Medications for severe back pain

No matter how much we say that severe back pain should be diagnosed and treated by specialists, people are still not in a hurry to share their grief with a doctor. Without thinking much about what to do if their back hurts badly, they often prefer the knowledge of pharmacists to that of medical specialists. For many, the mere fact of severe pain is enough to rush to the pharmacy for painkillers.

What can pharmacy workers offer in connection with back pain? Since injection therapy works fastest and most effectively in case of pain syndrome, injections can be considered emergency medications for severe back pain, i.e. medications in the form of solutions, mainly from the NSAID category. The most frequently prescribed medications include Ketonal, Diclofenac, Meloxicam, Ibuprofen, Voltaren, etc.

"Ketonal" is an effective non-steroidal anti-inflammatory drug prescribed for severe pain in muscles and joints. Intramuscular injections of the drug act quite quickly - within 10-15 minutes, and with intravenous administration, pain relief occurs within the first 5 minutes. For unbearable pain, "Ketonal" can be combined with narcotic analgesics, and morphine is even allowed to be used in one injection with ketoprofen (the active substance of the drug "Ketonal").

Ketonal solution can be administered intramuscularly 1 to 3 times a day, 1 ampoule at a time, while the daily dose of ketoprofen should not exceed 200-300 mg. The total dose of the drug depends on the patient's age, his condition and the body's response to the treatment, but preference is given to the minimum effective doses and a short course of treatment.

In severe cases, the drug is prescribed for intravenous infusions. The course of treatment in this case is no more than 2 days. The infusions themselves require from half an hour to 1 hour. But the main thing is that they can only be carried out in a hospital setting, while intramuscular administration is quite possible in an outpatient or home setting.

In addition to the injection solution, the drug also comes in other forms (capsules, tablets, rectal suppositories), which can be used instead of injections or in combination with them, but without exceeding the maximum permissible doses.

Regular Ketonal capsules are taken according to the following scheme: 1 capsule 3-4 times a day during or after meals. Ketonal Duo and prolonged-release tablets with increased dosages should be taken 1-2 pieces a day at intervals of at least 12 hours. Both capsules and tablets should be washed down with plenty of liquid, including milk. Oral NSAIDs can have a negative effect on the gastric mucosa, so it is recommended to combine their use with antacids.

Rectal suppositories "Ketonal" are recommended to be used 1 or 2 times a day. As part of combination therapy, they can be combined with injections and tablets.

Contraindications to the drug include intolerance to any of the components of the drug and salicylic acid preparations. Due to the irritating effect of the drug on the stomach, it is not recommended for patients with gastric ulcer and duodenal ulcer, especially during an exacerbation of the disease. Other contraindications include chronic non-ulcer dyspepsia and gastrointestinal bleeding, including those in the patient's history, other types of bleeding, severe liver and kidney disease with developing organ failure, severe heart failure, bronchial asthma, allergic rhinitis, and a tendency to hemorrhage.

The drug is not used to treat children. It is prescribed to pregnant women only as a last resort during the first 6 months of pregnancy, after which its use is contraindicated. During breastfeeding, taking the drug is undesirable. In elderly people, the risk of developing side effects of the drug increases, so it is important to stick to low doses, as well as monitor the blood composition and the patient's condition.

If the patient is forced to take anticoagulants and antithrombotic agents due to an existing pathology, Ketonal is not prescribed to him, since such a combination of drugs increases the risk of bleeding. Simultaneous use of Ketonal and diuretics or drugs for the treatment of hypertension is undesirable, since this can reduce the effect of the latter.

Side effects of the drug are observed infrequently. They are usually associated with the negative impact of NSAIDs on the mucous membrane of the gastrointestinal tract: gastralgia, dyspeptic symptoms and other disorders in the digestive system, which are more typical for oral forms of the drug.

If you take the drug in large doses, there is a risk of developing all kinds of bleeding.

Patients with increased sensitivity to acetylsalicylic acid may experience bronchospasm, dyspnea, anaphylaxis and shock (rare). Patients often complain of headaches, increased fatigue, drowsiness, dizziness, impaired body sensitivity with the appearance of a crawling sensation. But on the other hand, reactions such as increased anxiety, sleep disturbances due to nightmares are also possible. There have also been complaints of visual impairment and tinnitus, skin rash and itching, and edema.

