juosmens-skausmas\/53594\">juosmens skausmas<\/a> yra pagrindin\u0117 fizin\u012f aktyvum\u0105 ribojanti prie\u017eastis jauniems \u017emon\u0117ms iki 45 met\u0173, jo gydymo i\u0161laidas lenkia tik \u0161irdies lig\u0173 ir v\u0117\u017eio gydymas. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\">\u00a0<\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kod\u0117l <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/juosmens-skausmas\/53594\">juosmens skausmas<\/a> tampa l\u0117tinis?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Tiksliai n\u0117ra \u017einoma. Bet toki\u0173 veiksni\u0173 (prognostini\u0173 \u201eraudon\u0173j\u0173 v\u0117liav\u0117li\u0173\u201c) paie\u0161ka ir korekcija yra labai svarbi. Skiriamos trys prie\u017eas\u010di\u0173 grup\u0117s:<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<ul>\n<li style=\"text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Neurofiziologiniai mechanizmai\u2013pvz.,periferini\u0173 skausmo receptori\u0173 sensitizacija, kamieno tinklinio darinio poky\u010diai ir kt.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li style=\"text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Psichologiniai mechanizmai ir gretutin\u0117s ligos \u2013 pakit\u0119s skausmo suvokimas, stebimas esant depresijai, nerimui. Tokie asmenys taip pat ken\u010dia nuo galvos skausm\u0173, nuovargio. Prognoz\u0117 greitai pasveikti blog\u0117ja, jei \u017emon\u0117s vartoja psichoaktyvi\u0173 med\u017eiag\u0173, r\u016bko, buvo nes\u0117kmingai konservatyviai <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li style=\"text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Ar chirurgi\u0161kai gydyti, esant juosmens skausmui ar kitoms l\u0117tin\u0117ms ligoms, serga cukriniu diabetu, turi kardiovaskulini\u0173 problem\u0173, kurios riboja fizin\u012f aktyvum\u0105.Svarbus po\u017ei\u016bris,kad tik visi\u0161kai pranykus skausmui galima gr\u012f\u017eti \u012f darb\u0105, kad fizinis aktyvumas yra \u017ealingas, kad s\u0117kmingas yra tik intervencinis gydymas ir t. t.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li style=\"text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Socialin\u0117s prie\u017eastys \u2013 problemos darbe, \u0161eimoje, invalidumo ar kompensacij\u0173 siekimas.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<\/ul>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kokios da\u017eniausios juosmens skausm\u0173 prie\u017eastys? <\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa4\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa4\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">85% nustatomos nespecifin\u0117s mechanin\u0117s prie\u017eastys \u2013 pvz., raumen\u0173, s\u0105nari\u0173, rai\u0161\u010di\u0173 pa\u017eeidimas, sukeltas mikrotraum\u0173, tarpslankstelinio disko, facetini\u0173 ir sakroiliakini\u0173 s\u0105nari\u0173 degeneracija, de\u00adgeneneracinis stuburo judesio segmento nestabilu\u00admas. Tiksli\u0105 prie\u017east\u012f nustatyti yra sunku, be to, n\u0117ra taip svarbu, nes prognoz\u0117 net ir negydant yra gera \u2013 9 i\u0161 10 ligoni\u0173 pasveiksta savaime per 6 savaites.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa8\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Stuburo judesio segmentas SJS<\/span><\/b><\/span><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">. Tai du gretimi stuburo slanksteliai su jungtimis. Skausmui atsirasti svarbus pa\u017eeidimas t\u0173 SJS strukt\u016br\u0173, kurias intervuoja nugarinio nervo \u0161akos r. sinuvertebralis (kitaip r. meningeus, r. recurrens). Priekin\u0117 SJS kolona, sudaryta i\u0161 slanksteli\u0173 k\u016bn\u0173, tarpslankstelinio disko ir priekinio bei u\u017epakalinio i\u0161ilgini\u0173 rai\u0161\u010di\u0173, atsakinga u\u017e svorio laikym\u0105 stovint, einant, b\u0117gant. U\u017epakalin\u0117 kolona, sudaryta i\u0161 lanko, skersini\u0173 ataug\u0173, keterin\u0117s ataugos, facetini\u0173 s\u0105nari\u0173 ir likusi\u0173 rai\u0161\u010di\u0173, leid\u017eia nugar\u0105 tiesti ir ribotai atlikti rotacinius judesius.