Analgesic and anti-inflammatory injections for back pain

Complaints about back pain can be heard from people of any age. Statistics show that every year about ¾ of the world's population seeks medical help with this problem. This symptom is typical for many diseases, and almost always requires drug treatment. Injections for back pain should be prescribed by a doctor after examination and determination of the cause of its occurrence. [ 1 ]

Indications for the procedure

Pain-relieving drug therapy is prescribed first. Its purpose is to alleviate the patient's condition and return him/her to the usual level of motor activity as soon as possible. In case of severe back pain, drugs of various groups are prescribed, based on the established diagnosis. If it is established that the cause of the pain syndrome is tissue damage that provoked the inflammatory process, the drugs of choice are non-steroidal anti-inflammatory drugs. In the initial stages of the disease process, preference is usually given to injection forms, later, when the pain weakens, they switch to taking tablets of the same name.

Injections of drugs of this group are prescribed for back and lower back pain of rheumatic, neurological, traumatic origin, for hepatic and renal colic, menstrual disorders. Non-steroidal anti-inflammatory drugs, in turn, can be divided into two groups by their action. Some drugs have a powerful anti-inflammatory effect and it is due to this that the pain syndrome is relieved when inflammation is reduced. These include Diclofenac, Indomethacin, Ketoprofen, Meloxicam, which are indicated specifically in cases of severe inflammation. Drugs of the second group are more effective in relieving pain and have an antipyretic effect, they are also called non-narcotic analgesics. In terms of anti-inflammatory activity, they are inferior to the drugs of the first group. Modern non-narcotic analgesics based on ketorolac - Ketorol, Ketanov, the long-known Analgin and its synonyms are used more often as painkillers.

For example, for radiculitis and back pain, bruises, sprains, dislocations, Diclofenac (Voltaren, Ortofen), Ketoprofen (Ketonal), Meloxicam (Movalis) are most often prescribed, which, in addition to the analgesic effect, have some therapeutic effect in this case - they relieve inflammation and swelling, improve blood circulation and metabolic processes in tissues.

In case of joint pain, rheumatism, arthritis, arthrosis, NSAIDs are indicated more as a pain reliever and to achieve some anti-inflammatory effect, however, they do not have a significant effect on the pathogenesis of such diseases.

A more pronounced therapeutic effect in degenerative changes in joints is provided by chondroprotective drugs, which contain regulators of cartilage tissue metabolism - Chondroitin sulfate (Artradol, Chondrolon) or Aflutop. The analgesic effect of these drugs is not so fast and is provided by their therapeutic effect: restoration of cartilage tissue, slowing down its destruction, increasing joint mobility. The drugs are indicated for back pain due to hernia, osteochondrosis, arthropathies.

Corticosteroid injections may be prescribed. They are indicated for back and joint pain of rheumatic origin. Synthetic hormones help to cope with severe inflammation and allergic reactions. The analgesic effect is associated with anti-inflammatory, anti-edematous and antihistamine effects. The pain is reduced by reducing the pressure on muscle tissue. Injections are indicated both locally - directly into the joint, and those that have a general effect (intramuscular). The effect of using synthetic hormonal drugs is usually powerful and long-lasting, but their side effects are also impressive.

Vitamin preparations are used for back pain. Vitamins of group B (B1, B6, B12) have a neuroprotective effect.

Acute back pain can be relieved with anesthetics, antispasmodics, homeopathic and herbal preparations. Indications for injection therapy are based on the patient's complaints, examination results, tolerance of certain groups of drugs and the presence of contraindications. [ 2 ]

What injections help with back pain?

There is no single magic remedy that would quickly relieve pain in all cases. Back pain is a symptom caused by various reasons. Therefore, it is possible to effectively and quickly help in cases where the cause of the pain has been established. Such treatment will not only eliminate the pain, but also prevent further development of the disease.

Non-steroidal anti-inflammatory drugs are most widely used for acute and chronic back pain, since in most cases they effectively eliminate pain, while simultaneously relieving the symptoms of the inflammatory process.

