Painkillers 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 seek medical help with this particular problem. Such a symptom is characteristic of many diseases, and almost always it is necessary to resort to drug treatment. Injections for back pain should be prescribed by a doctor after an examination and determination of the cause of its occurrence. [1]

Indications for carrying out

Pain medication is given first. Its purpose is to alleviate the patient's condition and return him to the usual level of motor activity as soon as possible. With 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, non-steroidal anti-inflammatory drugs are the drugs of choice. In the initial stages of the disease process, injectable forms are usually preferred, later, when the strength of pain is weakened, they switch to taking the tablets of the same name.

Injections of drugs of this group are prescribed for pain in the back and lower back of rheumatic, neurological, traumatic origin, with hepatic and renal colic, menstrual disorders. Non-steroidal anti-inflammatory drugs, in turn, can be divided into two groups according to their action. Some drugs have a powerful anti-inflammatory effect and it is thanks to him that pain syndrome is stopped when inflammation is reduced. These include Diclofenac, Indomethacin, Ketoprofen, Meloxicam, which are indicated precisely in cases of a pronounced inflammatory process. The drugs of the second group more effectively anesthetize and have an antipyretic effect, they are also called non-narcotic analgesics. In terms of anti-inflammatory activity, they are inferior to the means 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, with radiculitis and back pain, bruises, sprains, dislocations, Diclofenac (Voltaren, Ortofen), Ketoprofen (Ketonal), Meloxicam (Movalis) are most often prescribed, which, in addition to an analgesic effect, have some therapeutic effect in this case - they relieve inflammation and puffiness, improve blood circulation and metabolic processes in tissues.

With joint pain, rheumatism, arthritis, arthrosis, NSAIDs are more indicated as an anesthetic 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 the joints is provided by chondroprotective preparations, which contain cartilage tissue metabolism regulators - Chondroitin sulfate (Artradol, Chondrolon) or Aflutop. The analgesic effect of these drugs is not so fast and is ensured by their therapeutic effect: restoration of cartilage tissues, slowing down their destruction, and increasing joint mobility. The drugs are indicated for back pain with hernia, osteochondrosis, arthropathies.

Corticosteroid injections may be given. They are indicated for pain in the back and joints of rheumatic origin. Synthetic hormones help to cope with a strong inflammatory process and allergic reactions. The analgesic effect is associated with anti-inflammatory, decongestant and antihistamine effects. Pain is reduced by reducing pressure on muscle tissue. Injections are indicated both local - directly into the joint, and having a general effect (intramuscular). The effect of the use of synthetic hormonal drugs is usually powerful and long-term, but their side effects are impressive.

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

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

What injections help with back pain?

There is no one magic remedy that would quickly relieve pain in all cases. Back pain is a symptom caused by various causes. Therefore, it is possible to help effectively and quickly in cases where the cause of the pain is established. Such treatment will not only eliminate 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 the pain syndrome, simultaneously relieving the symptoms of the inflammatory process.

Drugs of this group have a central analgesic effect directly on the brain at the level of the thalamus, blocking the upward transmission of pain impulses, and also 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 fosolipase A, interrupting the cyclooxygenase and / or lipoxygenase reactions. The mechanical sensitivity of noniceptive fibers is also reduced due to the anti-edematous action of the drugs.

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

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

Newer drugs in this group are mainly 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, so far no convincing evidence of this fact has been found.

In combination with NSAIDs, and often as monotherapy, injections of B vitamins (B1, B6, B12) are prescribed, the latter of which has the most pronounced analgesic activity. Vitamin therapy is considered effective in cases of acute pain. Complex preparations are more often used: Vitakson, Neurobion. The analgesic effect provides the ability of vitamins to restore damaged nerve fibers, their myelin sheaths. This affects the metabolic processes in the nerve fibers, ensuring the normalization of the transmission of impulses and muscle innervation. Complex vitamin preparations Milgamma, Kombilipen contain lidocaine, which supplements and accelerates the onset of pain relief. In cases of chronic recurrent pain, vitamin therapy is not appropriate.

NSAIDs are also combined with glucocorticosteroids. Indications for this combination are 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 efficiency, 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 is quite high even in medium doses (comparable to opioids), Ibuprofen, as the least toxic non-steroidal anti-inflammatory drug.

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

For severe pain, the method of blockade with novocaine or lidocaine is also used - an injection into points located as close as possible to the exits of the nerve 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 reinforce each other's action and provide a long-term analgesic effect.

Somewhat less often they recall the analgesic activity of injections of plant biostimulants and homeopathic preparations. Such funds, contrary to the popular belief of many representatives of official medicine, are not placebos and effectively relieve pain, while providing a therapeutic effect. In addition, they do not have the ability to cause as 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

The relief of severe pain and the return of mobility to the patient is a priority in acute diseases and exacerbations of chronic ones. Conducting adequate anesthesia is possible only with the appointment of a drug whose analgesic activity correlates with the intensity of pain. For a long time, the most effective, coping with any pain, were narcotic drugs - opiates and morphines. However, in addition to anesthesia, they made the patient sleepy, passive, depressed psychomotor functions and were addictive.

