Aduh Aduh Sakit Belakang

APA yang anda lakukan bila mengalami sakit belakang? Adakah cukup sekadar mengambil ubat penahan sakit, berurut, mendapatkan rawatan pakar atau mencuba rawatan alternatif?

Apa pun jawapannya, jangan ambil mudah kerana sakit belakang kronik juga boleh mengundang gangguan fungsi seksual terutama kepada kaum lelaki.

Pakar Reumatologi dan Sakit Kronik, Dr. Anwar Samhari Md. Arshad berkata, sakit belakang kronik yang berterusan boleh menjejaskan keupayaan seks lelaki secara langsung atau tidak.

“Ia berlaku apabila sakit belakang berada di tahap kedua dan ketiga di mana kesakitan dirasakan berterusan walaupun selepas pengambilan ubat penahan sakit.

“Kesakitan tersebut menekan atau menghimpit saraf sakrum menyebabkan ia menekan terus saraf pelvik lalu mengganggu keupayaan seksual termasuk mati pucuk,” kata pakar dari Pusat Perubatan KPJ Pulau Pinang itu.

Selain itu kata beliau, pesakit juga boleh mengalami gangguan fungsi seksual secara tidak langsung akibat pengambilan ubat terapeutik dan juga disebabkan kemurungan, stres dan gangguan psikologi.

Semua itu kata beliau berpunca daripada kesakitan biasa yang dipandang ringan oleh pesakit dan dibiarkan tanpa melakukan sebarang rawatan.

Apa itu sakit belakang?

Dr. Anwar berkata, rasa sakit di bahagian tengkuk, tulang belakang dan punggung yang berpanjangan lebih daripada enam minggu hingga tiga bulan boleh ditafsirkan sebagai sakit belakang kronik.

“Jika bercakap tentang sakit belakang, hampir semua orang mengalami sakit belakang. Tapi bila diambil paracetamol atau ubat tahan sakit dan berehat, lama kelamaan kesakitan itu akan hilang,” katanya.

Jelas beliau sakit belakang berpunca daripada kecederaan di bahagian otot, saraf, tulang, sendi atau struktur lain pada tulang belakang.

Kecederaan itu, katanya, disebabkan pekerjaan atau perbuatan berterusan hingga menjejaskan kesihatan tulang belakang. Biasanya ia berlaku kepada mereka yang melakukan sesuatu kerja untuk tempoh yang lama seperti pemandu lori, mengangkat bebanan berat dan juga tidak mempraktikkan kesihatan ergonomik dalam perbuatan seharian.

Rasa sakit itu kata Dr. Anwar, mungkin seperti dicucuk-cucuk, rasa sengal atau berdenyut, mungkin untuk tempoh yang panjang atau sekali sekala.

Ia juga mungkin dirasai pada satu tempat atau merebak dari satu kawasan ke kawasan yang lain.

Kata beliau lagi, jenis sakit belakang yang kerap menyerang lelaki berusia antara 30 hingga 40 tahun adalah sakit sendi dan slipped disc atau disc tergelincir.

“Bagi mereka yang berusia antara 40 hingga 50 pula kerap mengalami sakit sendi faset. Manakala bagi lelaki berusia 60 hingga 70 tahun pula biasa mengalami spinal stenosis,” katanya.

Simptom umum:

Menurut Dr. Anwar berkata, tanda-tanda utama sakit belakang adalah rasa sakit di bahagian pinggang yang menjalar ke punggung, paha dan seterusnya ke betis. Ada juga pesakit yang rasa sakit dan kebas mencucuk hingga bahagian betis, paha dan kaki.

Kaki pesakit juga katanya, berasa lemah. Pada peringkat permulaan ia lebih bersifat mekanikal di mana bagi individu yang melakukan kerja berat akan mengalami rasa sakit. Selepas mengambil paracetamol atau ubat penahan sakit dan berehat, sakit itu akan beransur hilang.

“Pada peringkat kedua, setiap hari pesakit akan merasa sakit. Walaupun berehat dan mengambil penahan sakit, kesakitan masih dirasai,” katanya.

Sakit itu berlanjutan hingga menekan saraf sakrum dan menjejaskan keupayaan seksual. Bukan setakat itu, ia juga menjejaskan fungsi pundi kencing menyebabkan pesakit gagal mengawal pembuangan air kencing dan juga besar.

“Jika keadaan ini berlaku pesakit memerlukan rawatan segera,” katanya.