Medicines of this group have a central analgesic effect directly on the brain at the level of the thalamus, blocking the ascending transmission of pain impulses, as well as inhibiting the production of prostaglandins E2 and F2-α, thereby providing peripheral and visceral analgesic effects. The mechanism of inhibition of the synthesis of prostaglandins and leukotrienes is associated with the anti-inflammatory effect of non-narcotic analgesics, which, by strengthening lysosomal membranes, block the enzymatic activity of phospholipase A, interrupting cyclooxygenase and / or lipoxygenase reactions. The mechanical sensitivity of noniceptive fibers is reduced due to the anti-edematous effect of drugs.

If the prescribed drug of this class does not help, it is not advisable to change it to another or increase the dose. It is recommended to combine different forms with the same active substance for greater effectiveness, for example, injections and cream.

When choosing a drug in each specific case, the doctor is guided by the presence of risks associated with concomitant pathologies in the patient. With a high probability of developing hemorrhagic effects or dyspepsia, NSAID injections are prescribed in combination with proton pump inhibitors - Rabeprazole, Omez. In the presence of arterial hypertension - with drugs that reduce blood pressure. [ 3 ]

Newer drugs in this group are primarily aimed at inhibiting the second isoform of cyclooxygenase, which is formed only in the presence of inflammation (Meloxicam, coxibs). They are positioned by manufacturers as safer in terms of side effects, however, convincing evidence of this fact has not yet been found.

In combination with NSAIDs, and often as monotherapy, injections of B vitamins (B1, B6, B12) are prescribed, with the latter having the most pronounced analgesic activity. Vitamin therapy is considered effective in cases of acute pain. Complex drugs are most often used: Vitaxon, Neurobion. The analgesic effect is provided by the ability of vitamins to restore damaged nerve fibers, their myelin sheaths. This affects the metabolic processes in nerve fibers, ensuring the normalization of impulse transmission and muscle innervation. Complex vitamin drugs Milgamma, Combilipen contain lidocaine, which complements and accelerates the onset of pain relief. In cases of chronic recurrent pain, vitamin therapy is not advisable.

NSAIDs are also combined with glucocorticosteroids. The indication for such a combination is chronic pain in rheumatic diseases. The drugs are prescribed in high doses and are used for a long course. But such treatment, in addition to effectiveness, has many disadvantages. Side effects increase, in particular, from the digestive organs and the cardiovascular system. The drugs of choice among NSAIDs in this case are Diclofenac, Ketoprofen, whose analgesic activity even in medium doses is quite high (comparable to opioids), Ibuprofen, as the least toxic non-steroidal anti-inflammatory drug.

If severe back pain does not subside within a week, in the absence of infectious lesions of the spine (tuberculosis, syphilis, etc.), local injections of corticosteroids can be used.

In case of severe pain, a method of blockade with novocaine or lidocaine is also used - an injection into points located as close as possible to the nerve exits in order to “turn it off”.

Quite often, acute pain occurs with muscle spasms, in which case injections of antispasmodics, in particular, No-shpa, will be effective. Even more effective will be its combination with another analgesic, for example, Ketorolac. They mutually enhance each other's action and provide a long-lasting analgesic effect.

Less frequently mentioned is the analgesic activity of injections of plant biostimulants and homeopathic preparations. Such remedies, contrary to the popular opinion of many representatives of official medicine, are not a placebo and are quite effective in relieving pain, while providing a therapeutic effect. In addition, they do not have the ability to cause such impressive side effects as the most popular drugs for back pain - non-steroidal anti-inflammatory drugs. [ 4 ]

Names and list of injections for back pain

Relief of severe pain and return of mobility to the patient is a priority task in acute diseases and exacerbations of chronic diseases. Adequate pain relief is possible only with the prescription of a drug whose analgesic activity correlates with the intensity of pain. For a long time, the most effective drugs for coping with any pain were narcotic drugs - opiates and morphines. However, in addition to pain relief, they made the patient sleepy, passive, suppressed psychomotor functions and caused addiction.