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa9\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa9\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kas b\u016bdinga facetin\u0117s jungties sindromui?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Rytinis sukaustymas, juosmens s\u0105stingis, skausmo plitimas \u012f s\u0117dmenis, \u0161launis, skausmo stipr\u0117jimas ilgai b\u016bnant vienoje pozoje ir tiesiantis, skausmo ma\u017e\u0117jimas judant ir lenkiantis. Da\u017eniausiai matoma juosmenin\u0117s suburo dalies hiperlordoz\u0117, \u012ftempti paravertebraliniai raumenys, palpuojant facetin\u0117s (kitaip zygapofizealin\u0117s)jungties srit\u012f juntamas skausmas. Kadangi tai vienas i\u0161 paprast\u0173 mechanini\u0173 nugaros skausm\u0173 \u2013 jutimo ir motorikos sutrikim\u0173 n\u0117ra, tempimo simptomai neigiami. Ta\u010diau galimi diagnostiniai sunkumai: esant \u012ftemptam m. psoas \u2013 ribota \u0161launies rotacija, esant \u012ftemptam pakinkliui \u2013 sunki tempimo simptom\u0173 interpretacija, kartais silpni koj\u0173 sausgysliniai refleksai\u2013\u012ftariamosperiferin\u0117snerv\u0173sitemos ligos, esant \u012ftemptiems paravertebraliniams raumenims \u2013 lokali odos hiperestezija. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\">\u00a0<\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Ar da\u017enos yra tarpslankstelini\u0173 disk\u0173 i\u0161var\u017eos? <\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Degeneraciniai tarpslankstelini\u0173 disk\u0173 pakitimai, nustatomi rentgenologi\u0161kai ir kitais instrumentiniais tyrimais, yra da\u017eni, bet i\u0161var\u017e\u0173 sukelta radikulalgija ar <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/radikulitas\/72713\">radikulopatija<\/a>\u00a0nustatoma tik 2\u201310% ligoni\u0173, varginam\u0173 \u016bminio juosmens skausmo. Toki\u0173 lig\u0173 pikas 40\u201359 metai, operuojam\u0173 ligoni\u0173 am\u017eiaus vidurkis apie 42 metus. Priklausomai nuo i\u0161siver\u017eusios tarpslankstelinio disko dalies lokalizacijos ir i\u0161var\u017eos stadijos, juosmens skausmo gali neb\u016bti (vertikali \u2013 \u0160morlio i\u0161var\u017ea), kyla paprastas mechaninis skausmas (lumbago, lumbalgija, jei yra priekin\u0117 i\u0161var\u017ea) arba i\u0161sivysto radikulalgija \u2013 a\u0161trus, gerai lokalizuotas, da\u017eniausiai plintantis iki kulno ar koj\u0173 pir\u0161t\u0173 gal\u0173 skausmas, taip pat galimi tempimo simptomai (\u0161onin\u0117 ir u\u017epakalin\u0117 \u0161onin\u0117 i\u0161var\u017eos), o jei spaud\u017eiamos \u0161aknel\u0117s, inervacijos zonoje sutrinka jutimas ar motorika \u2013 nustatoma radikulopatija. Vidurin\u0117 i\u0161var\u017ea gali spausti kelias \u0161akneles ir sukelti cauda equina sindrom\u0105, pasirei\u0161kiant\u012f abiej\u0173 koj\u0173 skausmais, plintan\u010diais iki kuln\u0173 ar koj\u0173 pir\u0161t\u0173 gal\u0173, \u012fvairaus sunkumo jutimo sutrikimais kojose ir tarpviet\u0117je, koj\u0173 silpnumu, esant silpniems <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 8.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"page-break-before: always; margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">sausgysliniams refleksams(periferin\u0117sparez\u0117s)irdubens organ\u0173 funkcijos sutrikimui. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Default\" style=\"margin: 0cm 0cm 0pt;\">\u00a0<\/p>\n<p class=\"Default\" style=\"margin: 0cm 0cm 0pt;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kaip radikulalgij\u0105 diferencijuoti nuo lumboi\u0161algijos?