Taking the drug can cause various changes in the blood composition and provoke both bleeding and blood clots. It is believed that "Ketonal", as a representative of NSAIDs, increases the risk of thrombus formation and related pathologies (for example, myocardial infarction). In addition, laboratory indicators often indicate some malfunctions in the liver.

"Meloxicam" is a non-steroidal anti-inflammatory drug from the oxicam group, which effectively relieves inflammation and pain in spinal diseases. The drug is produced in the form of injections and tablets. The injection solution is intended strictly for intramuscular administration and can be used for treatment at home.

Usually, pain syndrome is treated with injections only in the first days of exacerbation (2-3 days), and then they switch to the tablet form. Injections are made 1 or 2 times a day, 7.5 mg of meloxicam. The daily dose of the drug, regardless of the form used, is 15 mg.

The daily dose for elderly patients and those with severe liver and kidney dysfunction is 7.5 mg of meloxicam.

The drug is not prescribed for exacerbation of gastric and duodenal ulcers, and caution is exercised during periods of remission of inflammatory diseases of the gastrointestinal tract. A general contraindication is hypersensitivity to the components of the drug, other NSAIDs, especially acetylsalicylic acid. If the patient's medical history includes cases of angioedema, urticaria and other manifestations of allergy or anaphylaxis after taking any NSAIDs, drugs in this category are not prescribed.

Other contraindications include: bleeding from the gastrointestinal tract and other organs of any etiology (the presence of such episodes in the patient's medical history is also an obstacle to taking or administering the drug), severe liver and kidney pathologies, as a result of which their functions are severely impaired, decompensated heart failure, bronchial asthma.

"Meloxicam" is not used to treat pregnant women and children under 15 years of age. Breastfeeding should be stopped during treatment with the drug.

Common side effects of the drug include headaches (sometimes with loss of consciousness), gastrointestinal disorders (dyspepsia, epigastric pain, nausea, bowel disorders), various allergic reactions, edema, and development of anemia. Less common are changes in blood composition, tinnitus and temporary deterioration of vision, nightmares and daytime sleepiness, increased blood pressure and pulse rate. Rarely, there were complaints about liver and kidney dysfunction (although the drug caused serious pathologies in isolated cases, if the patient already had disorders in the body).

If the use of NSAIDs is quite possible for the treatment of back and lower back pain at home, then the use of corticosteroids should include medical supervision of the patient's condition. Steroid drugs help to relieve even very severe pain, especially if they are administered together with painkillers (lidocaine, novocaine, etc.). However, the effect of such treatment will not be long-lasting, and hormonal drugs have more contraindications and side effects than NSAIDs.

In case of unbearable pain, when conventional analgesics and non-steroidal drugs do not help, there is no particular choice, so doctors prescribe corticoids: "Hydrocortisone" and "Betamethasone" (administered intravenously, intramuscularly, and also in the form of intra-articular and periarticular blockades, i.e. into the periarticular sac), "Prednisolone" (intravenous and deep intramuscular injection), "Diprospan" (administered only intramuscularly and relieves severe pain, but is not suitable for treating elderly people and can be addictive).

Treatment with injections of hormones and NSAIDs certainly gives good results, but with persistent tension and painful muscle spasms they will not give a good effect without the use of muscle relaxants, many of which can be administered by injection (Mydocalm, Miaksil, Norflex, Disipal, Tolperil, etc.).

"Mydocalm" is a muscle relaxant that is successfully used to treat pain caused by exacerbations of spinal diseases and muscle hypertonicity. Injection treatment is indicated only in case of severe back muscle spasm. In this case, the patient is allowed to make 2 intramuscular injections of 100 mg of tolperisone per day (1 ampoule of solution) or to administer the drug intravenously once a day as a slow infusion.

The drug is interesting because in addition to the muscle relaxant tolperisone hydrochloride, it contains the anesthetic lidocaine, which is what makes the drug so effective in combating back pain caused by overexertion and spasms of muscle fibers.