The modern approach to treatment is to activate the patient even during periods of acute pain. Long-term bed rest has a negative impact on the effectiveness of treatment and contributes to the chronicity of pain, feasible physical activity contributes to the activation of blood circulation, faster restoration of damaged tissues, and reduces the risk of chronic pain and disability.

Currently, the main drugs used in the case of pain syndrome of various genesis are non-narcotic analgesics or non-steroidal anti-inflammatory drugs. Their list is very extensive - more than 25 names of active substances and even more trade names. These drugs quickly relieve pain syndrome without causing inhibition and returning mobility to the patient, which is more consistent with modern treatment tactics.

The most frequently prescribed drugs for back pain are traditional drugs (non-selectively blocking the enzymatic activity of cyclooxygenases): Diclofenac, Ketorolac, Ibuprofen, Ketoprofen, Indomethacin; as well as Meloxicam, which primarily blocks COX-2. Highly selective cyclooxygenase-2 blockers - coxibs (Celebrex, Vioxx) are prescribed less frequently, since their action has not yet been fully studied, the advertised safety has not been reliably confirmed, and the price of these drugs is much higher.

If systemic use of NSAIDs does not help, the doctor may prescribe novocaine/lidocaine blockades. This method of treatment should be practiced by a specialist who has mastered the technique of its implementation. Blockades are performed for back pain of various origins - inflammatory, traumatic, degenerative-dystrophic. The introduction of local anesthetics (Novocaine, Lidocaine) into the pain center relieves pain irritation, turning off peripheral innervation, and also helps improve tissue trophism. [ 5 ]

Injections of cortisone and other glucocorticosteroids, such as Diprospan, are also used to perform blockades. Blockades with hormonal drugs are justified in cases of severe inflammation and tissue swelling that compress nerve endings and thereby cause intense pain syndrome.

To relieve muscle and vascular spasms in case of prolonged acute pain syndrome, relaxing injections for back pain are prescribed, for example, injections of No-shpa, Mydocalm, and Troichatka.

Quite often lately, vitamin injections have been prescribed for back pain. Milgamma, Vitaxon, Neurobion and other complexes can really eliminate moderate back pain, and sometimes even cope with severe pain. However, it makes sense to prescribe them for acute inflammatory processes and neuropathies. In cases of chronic pain, specialists do not consider such treatment effective.

Homeopathic injection preparations Traumeel S and Ziel T are used both systemically and locally – injections are made into the joint and acupuncture points.

Among herbal remedies for back pain due to a herniated disc, aloe injections in combination with B vitamins (you can use Milgamma) can help.

Brief description of the most popular drugs

Modern medicine has a fairly large arsenal of non-narcotic analgesics. Non-steroidal anti-inflammatory drugs are in first place in terms of demand among them. When strong pain-relieving injections are needed for back pain, the drug of choice can be considered drugs with the active ingredient - ketorolac tromethamine. They are produced under various trade names: Ketorol, Ketanov, Ketorolac, Toradol, Relak, etc.

Ketorol and its synonyms cope with moderate and severe pain syndrome of various origins after surgical interventions and injuries, overexertion, with degenerative-dystrophic changes in tissues. They relieve muscle and neurological back pain, and are used for pain relief in oncology practice. The active ingredient affects the enzymatic activity of cyclooxygenases, like other NSAIDs, inhibiting the production of prostaglandins. Its systemic analgesic effect is several times greater than the anti-inflammatory and antipyretic effect, so ketorolac preparations are used mainly as painkillers, and the origin of pain does not matter. The analgesic effectiveness of this active substance exceeds all known drugs in its group and is comparable to centrally acting analgesics (narcotic). But Ketorol and its synonyms, unlike them, do not suppress psychomotor functions and the respiratory center of the brain, do not have a significant effect on the state of the heart muscle and do not cause serious hemodynamic disorders. It (like other NSAIDs) thins the blood, however, does not affect ATP-induced platelet aggregation, increasing bleeding, but not reducing the quantitative indicator of platelets and the prothrombin index.