<\/span><\/b><\/span><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u0160aknelinio skausmo charakteristikos: <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<ul>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Dermatomin\u0117 lokalizacija. Jutimo sutrikimo (parestezijos ar hipestezijos) lokalizacija tiksliau atspindi pa\u017eeist\u0105 \u0161aknel\u0119, negu skausmo lokalizacija. Jei klini\u0161kai \u012ftariamas L2 ar L3 \u0161aknel\u0117s pa\u017eeidimas \u2013 pirmiausia galvojama apie i\u0161plitusius ma\u017eojo dubens navikus, nugaros smegen\u0173 navikus, kraujagysli\u0173 malformacijas ir kt., kartais tokie pa\u017eeidimai b\u016bna esant ry\u0161kiai skoliozei ir lateralin\u0117ms i\u0161var\u017eoms. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Skausmas stipr\u0117ja \u010diaudint, kosint, stanginantis, nes labiau suspaud\u017eiamos pa\u017eeistos \u0161aknel\u0117s prisipild\u017eiusiomis epiduralin\u0117mis venomis. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Skausmas pa\u017eadina i\u0161 miego ver\u010diantis arba gulin\u010dio ligonio papra\u0161ius prilenkti galv\u0105 priekr\u016btin\u0117s, nes lenkiantis stuburas pailg\u0117ja, \u0161aknel\u0117s labiau spaud\u017eiamos. Gulint tiesiai ir ramiai skausmas yra silpniausias.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Skaumas stipr\u0117ja siaurinant ang\u0105, per kuri\u0105 i\u0161eina \u0161aknel\u0117, pavyzd\u017eiui, lenkiantis \u012f pa\u017eeist\u0105 pus\u0119.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Geriausiai \u017einomas ir aptinkamas (nes da\u017eniausiai pa\u017eeid\u017eiamos L5\u2013S1 \u0161aknel\u0117s) tempimo simptomas \u2013 Lasegue, kitaip vadinamas tiesios kojos k\u0117limo testu (TKKT), kur\u012f dar labiau pary\u0161kina kartu atliekama p\u0117dos dorsifleksija).Teigiamas TKKT yra tada,kai skausmas plinta \u017eemiau keli\u0173. Esant labai ry\u0161kiam skausminiam sindromui, gali b\u016bti teigiamas ir sveikosios kojos TKKT. D\u0117l tikro, o ne simuliuojamo \u0161akneli\u0173 tempimo, ligonis negali s\u0117d\u0117ti lovoje i\u0161tiestomis kojomis, negali stov\u0117damas pasilenkti \u012f priek\u012f nepalenkdamas pa\u017eeistos kojos, jam sunku s\u0117d\u0117ti skaudam\u0105 koj\u0105 u\u017ek\u0117lus ant sveikosios.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<\/ul>\n<p class=\"Pa8\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Lumboi\u0161algija \u2013 tai bukas, blogai lokalizuotas s\u0117dmens, u\u017epakalinio \u0161launies pavir\u0161iaus skausmas, neplintantis \u017eemiau keli\u0173, nesant jutimo, motorikos sutrikimo ir tempimo simptom\u0173, atliekant TKKT skaud\u0117ti gali, bet skausmas neplis \u017eemiau keli\u0173. Tai vienas i\u0161 atspind\u017eio skausm\u0173, kurio prie\u017eastis gali b\u016bti ne tik paprasta mechanin\u0117 vertebrogenin\u0117, bet ir visceralin\u0117 (ginekologin\u0117s, urologin\u0117s, vir\u0161kinamojo trakto ligos), abdominalin\u0117s aortos ligos, klubo s\u0105nario ligos.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\">\u00a0<\/p>\n<p class=\"Pa5\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kaip vertinti juosmens skausm\u0105?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Renkama \u012fprastin\u0117 skausmo anamnez\u0117: <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<ul>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kur skauda; labai gerai, kai ligoniui pateikiamas pie\u0161in\u0117lis, kuriame jis pa\u017eymi skaudam\u0105 viet\u0105,<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kaip skauda; skirtingi A. Pakulos klausimyno skausma\u017eod\u017eiai leid\u017eia diferencijuoti nociceptinio ir neuropatinio skausmo komponentus, <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kaip stipriai skauda; pasirinktinai naudojamos skaitmenin\u0117, \u017eodin\u0117 ar \u201eveiduk\u0173\u201c skal\u0117s, patvirtintos Lietuvos SAM 2004 m. \u012fsakymu Nr.V-608, <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kur plinta,<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kokie lydintys rei\u0161kiniai, <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">kas blogina ir gerina b\u016bkl\u0119: gul\u0117jimas, s\u0117d\u0117jimas, stov\u0117jimas, judesiai, medikamentai, proced\u016bros.