No matter how much we say that the diagnosis and treatment of severe back pain should be carried out by specialists, people still do not hurry to share their grief with the doctor. Strongly without thinking about what to do, if your back hurts badly, they often prefer the knowledge of pharmacists than medical specialists. For many, the mere fact of the presence of a strong pain syndrome is enough to get a pharmacy for painkillers.
So what about the back pain workers in pharmacies can offer? Since injection therapy is the fastest and most effective way for pain syndrome, first aid in case of severe back pain can be considered injections, i.e. Drugs in the form of solutions mainly from the category of NSAIDs. The most frequently prescribed drugs 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, anesthesia occurs within the first 5 minutes. For unbearable pains, “Ketonal” can be combined with narcotic analgesics, and morphine can even be used in the same injection with ketoprofen (the active substance of the “Ketonal” preparation).
Solution "Ketonal" intramuscularly, you can enter from 1 to 3 times a day in 1 ampoule, 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 minimally effective doses and a short course of treatment.
In severe cases, the drug is prescribed for intravenous infusion. The course of treatment in this case is not more than 2 days. Themselves infusions require from half an hour to 1 hour of time. But most importantly, they can be carried out only in a hospital, while intramuscular administration is quite possible in outpatient or at home.
In addition to the injection solution, the drug has other forms of release (capsules, tablets, rectal suppositories), which can be used instead of injections or in conjunction with them, but without exceeding the maximum allowable norms.
Conventional capsules "Ketonal" take the scheme: 1 capsule 3-4 times a day during or after meals. "Ketonal Duo" and retard tablets with prolonged action and overestimated dosages should be taken 1-2 pieces per day with an interval of at least 12 hours. Both capsules and tablets should be washed down with plenty of liquid, including milk. Peroral drugs from the category of NSAIDs can have a negative effect on the gastric mucosa, so their reception is recommended to be combined with the reception of antacids.
Rectal suppository "Ketonal" is recommended to use 1 or 2 times a day. In combination therapy they can be combined with injections and tablets.
Contraindications to the drug are considered 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 and duodenal ulcers, especially during the exacerbation of the disease. Other contraindications are chronic non-ulcer dyspepsia and bleeding from the gastrointestinal tract, including those in the patient's history, other types of bleeding, severe liver and kidney diseases with developing organ failure, severe heart failure, bronchial asthma, allergic rhinitis, and a tendency to hemorrhage (hemorrhage).
The drug is not used to treat children. Pregnant women are prescribed it only as a last resort during the first 6 months of pregnancy, then its reception is contraindicated. During breastfeeding, taking the drug is undesirable. In older people, the risk of side effects of the drug increases, so it is important to stick to low doses, as well as monitor the blood and the patient’s condition.
If the patient is forced to take anticoagulants and antithrombotic agents in connection with the existing pathology, “Ketonal” is not prescribed to him, because this combination of drugs increases the risk of bleeding. Simultaneous use of Ketonal and diuretics or agents for the treatment of hypertension is undesirable, as this may reduce the effect of the latter.
Side effects of the drug are observed infrequently. Usually they are associated with the negative effect of NSAIDs on the mucosa of the gastrointestinal tract: gastralgia, dyspeptic symptoms and other disorders in the digestive system, which are more characteristic of peroral forms of the drug.
If you take the drug in high doses there is a risk of all kinds of bleeding.
Patients with hypersensitivity to acetylsalicylic acid may cause bronchospasm, shortness of breath, anaphylaxis and shock (rarely). Often patients complain of headaches, fatigue, drowsiness, dizziness, impaired sensitivity of the body with the appearance of crawling. But on the other hand, such reactions as increased anxiety, sleep disturbances due to bad dreams are possible. There were also complaints of visual impairment and the appearance of tinnitus, the appearance of skin rash and itching, edematous syndrome.
The drug can cause various changes in the composition of the blood and causing both bleeding and blood clots. It is believed that "Ketonal", as a representative of NSAIDs, increases the risk of blood clots and related pathologies (for example, myocardial infarction). In addition, laboratory indicators often indicate some malfunction of the liver.
“Meloxicam” is a nonsteroidal anti-inflammatory agent from the group of oxycams, which effectively relieves inflammation and pain in diseases of the spine. The drug is made in the form of injections and tablets. The injection solution is designed strictly for intramuscular injection and can be used for treatment at home.
Usually pain injections are treated only in the first days of exacerbation (2-3 days), and then transferred to the tablet form. Injections are made 1 or 2 times a day with 7.5 mg of meloxicam. The daily dose of the drug, regardless of the form of release used, is 15 mg.
The daily dose for elderly patients and those who have serious disorders of the liver and kidneys is 7.5 mg of meloxicam.
The drug is not prescribed for exacerbation of gastric and duodenal ulcers, and during periods of remission of inflammatory diseases of the gastrointestinal tract, caution is exercised. A general contraindication is hypersensitivity to the components of the drug, other NSAIDs, especially to acetylsalicylic acid. If the patient has a history of angioedema, urticaria and other manifestations of allergy or anaphylaxis after taking any NSAIDs, no drugs of this category are indicated.