The frequency of injections and dosages are prescribed by the doctor individually, taking into account the severity of symptoms. The minimum effective single dose (from 10 to 30 mg of the active ingredient of the drug - ketorolac tromethamine) is administered, observing a time interval of four to six hours between injections. If necessary, injections are given every two hours. The maximum amount that can be administered to an adult is 90 mg per day. Injections are given for no more than two days, then they switch to oral administration. The permissible duration of treatment with the drug is a week. Side effects are not often observed, but lethargy, drowsiness, dizziness, headache may appear, or, on the contrary, the patient becomes restless and irritable. Various digestive disorders, abdominal and muscle pain, dry mouth, hyperhidrosis and tachycardia may be observed.

Quite often there is a need to prescribe anti-inflammatory injections to a patient for back pain. In this case, preference is given to NSAIDs with a predominance of the ability to stop the inflammatory process. In diseases of rheumatic origin, they help restore lost mobility - relieve swelling of joints and soft tissues, which helps eliminate morning stiffness and reduce pain. In addition, they have a pronounced analgesic effect. Some are comparable in strength to anti-inflammatory.

Ketonal (ketoprofen) is second only to ketorolac in pain relief efficiency, however, its anti-inflammatory activity is significantly higher, so its use is more justified in inflammatory and degenerative diseases: arthritis of the spinal joints of various origins (rheumatoid, psoriatic, reactive), sciatica, lumbago, and others. Ketonal injections are administered intramuscularly one to three times a day. A single dose is one ampoule (100 mg). Suppositories or tablets can be used in parallel. Intravenous administration is only performed in a hospital setting. Adverse effects are rare and are consistent with those of other NSAIDs.

Diclofenac (synonyms: Voltaren, Diclac, Diclobene, Naklofen, Ortofen, etc.) has been deservedly popular for over half a century. Despite the emergence of many new non-steroidal anti-inflammatory drugs, a Diclofenac injection for back pain is a classic treatment option for patients without contraindications to this drug. Intramuscular administration of this drug to relieve inflammation and pain is widely practiced in surgery, orthopedics, rheumatology, neurology, gynecology, and oncology. Diclofenac injections help relieve pain from sports and household injuries - sprains, dislocations, fractures, bruises, relieve renal and hepatic colic, and often acute and intense pain is relieved with literally one injection, then the patient is transferred to taking other forms of the drug - tablets, suppositories, ointments. This drug is inferior to the two mentioned above in analgesic activity. Its ability to suppress inflammation mediators is also weaker than, for example, Indomethacin. However, the drug is well tolerated and relatively safe. Diclofenac causes ulcerogenic side effects less often than Ibuprofen and Naproxen, since it inhibits the enzymatic activity of COX-1 less strongly. It blocks the second isoform of the enzyme to a greater extent, but less strongly than coxibs, due to which it has lower cardiotoxicity. At the same time, its action is sufficient to achieve optimal anti-inflammatory and analgesic action in pain syndromes of various origins.

Injections of diclofenac sodium are prescribed to quickly achieve pain relief. As a rule, one intramuscular injection per day is enough, but sometimes two are prescribed - deep into different buttocks with an interval of several hours. Injection treatment continues for no more than two days. Then they switch to taking tablet forms, using suppositories and ointments. In non-injection forms, treatment can be long-term.

Meloxicam (Movalis, Amelotex, Melbek, Lem) is an NSAID that inhibits primarily the enzymatic activity of COX-2, which is formed only in inflamed organs, so it should have a less pronounced adverse effect on the digestive organs than non-selective NSAIDs, however, for heart patients it may be even more dangerous than they are.

This drug relieves pain and inflammation in the back well. Meloxicam has a more prolonged effect than traditional drugs, such as Diclofenac. It is almost completely bound to serum proteins in the blood, its concentration in the synovial fluid is also high - ½ of the plasma. Meloxicam injections are given only intramuscularly, once a day. Their effect is felt after a quarter of an hour and lasts quite a long time. Injection treatment is indicated in the first days, later they switch to other forms and in chronic arthritis, long-term treatment is possible in the lowest effective dose.

