Nonsteroidal anti-inflammatory drugs and back pain

Aceclofenac (Aceclofenac)

Film-coated tablets

Pharmacological action:

NSAID, a derivative of phenylacetic acid; has anti-inflammatory, analgesic and antipyretic effects associated with non-selective suppression of COX1 and COX2, which regulate the synthesis of Pg.

Indications for use:

Inflammatory diseases of the musculoskeletal system (rheumatoid arthritis, psoriatic and juvenile arthritis, ankylosing spondylitis; gouty arthritis, osteoarthritis). It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease

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Acetylsalicylic acid (Acetylsalicylic acid)

Tablets, effervescent tablets

Pharmacological action

NSAID; has anti-inflammatory, analgesic and antipyretic effects associated with non-selective inhibition of the activity of COX1 and COX2, which regulate the synthesis of Pg. As a result, Pg, which ensures the formation of edema and hyperalgesia, is not formed. A decrease in the content of Pg (mainly E1) in the thermoregulation center leads to a decrease in body temperature due to the expansion of skin vessels and increased sweating. The analgesic effect is due to both central and peripheral action.

Reduces platelet aggregation, adhesion and thrombus formation by suppressing thromboxane A2 synthesis in platelets. The antiplatelet effect lasts for 7 days after a single dose (more pronounced in men than in women). Reduces mortality and the risk of myocardial infarction in unstable angina. Effective in primary prevention of cardiovascular diseases, especially myocardial infarction in men over 40 years of age, and in secondary prevention of myocardial infarction.

In a daily dose of 6 g or more, it suppresses prothrombin synthesis in the liver and increases prothrombin time. It increases plasma fibrinolytic activity and reduces the concentration of vitamin K-dependent coagulation factors (II, VII, IX, X). It increases the incidence of hemorrhagic complications during surgical interventions and increases the risk of bleeding during anticoagulant therapy.

Stimulates the excretion of uric acid (impairs its reabsorption in the renal tubules), but in high doses.

Blockade of COX1 in the gastric mucosa leads to inhibition of gastroprotective Pg, which can cause ulceration of the mucosa and subsequent bleeding. Less irritating effect on the gastrointestinal mucosa is possessed by medicinal forms containing buffer substances, enteric coating, and also special "effervescent" forms of tablets.

Indications for use

Feverish syndrome in infectious and inflammatory diseases.

Mild or moderate pain syndrome (of various origins): headache (including that associated with alcohol withdrawal syndrome), migraine, toothache, neuralgia, lumbago, radicular syndrome, myalgia, arthralgia, algomenorrhea.

[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]

Paracetamol (Paracetamol)

Tablets, soluble tablets, effervescent tablets, capsules, infusion solution, syrup, rectal suppositories

Pharmacological action

Non-narcotic analgesic, blocks COX1 and COX2 mainly in the central nervous system, affecting the pain and thermoregulation centers. In inflamed tissues, cellular peroxidases neutralize the effect of paracetamol on COX, which explains the almost complete absence of an anti-inflammatory effect. The absence of a blocking effect on the synthesis of Pg in peripheral tissues determines the absence of a negative effect on water-salt metabolism (Nat- and water retention) and the gastrointestinal mucosa.

Indications for use

Fever syndrome against the background of infectious diseases; pain syndrome (mild and moderate): arthralgia, myalgia, neuralgia, migraine, toothache and headache, algomenorrhea.

Dexketoprofen (Dexketoprofen)

Solution for intravenous and intramuscular administration, film-coated tablets

Pharmacological action

NSAID, a propionic acid derivative, has analgesic and antipyretic effects; the anti-inflammatory effect is insignificant. The mechanism of action is associated with non-selective inhibition of COX1 and COX2 and disruption of Pg synthesis. The analgesic effect occurs after 30 minutes and lasts for 4-6 hours.