Among other contraindications it is worth noting: bleeding from the gastrointestinal tract and other organs of any etiology (the presence of such episodes in the patient’s history is also an obstacle to taking or administering the drug), severe liver and kidney pathologies, due to 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 for the period of drug treatment should stop.
Frequent side effects of the drug are: headaches (sometimes with loss of consciousness), disorders of the gastrointestinal tract (dyspepsia, epigastric pain, nausea, stool disorders), various allergic reactions, edema, the development of anemia. Less common are changes in blood composition, the appearance of tinnitus and temporary visual impairment, nightmares and daytime sleepiness, an increase in blood pressure and pulse rate. Rarely, there were complaints of violations of the liver and kidneys (although the drug caused serious pathologies in isolated cases if the patient already had abnormalities in the body).
If the use of NSAIDs is quite possible for the treatment of back pain and lower back pain at home, then the use of corticosteroids should include medical monitoring of the patient's condition. Steroid drugs help to stop even a very strong pain syndrome, especially if they are administered together with anesthetics (lidocaine, novocaine, etc.). However, the effect of such treatment will not be durable, and hormonal agents have more contraindications and side effects than NSAIDs.
With unbearable pain, when conventional analgesics and nonsteroidal drugs do not help, there is not much choice, so doctors prescribe corticoids: “Hydrocortisone” and “Betamethasone” (administered intravenously, intramuscularly, and also in the form of blockades intra-articular and periarticular, i.e. Bag), Prednisolone (intravenous and deep intramuscular administration), Diprospan (injected only intramuscularly and relieve severe pain, but not suitable for the treatment of older people and can be addictive).
Treatment with injections of hormones and NSAIDs undoubtedly 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 injected (Mydocalm, Myaxil, Norflex, “Disipal”, “Tolperil”, etc.).
"Mydocalm" is a muscle relaxant that is successfully used to treat pain caused by exacerbations of diseases of the spine and muscle hypertonia. Injection treatment is indicated only with a strong spasm of the back muscles. In this case, the patient is allowed to make 2 intramuscular injections of 100 mg of tolperisone (1 ampoule of solution) per day or to administer the drug intravenously once a day in the form of a slow infusion.
The drug is interesting because in addition to the muscle relaxant tolperisone hydrochloride it contains lidocaine anesthetic, which accounts for the high efficacy of the drug in fighting back pain as a result of overstressing and cramping of muscle fibers.
Injections are shown only at the initial stage of treatment, after which it is possible to 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 definitely need to drink plenty of water (at least 1 cup). The daily dose, depending on the patient's condition, can vary from 150 to 450 mg of tolperisol. The daily dose is recommended to be divided into 3 doses.
The drug is not prescribed for hypersensitivity to its components, an autoimmune disease called "myasthenia gravis" with its characteristic weakness of the skeletal muscles, during breastfeeding and in the 1st trimester of pregnancy. Babies are allowed only the drug in the form of tablets in low dosages, corresponding to the weight of a small patient.
In half the cases of side effects of the drug, it was about drug hypersensitivity reactions that did not cause a danger to the lives of patients and usually took place on their own. Another frequent side effect is skin hyperemia at the injection site. Rare side effects of the drug in less than 1% of patients are anorexia, sleep disturbances, headaches and dizziness, lowering blood pressure, abdominal discomfort, nausea and dyspeptic symptoms, weakness and pain in muscles and limbs, fatigue and general weakness. More serious reactions occur very rarely.
If we are talking about damage to the nerve roots, then to relieve pain, we need not only nerve decompression measures, but also the use of drugs that help restore damaged nerve fibers and stabilize the overall nervous system. Such drugs used for intramuscular administration include the “Neurobion” and “Trigamma” preparations, which are similar in composition (vitamins B1, B6 and B12). But the effect of the second drug on pain is stronger because it also includes lidocaine anesthetic.
"Trigamma" is a drug with anti-inflammatory and local anesthetic action, which improves the metabolism in the nerve tissues. It can be used for a variety of diseases involving neurological back pain.
For the treatment of severe pain, the solution is injected deep into the muscle. The procedure is carried out daily, slowly, using each time 2 ml of the drug. This treatment regimen is applied for 5-10 days, after which the injection can be done at intervals of 1-2 days or go to the pill.
The drug is not prescribed for the treatment of children and patients with hypersensitivity to the components of the drug. Another contraindication is heart failure in the stage of decompensation. It is not recommended to use the drug during pregnancy, as well as during breastfeeding.
The most frequent side effects of the drug are allergic reactions, although they occur infrequently, flowing in a mild form (in the form of pruritus and rash). Less often, patients complain of increased sweating (hyperhidrosis), rapid heart rate, and the appearance of acne on the body.
Diagnosis and treatment of severe back pain at home are hampered not only by the lack of patient knowledge about the causes of pain, but also by the fact that not everyone is able to give themselves injections. In addition, not every patient has a relative next to him or is familiar with the skills of a nurse. So it turns out that the universal remedies for severe back pain are not injections, but pills. Let them not act so quickly, in combination with external agents, they are quite capable of coping with an unpleasant symptom.