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<\/ul>\n<p class=\"Pa9\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa9\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">D\u0117l ko dar gali skaud\u0117ti juosmen\u012f?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa8\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa8\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Retas, bet rimtas prie\u017eastis: traum\u0105, infekcij\u0105, navikus (\u012f slankstelius da\u017eniausiai metastazuoja skydliauk\u0117s, kr\u016bties, plau\u010di\u0173, inkst\u0173, prostatos navikai) \u2013 reikia \u012ftarti jau pirmojo apsilankymo metu. Padeda diagnostin\u0117s \u201eraudonosios v\u0117liav\u0117l\u0117s\u201c:<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<ul>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Jaunesnis nei 20 met\u0173 ar vyresnis nei 50 met\u0173 pacientas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Nuolatinis progresuojantis skausmas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Skausmas ramiai gulint, nakt\u012f;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Labiau akcentuojamas ne skausmas, o rytinis \u0105stingis;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Dubens organ\u0173 funkcijos sutrikimas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kar\u0161\u010diavimas; <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Svorio netekimas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Ilgalaikis gliukokortikoid\u0173 vartojimas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Intravenini\u0173 narkotik\u0173 vartojimas;<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Trauma.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<\/ul>\n<p class=\"Pa10\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\">\u00a0<\/p>\n<p class=\"Pa10\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kada reikia pagalvoti apie neurogenin\u0119 klaudikacij\u0105?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Jeigu ligonis skun\u017eiasi epizodiniu koj\u0173 silpnumu, juosmens ir koj\u0173 skausmais, kuriuos provokuoja ilgesnis stov\u0117jimas, vaik\u0161\u010diojimas, atsilo\u0161imas, b\u016bkl\u0119 gerina pasilenkimas, atsis\u0117dimas. Spinalin\u0117s stenoz\u0117s anatominiai komponentai: degeneravusio tarpslankstelinio disko prolabacija, facetini\u0173 s\u0105nari\u0173 ir geltonojo rai\u0161\u010dio hipertrofija.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa10\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\">\u00a0<\/p>\n<p class=\"Pa10\" style=\"margin: 0cm 0cm 0pt; line-height: normal;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kokie instrumentiniai ir laboratoriniai tyrimai reikalingi?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Jei nustatomi neurologiniai pa\u017eeidimo simptomai ar kitos diagnostin\u0117s \u201eraudonosios v\u0117liav\u0117l\u0117s\u201c, pradin\u012f tyrimo plan\u0105 sudaryti nesunku: reikalingas bendrasis kraujo tyrimas, ENG, bendrasis \u0161lapimo tyrimas ir juosmenin\u0117s stuburo dalies dviej\u0173 kryp\u010di\u0173 rentgenograma. Labai svarbu instrumentini\u0173 tyrim\u0173 radinius derinti su klinika. Stuburo kompiuterin\u0117 tomografija geriausiai atspindi kaulini\u0173 strukt\u016br\u0173 pakitimus (trauma), o magneto rezonansin\u0117 tomografija\u2013 nugaros smegen\u0173, \u0161akneli\u0173, tarpslankstelini\u0173 disk\u0173 ir kit\u0173 mink\u0161t\u0173j\u0173 audini\u0173 pa\u017eeidimus (tarpslankstelini\u0173 <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 8.