Indications for use

Pain syndrome of mild and moderate intensity (of various origins): acute and chronic diseases of the musculoskeletal system (including rheumatoid arthritis, arthrosis, osteochondrosis), algomenorrhea, toothache. Intended for symptomatic therapy, reduction of pain and inflammation at the time of use, does not affect the progression of the disease.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Diclofenac (Diclofenac)

Film-coated tablets, prolonged-release capsules, modified-release capsules, solution for intravenous and intramuscular administration, rectal suppositories, prolonged-release tablets

Pharmacological action:

NSAID, a derivative of phenylacetic acid; has anti-inflammatory, analgesic and antipyretic effects. Non-selectively inhibiting COX1 and COX2, disrupts the metabolism of arachidonic acid, reduces the amount of Pg in the inflammation focus. Most effective for inflammatory pain. Like all NSAIDs, the drug has antiplatelet activity

Indications for use:

Inflammatory and degenerative diseases of the musculoskeletal system, including rheumatoid, psoriatic, juvenile chronic arthritis, ankylosing spondylitis (Bechterew's disease), osteoarthrosis, gouty arthritis (fast-acting dosage forms are preferred in acute gout attacks), bursitis, tendovaginitis. The drug is intended for symptomatic therapy, pain and inflammation reduction at the time of use, and does not affect the progression of the disease.

Pain syndrome: headache (including migraine) and toothache, lumbago, sciatica. ossalgia, neuralgia, myalgia. arthralgia. radiculitis, in oncological diseases, post-traumatic and postoperative pain syndrome, accompanied by inflammation.

Algomenorrhea; inflammatory processes in the pelvis, including adnexitis

Infectious and inflammatory diseases of the ENT organs with severe pain syndrome (as part of complex therapy): pharyngitis, tonsillitis, otitis.

Feverish syndrome in "cold" diseases and flu.

[ 17 ], [ 18 ], [ 19 ]

Indometacin (Indomethacin)

Capsules, injection solution, rectal suppositories, film-coated tablets

Pharmacological action

NSAID, derivative of indoleacetic acid; has anti-inflammatory, analgesic and antipyretic effects associated with non-selective suppression of COX1 and COX2, which regulate the synthesis of Pg. Has an antiplatelet effect.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, psoriatic, juvenile chronic arthritis, arthritis in Pelgett's and Reiter's disease, neuralgic amyotrophy (Parsonage-Turner disease), ankylosing spondylitis (Bechterew's disease), gouty arthritis (in acute gout attacks, fast-acting dosage forms are preferable), rheumatism.

Pain syndrome: headache (including menstrual syndrome) and toothache, lumbago, sciatica, neuralgia, myalgia, after injuries and surgeries, accompanied by inflammation, bursitis and tendonitis (most effective when localized in the shoulder and forearm area).

Algomenorrhea; Bartter's syndrome (secondary hyperaldosteronism); pericarditis (symptomatic treatment); childbirth (as an analgesic and tocolytic agent); inflammatory processes in the pelvis, including alnexitis.

Non-closure of the ductus botallus.

Infectious and inflammatory diseases of the ENT organs with severe pain syndrome (as part of complex therapy): pharyngitis, tonsillitis, otitis.

Fever syndrome (including lymphogranulomatosis, other lymphomas and liver metastases of solid tumors) - in case of ineffectiveness of ASA and paracetamol. The drug is intended for symptomatic therapy, reduction of pain and inflammation at the time of use, does not affect the progression of the disease.

Metamizole Sodium (Metamizole Sodium)

Capsules, solution for intravenous and intramuscular administration, rectal suppositories (for children), tablets, tablets for children

Pharmacological action

A non-narcotic analgesic drug, a pyrazolone derivative, non-selectively blocks COX and reduces the formation of Pg from arachidonic acid.

Prevents the conduction of extra- and proprioceptive pain impulses along the Goll and Burdach bundles, increases the excitability threshold of the thalamic pain sensitivity centers, and increases heat transfer.

A distinctive feature is the slight expression of the anti-inflammatory effect, which causes a weak effect on water-salt metabolism (Na+ and water retention) and the mucous membrane of the gastrointestinal tract. It has an analgesic, antipyretic and some antispasmodic (in relation to the smooth muscles of the urinary and biliary tract) effect.