Xefocam (lornoxicam) is a drug related to the previous one. It is used as a symptomatic pain reliever, which also has a fairly high anti-inflammatory activity. It is not selective in relation to cyclooxygenase, it inhibits the enzymatic activity of both isoforms. It is used by injection after injuries and surgeries, to relieve attacks of lumbago, sciatica, radicular syndromes in osteochondrosis. Intramuscular injections are prescribed on an outpatient basis, and intravenous injections are prescribed in a hospital setting. First, 8 mg of the drug is injected deep into the muscle, and if necessary, the same amount can be injected additionally on the same day. This drug is intended for short-term use.

The above and other non-steroidal anti-inflammatory drugs must be prescribed by a doctor. Injections are used for a short time, often only once. The drug is selected based on several prerequisites: tolerance, age of the patient, the presence of chronic diseases that require combining injections for back pain with other medications.

The drugs in this group have many undesirable effects, and the risk of their occurrence is dose-dependent, so the doctor's recommendations regarding dosage should be strictly followed. Most often, this is a disruption of the digestive organs, and the ability of NSAIDs to thin the blood provokes the development of gastrointestinal bleeding, sometimes asymptomatic. Also, cardiovascular complications are characteristic of drugs in this group.

They are not prescribed to pregnant and lactating women, children under 12-15 years of age, patients with aspirin triad, peptic ulcer, bleeding tendency and with decompensated severe cardiovascular, liver and kidney pathologies.

The local anesthetic drugs Novocaine and Lidocaine also have predominantly analgesic and moderate anti-inflammatory activity. These injection solutions are used to perform blockades directly in places of pain in osteochondrosis, hernias and protrusions, spondyloarthritis and arthrosis. Blockades with anesthetics help to quickly eliminate symptoms, they can be repeated many times. Due to the local administration of the injection solution and the entry of only a small amount into the systemic bloodstream, the risk of undesirable effects is significantly reduced.

Novocaine injections are given directly into the periarticular tissues or channels through which nerves pass (local blockades).

Another method of performing blockades is segmental. In this case, injections of anesthetic are made into a specific perivertebral area of skin, muscle or bone tissue corresponding to the affected segment of the spine/spinal nerve/internal organs.

Most often, Novocaine is used for blockades for pain of various origins. It is a moderately active local anesthetic that blocks sodium channels, the occurrence and conduction of not only pain, but also other nerve impulses. When it enters the systemic bloodstream, it has a central anesthetic effect, preventing the synthesis of acetylcholine and blocking its release. The disadvantage of Novocaine is its short-term effect (about an hour). In order to prolong and enhance the effect, other anesthetics and solutions are added to the novocaine solution.

Lidocaine injections are most often prescribed for pain caused by degenerative-dystrophic processes in the spine. Lidocaine blockade relieves pain in two minutes. Its duration of action is approximately three hours.

Local anesthetics are not recommended for use in the treatment of pregnant and lactating women, patients with severe cardiac, hepatic and renal pathologies.

These drugs are generally well tolerated, but in some people they may cause an allergic reaction in the form of edema, itchy rash, hypotension, and difficulty breathing. Toxic effects of central action include dizziness and migraine-like pain, drowsiness, tachycardia, nausea, vomiting, involuntary emptying of the bladder or bowels, and blood picture disturbances.

In addition to medicinal effects, blockades may have traumatic side effects in the form of bruises, inflammation, necrosis, and local sensory impairment. [ 6 ], [ 7 ]

Steroid hormones have a pronounced anti-inflammatory effect. Due to this, an analgesic effect is achieved, and it is quite long-lasting - measured in weeks. Corticosteroid injections are done by inserting a needle between the vertebrae and outside the spinal cord membranes, that is, into the epidural area, joints connecting the vertebrae (facet), trigger zones - places in the ligaments or muscles that are sensitive to pain. This treatment is justified only in case of severe inflammation and tissue swelling, and is usually used to relieve significant pain caused by chronic collagenoses. Over the course of a year, even with good tolerance, the patient can eliminate the pain syndrome in this way no more than three times. These injections are also a symptomatic method, do not lead to regression of the disease and do not replace radical methods for eliminating the problem of compression pain. The first injections of corticosteroids help well, then their effectiveness begins to decrease from case to case.