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"page-break-before: always; margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">disk\u0173 i\u0161var\u017eos, spinalin\u0117 stenoz\u0117, navikai). <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa8\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Did\u017eiajai daliai ligoni\u0173, kuriems \u012ftariame paprast\u0105 mechanin\u012f juosmens skausm\u0105, prie\u0161 tai i\u0161vardyti tyrimai neduos jokios papildomos informacijos apie ligos prie\u017east\u012f ir nekeis gydymo taktikos. Tod\u0117l rekomenduojama \u0161iuos tyrimus atlikti ne pirm\u0105 kart\u0105 apsilankius, o po 4 savai\u010di\u0173, jei paskirtas gydymas bus neefektyvus. Manoma, kad anksti atlikti vizualiniai juosmenin\u0117s dalies tyrimai, nors ir nekei\u010dia diagnoz\u0117s ir gydymo, bet pagerina gydymo rezultatus, stebint ligonius po 8 m\u0117nesi\u0173.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa13\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa13\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Koks \u016bmini\u0173 juosmens skausm\u0173 gydymas yra neabejotinai veiksmingas?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Medikamentinis.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<ul>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Skiriama paprast\u0173j\u0173 analgetik\u0173 arba nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo, geriausiai geriam\u0173j\u0173 preparat\u0173. <\/span><\/span><\/li>\n<li><span class=\"A2\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Rekomenduojama vartoti tik vien\u0105 preparat\u0105 i\u0161 \u0161i\u0173 grupi\u0173. <\/span><\/span><\/span><span>\u016amiam skausmui mal\u0161inti pla\u010diausiai naudojama <strong>Dolmen<\/strong>, skirtiant po 1 tab. ar gran.paket\u0117l\u012f 3 kartus per dien\u0105.<\/span><span class=\"A2\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/span><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Veiksmingas NVNU yra diklofenakas (<b><a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a> retard<\/b>), kurio prailginto veikimo 100 mg kapsul\u0117s skiriamos kart\u0105 per dien\u0105 (ryte, jei skausmas vargina darbe, judant, arba vakare, jei vargina rytiniai skausmai), paprastosios tablet\u0117s po 50 mg (<b><a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a> 50 in tab.<\/b>) gali b\u016bti skiriamos ryte ir vakare, esant reikalui, i\u0161geriama papildoma tablet\u0117 dien\u0105. Greitesnis, bet trumpesnis yra intraraumenini\u0173 injekcini\u0173 form\u0173 poveikis. Jei ligonis jau yra vartoj\u0119s keli\u0173 r\u016b\u0161i\u0173 NVNU (diklofenako, ibuprofeno, indometacino ir kt.), jis gali pasakyti, kurie i\u0161 j\u0173 buvo veiksmingiausi. Jei yra vir\u0161kinamojo trakto pa\u017eeidimo rizika, skiriama selektyvi\u0173 cilooksigenaz\u0117s 2 inhibitori\u0173: nimesulido (<b><a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Nimesil\">Nimesil<\/a><\/b>), meloksikamo, lornoksikamo ar koksib\u0173.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u012erodytas ir papildomai su NVNU skiriam\u0173 miorelaksant\u0173 (tetrazepamo, tolperizono) efektyvumas. \u0160i\u0173 vaist\u0173 skyrim\u0105 riboja tik nepageidaujami rei\u0161kiniai \u2013 mieguistumas, svaigimas.