The effect develops 20-40 minutes after oral administration and reaches its maximum after 2 hours.

Indications for use

Feverish syndrome (infectious and inflammatory diseases, insect bites - mosquitoes, bees, gadflies, etc., post-transfusion complications);

Pain syndrome (mild and moderate): including neuralgia, myalgia, arthralgia, biliary colic, intestinal colic, renal colic, trauma, burns, decompression sickness, herpes zoster, orchitis, radiculitis, myositis, postoperative pain syndrome, headache, toothache, algomenorrhea

Celecoxib (Celecoxib)

Capsules

Pharmacological action

NSAID, selectively blocks COX2. When prescribed in high doses, long-term use or individual characteristics of the body, selectivity decreases. It has anti-inflammatory, antipyretic and analgesic effects, inhibits platelet aggregation. By inhibiting COX2, it reduces the amount of Pg (mainly in the inflammation focus), suppresses the exudative and proliferative phases of inflammation.

Indications for use

Rheumatoid arthritis, reactive synovitis. osteoarthrosis. ankylosing spondylitis, articular syndrome during exacerbation of gout, psoriatic arthritis. It is intended for symptomatic therapy, reduction of pain and inflammation at the time of use, does not affect the progression of the disease.

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Etoricoxib (Etoricoxib)

Film-coated tablets

Pharmacological action:

NSAID, selective COX-2 inhibitor, coxib. In therapeutic concentrations inhibits the formation of proinflammatory Pg. Has anti-inflammatory, analgesic and antipyretic effects. In doses less than 150 mg does not affect platelet aggregation and the gastrointestinal mucosa.

Indications for use

Symptomatic therapy of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gouty arthritis.

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Ketoprofen (Ketoprofen)

Tablets, capsules with modified release

Lyophilisate for the preparation of a solution for intramuscular administration, solution for intravenous and intramuscular administration,

Rectal suppositories

Pharmacological action

NSAID, has anti-inflammatory, analgesic and antipyretic effects associated with the suppression of the activity of COX1 and COX2, which regulate the synthesis of Pg. The anti-inflammatory effect occurs by the end of 1 week of administration.

Lysine salt of ketoprofen has equally pronounced anti-inflammatory, analgesic and antipyretic effects. It does not have a catabolic effect on articular cartilage.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid arthritis, psoriatic arthritis, Bechterew's disease (ankylosing spondylitis), gouty arthritis (fast-acting dosage forms are preferable in acute gout attacks), osteoarthrosis. It is intended for symptomatic therapy, pain and inflammation reduction at the time of use, does not affect the progression of the disease.

Pain syndrome: myalgia, ossalgia, neuralgia, tendinitis, arthralgia, bursitis, radiculitis, adnexitis, otitis, headache and toothache, in oncological diseases, post-traumatic and postoperative pain syndrome accompanied by inflammation.

Algomenorrhea, childbirth (as an analgesic and tocolytic agent).

Ibuprofen (Ibuprofen)

Film-coated tablets, capsules, rectal suppositories (for children), suspension for oral administration, effervescent tablets, solution for intravenous administration

Pharmacological action

NSAIDs; have analgesic, antipyretic and anti-inflammatory effects due to non-selective blockade of COX1 and COX2 and have an inhibitory effect on Pg synthesis. The analgesic effect is most pronounced in inflammatory pain. Like all NSAIDs, ibuprofen exhibits antiplatelet activity.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, juvenile chronic, psoriatic arthritis, osteochondrosis, neuralgic amyotrophy (Parsonage-Turner disease), arthritis in SLE (as part of complex therapy), gouty arthritis (in acute gout attacks, fast-acting dosage forms are preferable), ankylosing spondylitis (Bechterew's disease).

Pain syndrome: myalgia, arthralgia, ossalgia, arthritis, radiculitis, migraine, headache (including menstrual syndrome) and toothache, oncological diseases, neuralgia, tendinitis, tendovaginitis, bursitis, neuralgic amyotrophy (Parsonage-Turner disease), post-traumatic and post-operative, rational pain syndrome accompanied by inflammation.