The modern approach to treatment is to activate the patient even during acute pain. Prolonged bed rest adversely affects the effectiveness of treatment and contributes to chronic pain, feasible physical activity promotes blood circulation, faster recovery of damaged tissues, reduces the risk of chronic pain and disability.

Currently, the main drugs used in the event of pain syndrome of various origins are non-narcotic analgesics or non-steroidal anti-inflammatory drugs. Their list is very extensive - more than 25 active ingredients and even more commercial ones. These drugs quickly relieve pain without causing lethargy and return the patient's mobility, which is more consistent with modern treatment tactics.

The most commonly prescribed for back pain are traditional (non-selectively blocking the enzymatic activity of cyclooxygenases): Diclofenac, Ketorolac, Ibuprofen, Ketoprofen, Indomethacin; and also - blocking predominantly COX-2 Meloxicam. Highly selective cyclooxygenase-2 blockers - coxibs (Celebrex, Viox) 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 the systemic use of NSAIDs does not help, the doctor may prescribe novocaine / lidocaine blockade. 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 focus of pain relieves pain irritation, turning off peripheral innervation, and also improves tissue trophism. [5]

For blockades, injections of cortisone and other glucocorticosteroids, such as Diprospan, are also used. Blockades with hormonal drugs are justified in cases of severe inflammation and swelling of tissues that compress the nerve endings and thereby cause intense pain.

To relieve muscle and vascular spasms with prolonged acute pain syndrome, relaxing injections are prescribed for back pain, for example, injections of No-shpa, Mydokalma, triad.

Quite often, recently, with back pain, vitamins are prescribed in injections. Milgamma, Vitakson, Neurobion and other complexes can really eliminate moderate back pain, and sometimes cope with severe back pain. True, it makes sense to prescribe them for acute inflammatory processes and neuropathies. In cases of chronic pain, such treatment is not considered effective by experts.

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

Of the herbal preparations for back pain with a hernia of the spine, aloe injections in combination with B vitamins can help (Milgamma can be used).

Brief description of the most popular drugs

Modern medicine has a fairly large arsenal of non-narcotic analgesics. In the first place in demand among them are non-steroidal anti-inflammatory drugs. When strong analgesic injections are needed for back pain, drugs with the active ingredient, ketorolac tromethamine, can be considered the drug of choice. They are produced under different 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, overstrain, with degenerative-dystrophic changes in tissues. They stop muscular and neurological pains in the back, they are used for pain relief in oncological 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 anti-inflammatory and antipyretic, therefore, Ketorolac preparations are used mainly as painkillers, and the origin of the pain does not matter. The analgesic efficacy of this active substance surpasses all known drugs of its group and is comparable to centrally acting analgesics (narcotic). But Ketorol and its synonyms, unlike them, do not inhibit psychomotor functions and the respiratory center of the brain, do not significantly affect the state of the heart muscle and do not cause serious hemodynamic disturbances. It (like other NSAIDs) thins the blood, however, does not affect ATP-induced platelet aggregation, increasing bleeding, but not reducing the platelet count and prothrombin index.

The doctor prescribes the frequency of injections and dosage individually, taking into account the severity of the symptoms. The minimum effective single dose (from 10 to 30 mg of the active ingredient of the drug - ketorolac tromethamine) is administered, observing the time interval between injections of four to six hours. If necessary, injections are given every two hours. The maximum adult can enter 90 mg per day. Injections are made 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, or, conversely, the patient becomes restless and irritable. There may be various disorders of the digestive process, abdominal and muscle pain, dry mouth, hyperhidrosis and tachycardia.

Quite often there is a need to prescribe anti-inflammatory injections to the patient for back pain. In this case, NSAIDs are preferred with a predominance of the ability to stop the inflammatory process. In diseases of rheumatic origin, they help restore lost mobility - they relieve swelling of the articular and soft tissues, which helps to 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 in second place in terms of the effectiveness of pain relief after ketorolac, however, its anti-inflammatory activity is much higher, therefore, in inflammatory and degenerative diseases: arthritis of the joints of the spine of various origins (rheumatoid, psoriatic, reactive), sciatica, lumbago and others, its purpose will be more justified. Ketonal injections are prescribed intramuscularly with a frequency of one to three per day. A single dose is one ampoule (100 mg). In parallel, you can use suppositories or tablets. Intravenous administration is carried out only in a hospital setting. Undesirable effects are rare and consistent with those of other NSAIDs.