Studying the question of how to numb the back and lower back in case of intense pain syndrome, consider what strong painkillers are, which are able to help with back pain during peroral administration. The effective drugs with a pronounced analgesic effect include:
- "Ketorolac" and "Ketanov" (active ingredient Ketorolac),
- "Ketoprofen" and "Ketonal" (active ingredient Cotoprophen),
- " Indomethacin " (NSAIDs with the same active substance and pronounced analgesic ability),
- "Nimesulide" and "Nise" (active ingredient nimesulide, help even with severe acute pain for 20 minutes)
- "Meloxicam" and "Movalis" (active ingredient meloxicam),
- " Naproxen " (drug with the same active ingredient),
- "Voltaren" and "Ortofen" (active ingredient diclofenac),
- " Celebrex " (active ingredient celecoxib, effective in 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 nonsteroidal anti-inflammatory drugs and analgesics ("Ibuprofen", "Citramon", "Analgin", "Tempalgin", etc.) are commonly used to combat mild and moderate pain.
For the treatment of unbearable pain, patients may be prescribed narcotic analgesics tablets "Morphine", "Codeine", "Promedol", etc. In this case, it is especially important to monitor the dosage of drugs and not use them for a long time to avoid opiate dependence, which is much more difficult to treat than pain syndrome. But the main danger of such drugs lies in the depression of respiratory function.
For example, Morphine is a drug that excites the opioid receptors of the central nervous system and thereby provides an analgesic and sedative effect. It is this ability of the medicine that is used to relieve severe pain that cannot be relieved by other drugs.
The dosage of the drug is set individually and depends on the severity of pain, but the number of pills is constant (the interval between taking the pills is 4 hours, regardless of dose). A narcotic analgesic with the strongest pain syndrome can be prescribed even for children from 3 years old, while for children under 5 years old it is prescribed in a single dosage of 5 mg, and for children and teenagers under 12 years old at a dose of not 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 for hypersensitivity to its components, respiratory failure due to depression of the respiratory center in the brain, susceptibility to bronchospasm, acute abdomen, traumatic brain injuries, epilepsy. Other contraindications are paralytic intestinal obstruction and difficulties with bowel movements, severe liver disease, increased intracranial pressure, stroke, cachexia, and severe alcohol intoxication.
But even for healthy people, the drug represents a certain danger, because it is able to inhibit the respiratory and cough reflex, weaken the motility of the digestive tract and cause constipation, provoke hyperhidrosis, a drop in blood pressure, hot flashes, influence hormone production, disrupting hormones. 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, Mydocalm, Sirdalud, and Baclofen tablets have proven themselves, which can be used at home, but strictly adhering to the dosages recommended by your doctor, so as not to cause excessive muscle relaxation and disruption of the heart, which is also muscular body.
When it comes to severe pain it is often not enough just to take pills. The source of the pain must be acted upon comprehensively, which means that external agents (ointments, gels, solutions, creams), which also help with severe back pain, should not be ignored.
Most often in connection with pain in the back mention:
- ointment "Diclofenac" (NSAIDs),
- gel "Voltaren" (NPVS),
- "Fastum-gel" (NPVS),
- Finalgel (NPVS)
- ointment "Ketonal" (NPVS),
- gel "Nurofen" (NPVS),
- topical solution and Menovazin ointment (local anesthetic),
- gel "Dolobene" (combination drug,
- Ointment "Kapsikam" and "Bengay" (means with a vasodilator and irritant effects).
"Bengay" - a drug for local use in muscle and joint pain. It has a warming effect, improves blood circulation in the affected tissues, reduces the severity of muscle spasm. Due to the irritating and distracting action of the cream temporarily relieves deep pain symptoms.
“Bengay” is a completely safe cream that even pregnant women and nursing mothers can use for severe back pain. True, they need to do this with extreme caution, because the effect of the drug on the growing organism has not been studied. For the same reason, as well as due to the fact that the preparation 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 effect on the nervous system is more relevant for cases of inadvertent ingestion of ointment.
The drug should be applied to the skin in the area of localization of pain and rub well with active massage movements. The multiplicity of procedures for severe pain syndrome - 3-4 times a day. The course of treatment is individual, but manufacturers do not recommend applying the ointment for a long time (more than 10 days).
Contraindications to the drug a little: increased sensitivity of the body to the components of the drug, hypersensitivity to salicylates, bronchial asthma. The cream can not be applied to damaged skin, which has irritation, wounds, scratches.
Since the drug is applied topically, 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, up to a lethal outcome, are possible only with the use of the drug inside, therefore it should be kept out of reach of children.
Despite the fact that drug therapy for intense pain in the back does not always require the patient to stay in the hospital and can be successfully performed at home, self-activity in the selection and use of 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 speaks of serious violations and injuries, and the drugs used to treat it are not at all harmless, because even the use of vitamins should be strictly rationed.
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