Injections are indicated only at the initial stage of treatment, after which you can switch to tablets with the same name, which, unlike injections, do not contain an anesthetic component and are allowed even in childhood. Tablets are taken after meals, which increases the bioavailability of the drug. Tablets must be washed down with a sufficient amount of water (at least 1 glass). The daily dose, depending on the patient's condition, can range from 150 to 450 mg of tolperizole. It is recommended to divide the daily dose into 3 doses.

The drug is not prescribed for hypersensitivity to its components, an autoimmune disease called myasthenia gravis with its characteristic weakness of skeletal muscles, during breastfeeding and in the first trimester of pregnancy. Children are allowed only the drug in the form of tablets in low dosages corresponding to the weight of the small patient.

In half of the cases of side effects of the drug, there were hypersensitivity reactions to the drug, which did not pose a threat to the life of patients and usually passed on their own. Another common side effect is skin hyperemia at the injection site. Rare side effects of the drug, occurring in less than 1% of patients, are anorexia, sleep disorders, headaches and dizziness, decreased blood pressure, abdominal discomfort, nausea and dyspeptic symptoms, weakness and pain in muscles and limbs, increased fatigue and general weakness. More serious reactions occur very rarely.

If we are talking about damage to nerve roots, then to relieve pain syndrome, not only nerve decompression measures are needed, but also the use of drugs that help restore damaged nerve fibers and stabilize the nervous system as a whole. Such drugs, used for intramuscular injection, include the drugs "Neurobion" and "Trigamma", similar in composition (vitamins B1, B6 and B12). But the effect of the second drug on pain is stronger, since it also includes the anesthetic lidocaine.

"Trigamma" is a drug with anti-inflammatory and local anesthetic action, which improves metabolism in nerve tissues. It can be used for a variety of diseases accompanied by neurological back pain.

To treat severe pain, the solution is injected deep into the muscle. The procedure is performed daily, slowly, using 2 ml of the drug each time. This treatment regimen is used for 5-10 days, after which injections can be done at intervals of 1-2 days or you can switch to taking pills.

The drug is not prescribed for the treatment of children and patients with increased sensitivity of the body to the components of the drug. Another contraindication is heart failure in the decompensation stage. It is not recommended to use the drug during pregnancy and breastfeeding.

The most common side effects of the drug are allergic reactions, although they occur infrequently and are mild (in the form of skin itching and rash). Less often, patients complain of increased sweating (hyperhidrosis), increased heart rate, and acne on the body.

Diagnosis and treatment of severe back pain at home are complicated not only by the patient's lack of knowledge about the causes of the pain syndrome, but also by the fact that not everyone is able to give themselves injections. In addition, not every patient has a relative or friend with the skills of a nurse. So it turns out that universal remedies for severe back pain are not injections, but tablets. Although they do not act so quickly, in combination with external agents they are quite capable of coping with the unpleasant symptom.

When studying the question of how to relieve back and lower back pain in case of intense pain syndrome, let's consider what strong painkillers there are that can help with back pain when taken orally. Effective drugs with a pronounced analgesic effect include:

• "Ketorolac" and "Ketanov" (active ingredient ketorolac),
• "Ketoprofen" and "Ketonal" (active ingredient kotoprofen),
• " Indomethacin " (NSAID with the same active ingredient and pronounced analgesic ability),
• "Nimesulide" and "Nise" (active ingredient nimesulide, helps even with severe acute pain within 20 minutes),
• "Meloxicam" and "Movalis" (active ingredient meloxicam),
• " Naproxen " (a drug with the active ingredient of the same name),
• "Voltaren" and "Ortofen" (active ingredient diclofenac),
• " Celebrex " (active ingredient celecoxib, effective for acute pain).

These drugs belong to the category of NSAIDs with a pronounced analgesic effect, which raises them to the level of hormonal drugs. Other popular non-steroidal anti-inflammatory drugs and analgesics (Ibuprofen, Citramon, Analgin, Tempalgin, etc.) are commonly used to combat mild to moderate pain.

To treat unbearable pain, patients may be prescribed narcotic analgesic tablets such as Morphine, Codeine, Promedol, etc. In this case, it is especially important to monitor the dosage of the drugs and not to use them for a long time to avoid opium addiction, which is much more difficult to treat than pain syndrome. But the main danger of such drugs lies in the suppression of respiratory function.