Algomenorrhea, inflammatory process in the pelvis, including adnexitis, childbirth (as an analgesic and tocolytic agent).

Feverish syndrome in "colds" and infectious diseases.

It is intended for symptomatic therapy, reduction of pain and inflammation at the time of use, and does not affect the progression of the disease.

Ketorolac (Ketorolac)

Film-coated tablets, solution for intravenous and intramuscular administration, solution for intramuscular administration

Pharmacological action

NSAID, has a pronounced analgesic effect, also has anti-inflammatory and moderate antipyretic effect. The mechanism of action is associated with non-selective inhibition of the activity of COX1 and COX2, catalyzing the formation of Pg from arachidonic acid, which play an important role in the pathogenesis of pain, inflammation and fever. In terms of analgesic effect, it is comparable to morphine, significantly exceeds other NSAIDs.

After intramuscular administration and oral administration, the onset of analgesic action is noted after 0.5 and 1 hour, respectively, the maximum effect is achieved after 1-2 hours and 2-3 hours.

Indications for use

Pain syndrome of severe and moderate severity: injuries, toothache, pain in the postpartum and postoperative period, oncological diseases, myalgia, arthralgia, neuralgia, radiculitis, dislocations, sprains, rheumatic diseases. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Lornoxicam (Lornoxicam)

Film-coated tablets, lyophilisate for solution for intravenous and intramuscular administration

Pharmacological action

NSAID of the oxicam class; has anti-inflammatory, analgesic, antipyretic and antiplatelet effects. Suppresses proinflammatory factors, reduces platelet aggregation; by inhibiting COX1 and COX2, it disrupts arachidonic acid metabolism, reduces Pg production both in the inflammation focus and in healthy tissues; suppresses the exudative and proliferative phases of inflammation.

Indications for use

Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, joint syndrome during exacerbation of gout, bursitis, tendovaginitis.

Pain syndrome (mild and moderate intensity): arthralgia, myalgia, neuralgia, lumbago, sciatica, migraine, toothache and headache, algomenorrhea, pain from injuries, burns.

Fever syndrome ("colds" and infectious diseases). It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Vleloxicam (Meloxicam)

Tablets, solution for intramuscular administration, rectal suppositories, suspension for oral administration

Pharmacological action

NSAID, has anti-inflammatory, antipyretic, analgesic effects. Belongs to the class of oxicams; derivative of enolic acid.

The mechanism of action is inhibition of Pg synthesis as a result of selective suppression of the enzymatic activity of COX2. When prescribed in high doses, long-term use and individual characteristics of the body, COX2 selectivity decreases. Suppresses Pg synthesis in the area of inflammation to a greater extent than in the gastric mucosa or kidneys, which is associated with relatively selective inhibition of COX2. Less often causes erosive and ulcerative diseases of the gastrointestinal tract

Indications for use

Rheumatoid arthritis; osteoarthrosis; ankylosing spondylitis (Bechterew's disease) and other inflammatory and degenerative diseases of the joints, accompanied by pain syndrome. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Nimesulide (Nimesulide)

Tablets, oral suspension, dispersible tablets

Pharmacological action

NSAID, has anti-inflammatory, analgesic, antipyretic and antiplatelet effects. Unlike other NSAIDs, it selectively suppresses COX2, inhibits the synthesis of Pg in the inflammation focus; has a less pronounced inhibitory effect on COX1 (less often causes side effects associated with the inhibition of Pg synthesis in healthy tissues).

Indications for use

Rheumatism, ankylosing spondylitis (Bechterew's disease), osteoarthritis, synovitis, tendinitis, tendovaginitis, bursitis, pain syndrome (algomenorrhea, post-traumatic pain); back pain, neuralgia, myalgia, traumatic inflammation of soft tissues and the musculoskeletal system.

The drug is intended for symptomatic therapy, reduction of pain and inflammation at the time of use, and does not affect the progression of the disease.