Injections of steroid hormones are contraindicated for children, pregnant and lactating women, people with congenital vertebral pathologies, patients with spine surgery and infectious diseases. The patient's blood clotting process should not be impaired. Hormonal injections are not given to diabetics, people with decompensated severe cardiovascular pathologies, liver and kidney failure.

If corticosteroids are required, the doctor may prescribe injections of Cortisone or other medications of this class. Diprospan has the most powerful anti-inflammatory activity (the active ingredients are two betamethasone compounds: dipropionate and sodium phosphate). It is prescribed when other hormonal agents are ineffective. The dosage is individual.

Intra-articular and segmental injections should not cause pain. According to the instructions, the drug can be diluted with novocaine or lidocaine.

A new word in pain relief is a combined injection of a steroid hormone with ozone. For now, this treatment is being carried out at an experimental level. The injections were given to patients with vertebral hernias. The effect in most subjects was long-lasting – up to six months. Researchers suggest that ozone enhances the analgesic and anti-inflammatory effect of the hormonal injection.

Glucocorticosteroids can cause many unwanted complications, however, they are prescribed for short-term treatment of back pain, which allows such effects to be avoided in most cases.

To relieve back pain, intramuscular injections of a trinity are still used: analgin, diphenhydramine and papaverine, mixed in one syringe. Analgin is a long-known non-narcotic painkiller, NSAID, which was once widely used for any pain and could be found in any home medicine cabinet. Diphenhydramine is an antihistamine with a pronounced sedative effect. Papaverine is an antispasmodic. The complex of drugs has a fairly quick analgesic effect, relieves inflammation, muscle spasms and dilates blood vessels, providing a more active blood flow to the affected area. Diphenhydramine also stops excess histamine activity, which accompanies pain and inflammation, relieves agitation, helping the exhausted patient to relax and fall asleep.

However, modern NSAIDs are generally no less effective, and the troychatka contains such components as analgin and diphenhydramine, which are used less and less these days, since from the point of view of modern research these drugs are unsafe. And the duration of the troychatka is short-lived. Users periodically ask about 3 injections for back pain, apparently meaning an injection of the troychatka. There are three drugs, and one injection. And against the background of modern drugs, it is far from the most effective, and you can’t call it harmless. Analgin is prohibited in many countries of the world (USA, Germany, Sweden, etc.) due to serious complications caused by its active substance, in particular, agranulocytosis. Diphenhydramine is a prescription drug due to its pronounced sedation. Of course, one injection will probably not lead to a fatal change in the blood picture and will not make you a drug addict, however, the effect from it will be moderate, and the troychatka should not be used often.

No-shpa injections have a relaxing effect. This is also a well-known antispasmodic, especially effective in combination with NSAIDs and anesthetics. The effect of such a complex is longer. In addition, No-shpa relieves only the spastic part of the pain. Sometimes this is enough if the cause is a muscle spasm. If there is swelling and inflammation, then you cannot do without additional means.

No-shpa is considered a fairly safe remedy and rarely causes side effects, however, it is worth remembering that it dilates blood vessels, so hypotensive patients should be careful with this drug. People with severe diseases of internal organs too. Do not inject No-shpa to children and women carrying a child, as well as nursing mothers, without a doctor's prescription. It is also worth remembering the mutual enhancement of analgesic and antispasmodic effects when combining No-shpa with drugs that have such properties.

Sometimes a centrally acting muscle relaxant with an analgesic effect, Mydocalm, is prescribed – a complex drug containing the muscle relaxant tolperisone hydrochloride and the anesthetic lidocaine. The drug relieves back pain after injuries and surgeries, with muscle spasms and radicular syndromes. It is prescribed intramuscularly twice a day, one ampoule at a time. When used in combination with NSAIDs, a reduction in the dosage of the latter is usually required.

Vitamin injections for acute back pain can be a good alternative to the drugs described above. They have become quite common lately, since vitamin therapy is not fraught with such consequences as therapy with non-steroidal drugs and hormones. Vitamins of group B are known for their neurotropicity - they participate in metabolic processes, help strengthen the myelin sheaths of nerve fibers, maintain their integrity and, accordingly, restore impaired innervation of muscle tissue and normalize the transmission of nerve impulses.

