It is a process that can affect any part of the body and for very different causes, but the basic events are always the same.
Inflammation, also known as “phlogosis”, is a phenomenon that can affect any organ or tissue of the body and that can arise for very different causes, but the events that trigger and sustain it are always the same.
Arthritis, gastritis , myositis, bursitis, stomatitis , conjunctivitis , colitis, pharyngitis , tendonitis, gingivitis, appendicitis , otitis , cystitis , neuritis and many more… The names are many, practically one for each part of the body, but the meaning , all enclosed in that small and disturbing suffix “itis”, is only one: inflammation.
That is, burning, redness, swelling and, above all, pain. Symptoms experienced by everyone, since childhood, for the most varied reasons, acute or chronic, which tend to change with age. Let’s see the main ones.
The causes point by point
Inflammations of the musculoskeletal system can occur due to:
- trauma due to a blow or a fall
- damage to a muscle or joint caused by excessive or prolonged use,
- an incorrect posture maintained for a long time (especially in the case of the spine and neck, in the cervical area)
- a sudden movement
- a local chronic inflammatory disease (such as knee bursitis or plantar fasciitis, which affects the sole of the foot) or generalized ( rheumatoid arthritis , gout , etc.).
Inflammations affecting the muscles of the lower or upper limbs, back or neck, in addition to purely inflammatory symptoms, are often accompanied by more or less accentuated contracture or by weakness and difficulty in movement.
On the other hand, skin and mucous membranes can become inflamed as a reaction to an external wound or internal lesion (such as a mouth ulcer or a stomach ulcer ) or the inflammation can develop as a result of sensitization or irritation caused by specific substances, external, but also internal (as occurs in the irritation of the stomach and esophagus when one suffers from gastric acidity ).
Further inflammatory phenomena then derive from the aggression of the tissues by external pathogens such as bacteria and viruses: this is what happens, for example, to the mucous membranes of the nose, throat, bronchi, ear and bladder in case of colds , flu , pharyngitis, tonsillitis , laryngitis, bronchitis , otitis, cystitis , etc.
Particularly painful and often difficult to cure inflammations concern the nerves. In these cases, in addition to fortunately rare direct damage, they can be caused by:
- occasional excessive stimulation (this is the case of trigeminal neuralgia triggered by intense cold or tooth sensitivity)
- chronic alterations of the tissues surrounding the nerve and which tend to modify its functionality and promote its degeneration (as occurs in diabetic neuropathy)
- potentially harmful improper stresses (such as those due to bony prominences that can form in the vertebral canal in the presence of severe cervical arthrosis and compress the spinal cord).
In addition to severe pain, inflammations of the nerves are often accompanied by numbness, changes in sensitivity to heat, cold and touch, paraesthesia (tingling sensation, pins and needles, itching, etc.), muscle weakness and functional limitation, as typically occurs in the case of irradiation to the arm of the symptomatology of acute attacks of cervical arthrosis.
In addition to the localized ones, there are also inflammations extending to the whole organism (called systemic), which can be induced by the immune reaction prompted by an infection (such as, for example, influenza and hepatitis), by a allergy or from an autoimmune reaction, i.e. directed against components of our own organism, linked to very specific pathologies (such as rheumatoid arthritis, psoriasis , systemic lupus erythematosus and so on).
Lumbago and sciatica
Localized inflammations of the nervous system, common especially among adults and the elderly and a source of considerable suffering, are those involving the roots of the spinal nerves, mainly due to osteoarthritis of the vertebral column or compression determined by a herniated disc (consisting of lateral protrusion of an intervertebral disc).
In addition to the more generic low back pain (which can also have different causes, such as the contracture of the paravertebral muscles), among the best known painful conditions affecting the spinal nerves there is the so-called sciatica or sciatica, deriving from inflammation of the sciatic nerve ( called also ischial nerve), which originates from the lower spine (sacral plexus) and runs under the gluteal piriformis muscle and along the hamstrings, from the thigh to the calf and feet.
Sciatica is almost always unilateral (in the sense that it affects only one buttock and one leg at a time) and can be so painful that it prevents you from sitting or walking for a few days; not infrequently, it is accompanied by numbness and, sometimes, by contraction or weakness of the back muscles of the leg.
A symptomatology similar to that of sciatica can be determined by:
- piriformis syndrome, a rare condition in which the piriformis muscle, which connects the sacrum to the femur, “leans” on the sciatic nerve during specific movements of the pelvis and leg and causes it to become inflamed
- spondylolisthesis, a change in the spine corresponding to the forward displacement of one vertebra relative to the one below it
- compression of the spinal nerves, resulting from the encumbrance of the fetus and the transient alteration of the lumbar curvature of the spine associated with pregnancy or the presence of excess weight, especially if concentrated in the abdomen.
The basic mechanism is the same
Although there are many events that can trigger an inflammatory reaction, there is only one key mechanism: the activation of two specific enzymes called cyclooxygenases (Cox 1 and 2), present practically everywhere in the body, and the consequent release of prostaglandins.