For example, "Morphine" is a drug that stimulates opioid receptors of the central nervous system and thereby provides an analgesic and sedative effect. It is this ability of the drug that is used to relieve severe pain that cannot be relieved by other drugs.

The dosage of the drug is set strictly individually and depends on the severity of the pain syndrome, but the frequency of taking the tablets is constant (the interval between taking the tablets is 4 hours, regardless of the dose). A narcotic analgesic for severe pain syndrome can be prescribed even to children from 3 years old, while children under 5 years old are prescribed a single dose of 5 mg, and children and adolescents under 12 years old - in a dose of no more than 10 mg per dose.

The daily dose of the drug for adult patients should not exceed 200 mg, while treatment with high doses requires constant monitoring of the patient's body functions.

The drug is not prescribed in case of hypersensitivity to its components, respiratory failure due to depression of the respiratory center in the brain, tendency to bronchospasms, acute abdomen, previous craniocerebral injuries, epilepsy. Other contraindications are paralytic intestinal obstruction and difficulty with bowel movements, severe liver disease, increased intracranial pressure, stroke, cachexia, severe alcohol intoxication.

But even for healthy people the drug poses a certain danger, because it can suppress the respiratory and cough reflex, weaken the peristalsis of the gastrointestinal tract and cause constipation, provoke hyperhidrosis, a drop in blood pressure, hot flashes, affect the production of hormones, disrupting the hormonal background. Taking the drug is often accompanied by headaches, confusion, drowsiness, involuntary muscle twitching, nausea, abdominal pain, loss of appetite and weight, general weakness.

Among the centrally acting muscle relaxants, the tablets "Mydocalm", "Sirdalud", "Baclofen" have proven themselves well, which can be used at home, but strictly adhering to the dosages recommended by the doctor, so as not to cause excessive muscle relaxation and disruption of the heart, which is also a muscular organ.

When it comes to severe pain, taking pills alone is often not enough. The source of pain must be addressed comprehensively, which means you should not ignore external remedies (ointments, gels, solutions, creams), which also help with severe back pain.

Most often, in connection with back pain syndrome, the following are mentioned:

• Diclofenac ointment (NSAID),
• Voltaren gel (NSAID),
• "Fastum-gel" (NSAID),
• "Finalgel" (NSAID),
• Ketonal ointment (NSAIDs),
• Nurofen gel (NSAID),
• solution for external use and ointment "Menovazin" (local anesthetic),
• gel "Dolobene" (a combination drug,
• Kapsicam and Bengey ointments (drugs with vasodilating and local irritating effects).

"Bengay" is a preparation for local use for muscle and joint pain. It has a warming effect, improves blood circulation in the affected tissues, reduces the severity of muscle spasm. Due to its local irritant and distracting effect, the cream temporarily relieves deep pain symptoms.

"Bengay" is a completely safe cream that can be used even by pregnant women and nursing mothers for severe back pain. However, they should do this with special caution, because the effect of the drug on a growing organism has not been studied. For the same reason, and also because the drug contains salicylates, which are considered toxic in high doses, the drug is not used to treat patients under 18 years of age. Although the toxicity of the drug and its negative impact on the nervous system is more relevant in cases of accidental ingestion of the ointment.

The preparation should be applied to the skin in the area of localization of pain and rubbed in well with active massage movements. The frequency of procedures for severe pain syndrome is 3-4 times a day. The course of treatment is individual, but manufacturers do not recommend using the ointment for a long time (more than 10 days).

The drug has few contraindications: increased sensitivity of the body to the components of the drug, hypersensitivity to salicylates, bronchial asthma. The cream should not be applied to damaged skin, where there are irritations, wounds, scratches.

Since the drug is applied locally, most often patients experience side effects such as allergic reactions and skin irritation at the site of application of the drug (redness, swelling, burning, itching, skin rash, etc.). More serious reactions and symptoms, including death, are possible only when the drug is taken orally, so it should be kept out of reach of children.

Despite the fact that drug therapy for intense back pain does not always require the patient to be hospitalized and can be successfully carried out at home, self-activity in choosing and using effective drugs can have rather sad consequences. Diagnosis and treatment of severe back pain should be the work of specialists, because intense pain syndrome always indicates serious disorders and injuries, and the drugs used for its treatment are not at all harmless, because even the use of vitamins should be strictly regulated.

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