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<li><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u0160akneliniam skausmui slopinti reik\u0117s adjuvant\u0173: antidepresant\u0173 (jei n\u0117ra kontraindikacij\u0173, efektyviausi yra tricikliai antideprasantai, pvz., amitriptilinas) ar vaist\u0173 nuo traukuli\u0173, i\u0161 kuri\u0173 ma\u017eiausiai nepageidaujam\u0173 rei\u0161kini\u0173 sukelia gabapentinas ir pregabalinas. Jei toks derinys po 2\u20134 savai\u010di\u0173 bus neveiksmingas, reikalinga epidurin\u0117 gliukokortikoid\u0173 injekcija.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/li>\n<\/ul>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Reikalinga ramyb\u0117, bet trumpalaik\u0117 \u2013 1 ar 2 dienas, ilgiau nei kelios dienos lovos re\u017eimas, skatina skausmo tapim\u0105 l\u0117tiniu. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa13\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa13\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Koki\u0173 \u016bmini\u0173 juosmens skausm\u0173 gydymo metod\u0173 efektyvumo \u012frodym\u0173 tr\u016bksta arba jie n\u0117ra veiksmingesni u\u017e medikamentin\u012f gydym\u0105? <\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u0160iluma ar \u0161altis juosmens srityje, trakcija, manualin\u0117 terapija, korsetai. Akupunkt\u016br\u0105, mank\u0161t\u0105, masa\u017e\u0105 (kurio tam tikros r\u016b\u0161ys, pvz., akupres\u016brinis, gali tur\u0117ti teigiam\u0105 efekt\u0105 iki vieneri\u0173 met\u0173) tinka skirti l\u0117tiniams, o ne \u016bminiams juosmens skausmams gydyti, derinant su medikamentiniu gydymu. <\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa2\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\">\u00a0<\/p>\n<p class=\"Pa2\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><b><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Kada reikalinga neurochirurgo konsultacija?<\/span><\/b><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p class=\"Pa6\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">\u012e<\/span><\/span><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">tarus cauda equina sindrom\u0105, progresuojant neurologinei simptomatikai. Skausmas visada gydomas adekva\u010diai konservatyviai bent 6 savaites, operacinis gydymas \u2013 paskutin\u0117 skausmo gydymo priemon\u0117.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n<p>\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p class=\"Pa2\" style=\"margin: 0cm 0cm 0pt; line-height: normal; text-align: justify;\"><span class=\"A2\"><span style=\"font-size: 9pt; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\">Straipsnyje apra\u0161omi \u016bminio ir l\u0117tinio juosmens skausmo skirtumai, nurodomos pagrindin\u0117s \u016bminio juosmens skausmo prie\u017eastys, b\u016bdinga nespecifinio mechaninio, \u0161aknelinio skausmo ir spinalin\u0117s stenoz\u0117s klinika. Aptariamas tyrim\u0173 planas, rekomenduojamas \u012frodymais pagr\u012fstas \u016bminio juosmens skausmo gydymas.<\/span><\/span><span style=\"font-size: 9pt; color: black; font-family: Arial; mso-bidi-font-size: 10.5pt; mso-ansi-language: LT;\"><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[834,7434,7525,1232,6658,234,137,7437,126,1235,7652,6100,727],"site":[],"post_item_type":[27345],"class_list":["post-13340","post","type-post","status-publish","format-standard","hentry","category-gydymo-naujienos","tag-dicloberl","tag-isvarza","tag-isvarzos","tag-itemptam","tag-kitaip","tag-klinika","tag-ligonis","tag-navikai","tag-saltis","tag-skauda","tag-skausmas","tag-trauma","tag-veiksmingas"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=13340"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/13340\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=13340"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=13340"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=13340"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=13340"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=13340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}