Vitamins B1 (thiamine hydrochloride), B6 (pyridoxine hydrochloride), B12 (cyanocobalamin) are coenzymes that catalyze intermediate metabolic reactions in nerve fibers, thereby stabilizing the functioning of the central and peripheral nervous system.

Thiamine, breaking down in the body to di- and triphosphate, participates in carbohydrate absorption reactions. Its deficiency leads to the accumulation of under-oxidized carbohydrate metabolism metabolites in tissues, which disrupt the functions of nerve fibers. Vitamin B1 injections normalize carbohydrate metabolism, which has a beneficial effect on the synaptic transmission of neurotransmitters and the subsequent passage of nerve impulses to the periphery.

The products of phosphorylation of pyridoxine hydrochloride are coenzymes of almost all reactions of amino acid decarboxylation, which result in the formation of active neurotransmitters (adrenaline, dopamine, serotonin, histamine, etc.), transamination processes and the formation of hemoglobin.

Cyanocobalamin itself is an analgesic, a participant in the processes of hematopoiesis, a coenzyme for the formation of nucleic acids, choline. Its deficiency leads to demyelination of nerve fibers.

Clinical studies have proven the role of these vitamins in normalizing the functioning of the nervous system at all levels, reducing the manifestations of inflammation and decreasing the level of pain.

Vitamins in injections are prescribed by a doctor, as a rule, one vitamin is injected once a day in turn. For example, on the first day - an ampoule of B1, on the second - B6, on the third - B12. The injection of the same vitamin preparation is repeated two days later on the third. This scheme is followed because these vitamins are incompatible with each other. Thus, pyridoxine inhibits the transition of thiamine to the active form, and cyanocobalamin promotes the destruction of pyridoxine. Among all vitamins, thiamine most often causes allergic reactions, and in combination with cyanocobalamin, the risk of sensitization increases.

However, there are many complex preparations in ampoules, for example, Neurobion or Vitaxon, containing only vitamins B1, B6, B12. They are also effective for back pain, however, most specialists are inclined to use separate injection forms of vitamins.

Vitamin complexes are often enhanced by adding anesthetics, in particular, Lidocaine. Milgamma (Combilipen) contains the above-mentioned anesthetic in addition to three neurotropic vitamins. Injections of this solution are indicated for myalgia, pinched and inflamed nerve endings, and other disorders of nerve conduction in the musculoskeletal system of the body.

Vitamin injections are not prescribed to children, pregnant and lactating women, people sensitized to them, and patients with severe heart failure.

They can cause various allergic reactions. Failure to comply with the dosage or administration regimen prescribed by the doctor can lead to systemic reactions in the form of weakness, bradycardia, hypotension, and seizures.

Injections of homeopathic preparations Traumeel S and Ziel T can also be prescribed to relieve both acute back pain and the treatment of chronic diseases that manifest themselves as pain syndrome in this localization. The preparations should be prescribed by a doctor familiar with the specifics of the work of complex homeopathic preparations.

Traumeel C injections are indicated for back pain of inflammatory and traumatic genesis. The complex remedy has not only a quick pain-relieving effect, but also a therapeutic effect aimed at restoring damaged tissues by activating the body's own reserves. Each component of the drug is presented in a homeopathic dilution and provides it with a certain effect. Arnica montana, Aconite (Aconitum napellus) - an emergency remedy for pain in bones and soft tissues of various origins, wounds and injuries, strengthens arterial and venous vessels. Chamomile (Chamomilla recutita) - relieves acute pain, especially relevant for neuralgia. Yarrow (Achillea millefolium) has a relaxing effect, relieves the effects of falls from height, sprains, lifting heavy objects, bruises in the form of sharp piercing pain, Perennial Daisy (Bellis perennis) relieves pain associated with physical overexertion. Calendula officinalis accelerates healing, Echinacea activates the body's defenses, St. John's Wort (Hypericum perforatum) is used for lesions of the nervous system. Other plant components in combination with minerals - Soluble Mercury Hahnemann (Mercurius solubilis Hahnemanni) and Sulfur Liver (Hepar sulfuris) provide an effective action of the injection solution.