Jenis-jenis sakit belakang:

1. Slipped disc – disc tergelincir adalah masalah kecederaan pada tulang lembut (disc) yang juga dikenali sebagai disc intervertebral. Dalam istilah perubatan ia disebut spinal disc herniated/ prolapsed. Disc intervertebral boleh diumpamakan sekeping tulang lembut di antara tulang vertebra. Ia terdiri daripada satu tisu yang kuat (annulus fibrosus) di mana di dalamnya terkandung sejenis bahan yang lembut (nucleus polposus). Jelasnya, kecederaan pada disc intervertebral menyebabkan kerosakan pada annulus fibrosus. Akibatnya, ia menjadi bengkak dan seringkali juga pecah pada disc intervertebral.

2. Ankilosing spondilytis – merupakan sejenis artritis yang menjejaskan tulang belakang. Simptom termasuk kesakitan daripada leher hingga ke bahagian tulang bawah. Sakit tulang belakang jenis ini menjejaskan hingga 0.1 hingga 0.5 peratus orang dewasa. Biasanya kerap berlaku di kalangan lelaki berusia antara 20 hingga 30an. Ia jarang berlaku di kalangan wanita dan jika ada sekali pun, tidak begitu serius.

3. Sakit sendi faset- Adalah masalah yang jarang berlaku dan ia boleh menjejaskan bahagian bawah serta leher. Boleh menyebabkan simptom serius dan mengundang kecacatan kekal kepada pesakit. Bagaimanapun, masalah sendi faset jarang melibatkan saraf tulang belakang.

4. Spinal stenosis – Keadaan dimana saluran spinal mengecil dan menekan saraf spinal. Ini biasanya melibatkan kemerosotan spinal disebabkan penuaan. Kadangkala ia juga berpunca daripada disc tergelincir, osteoporosis atau tumor. Spinal stenosis boleh melibatkan kawasan cervical (tengkuk), torasik atau lumbar spinal. Jika ia berlaku di kawasan lumbar boleh menyebabkan kesakitan di bahagian bawah juga rasa kelainan di bahagian kaki, paha, tapak kaki atau punggung. Kadang kala ia juga boleh menjejaskan kawalan pundi kencing dan usus.

5. Sindrom myofasial – Berlaku kesakitan kronik dan bagi sesetengah kes, sakit yang teramat sangat dirasai. Ia diikuti sakit pada bahagian tertentu yang menyucuk.

6. Sindrom kauda equana – Kesakitan di bahagian bawah termasuk punggung, paha dan kaki. Juga berlaku kesakitan kronik dan bagi sesetengah kes, sakit yang teramat sangat dirasa. Boleh melibatkan penekanan di bahagian kelamin, menjejaskan kawalan pundi kencing dan sistem usus.

Bagaimana diagnosis

Biasanya pesakit perlu melalui ujian MRI di bahagian lumbar, pelvik dan torak. Ada juga sesetengah pesakit yang tidak dapat didiagnos menggunakan MRI perlu menjalani suntikan diagnostik blok.

Ujian darah dan air kencing juga diperlukan untuk mengenalpasti sakit belakang kronik.

Tidak seperti sakit belakang akut (akibat kemalangan), sakit belakang kronik tidak memerlukan ujian imbasan sinar-X.

Kata Dr. Anwar, sebanyak 70 hingga 80 peratus mereka yang mengalami sakit belakang tidak memerlukan pembedahan major.

“Biasanya mereka memerlukan rawatan multimodel peringkat demi peringkat,” katanya.

Rawatan tanpa pembedahan jelasnya memerlukan kaunseling, fisioterapi, rehat otot corticosteroid dan pengambilan ubat tahan sakit neuropatik.

Selain itu pemakaian alat sokongan tulang belakang juga membantu. Sekiranya rawatan tidak berkesan, doktor akan mengesyorkan suntikan minimalis seperti radio-frekuensi dan prosedur neurolysis.

Salah satu rawatan yang termaju adalah spinal cord stimulation. Stimulasi ini dilakukan dengan memasang implan pada saraf tunjang.

“Rawatan termoden ini sudah boleh didapati di dalam negara malah saya sendiri melakukannya. Walau bagaimanapun, ia memerlukan kos yang tinggi,” katanya.

Rawatan ini kata beliau dilakukan sekiranya lain-lain rawatan yang diberi tidak berkesan. Jelasnya, prosedur implan tersebut memerlukan generator dipasang di bahagian bawah kulit seperti pemasangan peacemaker pada jantung.

“Pesakit akan diberi alat kawalan di mana jika mereka berasa sakit akan menekan alat tersebut dan kesakitan berkurangan,” kata beliau.

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