Prostaglandins are substances characterized by a marked pro-inflammatory action, i.e. capable of promoting inflammation and the onset of characteristic symptoms.
In the case of localized inflammation, one of the first observable phenomena is the increase in blood circulation in the affected area, made possible by the vasodilation and the greater permeability of the small vessels which nourish the tissues and simultaneously carry away the waste products. For this reason, in a few moments, the inflamed area appears warmer, swollen and red.
Prostaglandins also have an irritating action on the nerve endings of sensitivity and pain, causing more or less intense discomfort depending on the case and worsening the pain caused by any mechanical or thermal stress (in burns) of the nerve endings themselves.
Inflammatory pain is typically sharp and burning (burning), but its characteristics can change depending on the site affected by the inflammation. The following table shows some examples.
Site of inflammation | Pain characteristics |
---|---|
Muscles or joints | Dull and constant at rest, but can inevitably become acute with movement , often preventing the affected part from being used for one or more days |
mucous membranes | Constant discomfort that worsens with contact or with the use of the inflamed part (typical of pharyngitis, gastritis, etc.) or presents an oscillating “colicky” pattern with alternating “pangs” and moments of relative respite (this is the case of colic, indeed, of any kind) |
Sometimes it can be valuable
Although annoying, inflammation is useful in many cases: it warns us that somewhere in our body there is something wrong or that a trauma has caused non-trivial damage that needs to be remedied.
Furthermore, inflammation induces us to be cautious, not to further stress the painful area and to rest, placing us in the ideal conditions to promote healing, spontaneous or supported by specific therapies.
Other times, however, the inflammatory reaction is completely useless or even harmful. It happens, for example, when it arises in an “unmotivated” way, for example due to an allergic disease (such as allergic dermatitis or oculorhinitis) or an autoimmune disease (such as rheumatoid arthritis or multiple sclerosis ) .
Whatever the reason that causes it, inflammation can and must be, at least in part, cured: first of all, in order not to suffer too much, but also to prevent its persistence from causing secondary damage to the tissues.
To do this, a large group of anti-inflammatory drugs can be used, capable of counteracting the production of prostaglandins through the direct inhibition of cyclo-oxygenases.
Symptoms must be treated
There are many types of anti-inflammatory drugs on the market, including self-medication (OTC), available in various formulations, to be chosen according to the type of inflammation in progress (local or systemic), the intensity of the symptoms, the possible presence of wounds and of the acute or chronic origin of the disorder.
The main useful remedies are represented by non-steroidal anti-inflammatory drugs ( NSAIDs ) available both for systemic use (tablets, sachets) and as preparations to be applied locally (creams, gels).
Oral NSAIDs are preferred for relieving very intense pain or when the inflammation affects a large area or is widespread in most or all of the body (for example, in arthritis).
Creams, ointments, gels, plasters and sprays are more suitable in case of joint or muscle inflammation associated with limited trauma (provided, however, that there are no abrasions or skin wounds, on which they must never be applied). Eye drops and nasal sprays help in case of eye inflammation and severe colds, while NSAID-based tablets to dissolve in the mouth are very effective against sore throats.
If you opt for oral NSAIDs, it is best to always take them on a full stomach (after lunch, dinner or breakfast ), to limit damage to the stomach lining and possibly combine them, if indicated by your doctor, with a gastroprotective drug.
In case of inflammation of the muscles that support the spine or neck, if contracture is present in addition to pain, it may be useful to combine NSAIDs with muscle relaxants, which must however be indicated by the doctor after checking the situation and absence of contraindications (especially in the elderly).
As an alternative to muscle relaxant drugs, in the post-acute phase of musculoskeletal inflammation, massage (performed by an expert professional) and the application of hot compresses or self-heating plasters (available in pharmacy), to be left in place for a few hours.
If you tend to periodically suffer from musculoskeletal inflammation and contractures, to reduce the risk of recurrences it is important to learn how to assume correct posture while sitting and sleeping, maintaining normal body weight, regularly practicing moderate physical activity and following cycles of physiotherapy.
If the inflammation does not pass or often returns
When an inflammation of the spine or another part of the musculoskeletal system is not relieved by 4-5 days of treatment with a topical or systemic NSAID or tends to recur often, spontaneously or following a particular physical activity, you should consult your doctor for further information.
Generally, in addition to the thorough visit and the possible referral to the orthopedist for a specialist evaluation, the first recommended examination is the X-ray to evaluate the state of the vertebrae or other joints involved and detect any osteoarthritis or other bone alterations (e.g. bumps, bone erosions or deformities, spondylolisthesis, abnormal curvature of the spine, etc.).
If the present symptoms lead to suspect the presence of a nerve or spinal cord suffering, other in-depth investigations may be required, such as the evoked potential test (to see how the nerve involved reacts to predefined stimulations) or the resonance magnetic.
Magnetic resonance imaging is especially necessary to examine in detail the relationship between the vertebral surfaces and the spinal cord or between an intervertebral disc and the roots of the nerves that come out of the sides of the spine, especially with a view to planning surgery (if the situation is such that it cannot be compensated with drugs and/or physiotherapy).
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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