The drug is available in different forms, which are well combined with each other and provide a more powerful effect. Injections can be made in any known way: into the muscle, under the skin, intravenously, as well as segmentally and intra-articularly. For acute pain, the recommended dose is one ampoule per day. It has virtually no side effects, however, if you are allergic to plants of the Asteraceae family, it is advisable not to use the drug. Also, Traumeel injections should not be given to people with tuberculosis, leukemia, autoimmune diseases, HIV-infected people due to the presence of the plant immunomodulator Echinacea.

The question of prescribing to pregnant and lactating women, as well as to children under twelve years of age, is decided by the doctor individually.

In case of pain syndrome caused by degenerative changes in the joints and cartilage of the spine, in particular, spondyloarthrosis, osteochondrosis, arthritis, myalgia and neuralgia, injections of the drug Ziel T may be prescribed. This complex homeopathic remedy has an analgesic and chondroprotective effect, helping to relieve inflammation and restore joint tissue. The drug normalizes metabolism and oxidation-reduction processes, improves tissue respiration and blood supply. Other forms of the drug - the ointment of the same name and sublingual tablets - can enhance the effect of the injection form.

Bioactive chondroprotector Aflutop stops destructive processes in the intercellular matrix of articular cartilage and activates the process of its restoration. The active ingredient of the injection solution is a concentrate of small sea fish, which includes chondroitin sulfate, amino acids, glycerophospholipids, proteoglycans, mineral components: iron, potassium, calcium, magnesium, manganese, copper, sodium, zinc; sugars, myoinotosole, etc. Injections are made for 20 days, one ampoule per day. The pain goes away due to the therapeutic effect, it is possible to supplement it if necessary, especially at the beginning of the course of treatment, with local anesthetic drugs.

May cause sensitization reactions in the form of skin rashes and myalgia in the first days of use. Caution is required when treating patients with autoimmune diseases. Not recommended for children and pregnant women because the effect on this contingent has not been studied.

Aloe injections can also help with back pain. The effect is achieved due to the fact that this plant is a natural biostimulant and adaptogen. Its use activates metabolic processes in tissue cells, improves tissue blood supply and promotes the restoration of damaged areas, increasing the body's own defenses and resistance to damaging factors. There is evidence that aloe injections can help with pain caused not only by inflammatory processes, but also by spinal degeneration. Aloe injections were used in combination with an injection course of vitamins B1, B6, B12 and Aflutop injections. Such a course of treatment should be prescribed by a doctor familiar with the action of drugs.

Of course, the side effects from the use of biostimulants and homeopathic preparations, as well as vitamins, cannot be compared with the effects of NSAIDs and corticosteroids.

However, according to statistics on medical prescriptions and sales, the best and most effective injections for back pain are non-steroidal anti-inflammatory drugs. More than 80% of practicing doctors prescribe them when treating this problem. These drugs, despite the side effects, are considered the gold standard for eliminating pain. However, not all specialists prefer the injection form of NSAIDs, although there is an opinion that injections are more effective than tablets and cause less damage to the gastrointestinal tract. In fact, the systemic use of tablet forms and suppositories is as effective as injections. Side effects on the digestive tract are due to the general effect on the body, and not the presence of a tablet in the stomach. But traumatic complications from injections can be much more serious. Therefore, many specialists are inclined to prescribe non-injectable forms of drugs.

A blockade for back pain is considered an effective method of pain relief. It has a lesser effect on the general condition of the body, since the drug is applied locally. However, this manipulation should be performed in medical institutions, not at home. Only a qualified specialist can perform the blockade procedure fully and with the least undesirable consequences for the patient.

The choice of a remedy for back pain should be left to the doctor, informing him not only about where it hurts and how, but also about the tolerance of medications, chronic diseases, the need for simultaneous use of other medications and discussing with him your medication preferences.