Diclofenac (synonyms: Voltaren, Diklak, Diclobene, Naklofen, Ortofen, etc.) has enjoyed well-deserved popularity for more than half a century. Despite the emergence of many new non-steroidal anti-inflammatory drugs, the Diclofenac injection for back pain is a classic treatment option for patients without contraindications to this remedy. 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 in sports and household injuries - sprains, dislocations, fractures, bruises, stop renal and hepatic colic, and often acute and intense pain is stopped with just one injection, then the patient is transferred to other forms of medication - tablets, suppositories, ointments. This remedy is inferior to the two mentioned above in analgesic activity. Its ability to suppress inflammatory mediators is also weaker than, for example, that of Indomethacin. However, the drug is well tolerated and relatively safe. Diclofenac rarely causes ulcerogenic side effects than Ibuprofen and Naproxen, since it inhibits the enzymatic activity of COX-1 to a lesser extent. To a greater extent, it blocks the second isoform of the enzyme, however, it is weaker than coxibs, due to which it has lower cardiotoxicity. At the same time, its action is sufficient to achieve the optimal anti-inflammatory and analgesic effect in pain syndromes of various origins.

Diclofenac sodium injections 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 is continued for no more than two days. Then they switch to taking tablet forms, the use of suppositories and ointments. In non-injectable forms, treatment can be long-term.

Meloxicam (Movalis, Amelotex, Melbek, Lem) refers to NSAIDs that predominantly inhibit the enzymatic activity of COX-2, which is formed only in inflamed organs, so it should have a less pronounced undesirable effect on the digestive organs than non-selective NSAIDs, however, for cores it maybe even more dangerous than them.

This drug relieves pain and inflammation in the back. Meloxicam has a more prolonged effect than traditional drugs, such as Diclofenac. It almost completely binds to serum proteins in the blood, in the synovial fluid its concentration is also high - ½ of the plasma. Meloxicam injections are made 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 at 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. In relation to cyclooxygenase, it is not selective, it inhibits the enzymatic activity of both isoforms. Injection is used after injuries and operations, to relieve attacks of lumbar pain (lumbago, sciatica, radicular syndromes in osteochondrosis). Outpatient prescribed intramuscular injections, in a hospital - intravenous. First, 8 mg of the drug is injected deep into the muscle, if necessary, an additional amount of the same amount can be injected on the same day. This drug is intended for short-term use.

The above and other non-steroidal anti-inflammatory drugs should be prescribed by a doctor. In injections, they are used for a short time, often only once. The drug is selected based on several prerequisites: tolerability, the age of the patient, the presence of chronic diseases in him, causing the need to combine injections for back pain with taking other medications.

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

They are not prescribed for pregnant and lactating women, children under 12-15 years of age, patients with the aspirin triad, peptic ulcer disease, bleeding tendency and decompensated severe cardiovascular, hepatic and renal pathologies.

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

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

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

Most often, for pains of various origins, Novocain is used for blockades. 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 released into the systemic circulation, it has a central anesthetic effect, preventing the synthesis of acetylcholine and blocking its release. The disadvantage of Novocain is the short duration of its action (about an hour). In order to prolong and enhance the action, other anesthetics and solutions are added to the novocaine solution.

Lidocaine injections are more often prescribed for pain caused by degenerative-dystrophic processes in the spine. Lidocaine blockade relieves pain in just two minutes. Its duration 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 usually well tolerated, but in some people they may cause an allergic reaction in the form of swelling, itchy rashes, hypotension, and shortness of breath. Toxic effects of the central action include dizziness and migraine-like pain, drowsiness, tachycardia, nausea, vomiting, involuntary emptying of the bladder or intestines, blood disorders.

In addition to drugs, blockades can have traumatic side complications in the form of bruises, inflammation, necrosis, and local sensitivity disorders. [6], [7]

Steroid hormones have a pronounced anti-inflammatory effect. At its expense, an analgesic effect is also achieved, and it is quite long - calculated for weeks. Corticosteroid injections are made by inserting a needle between the vertebrae and outside the membranes of the spinal cord, that is, into the epidural region, the 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 swelling of the tissues; it is usually used to relieve significant pain caused by chronic collagenoses. For 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 to eliminate 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 in children, pregnant and lactating women, people with congenital vertebral pathologies, patients with an operated spine and infectious diseases. The patient's blood coagulation process should not be disturbed. Hormonal injections are not made for diabetics, people with decompensated severe cardiovascular pathologies, liver and kidney failure.

If you need to use corticosteroids, your doctor may prescribe injections of Cortisone or other medications of this class. Diprospan has the most powerful anti-inflammatory activity (active ingredients are two betamethasone compounds: dipropionate and sodium phosphate). It is prescribed for the ineffectiveness of other hormonal agents. Dose individually.

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

A new word in pain relief is the combined injection of a steroid hormone with ozone. So far, such treatment is carried out at an experimental level. The injections were given to patients with vertebral hernias. The effect in most of the subjects was long - up to six months. The researchers suggest that ozone enhances the analgesic and anti-inflammatory effects of the hormone injection.

Glucocorticosteroids can cause many undesirable complications, however, they are prescribed for back pain for a short time, which allows such effects to be avoided in most cases.

To relieve pain in the back, intramuscular injections of the triad are still used: analgin, diphenhydramine and papaverine, mixed in one syringe. Analgin is a long-known non-narcotic pain reliever, NSAID, at one time widely used for any pain, it could be found in any home medicine cabinet. Diphenhydramine is an antihistamine drug 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 site of the lesion. Diphenhydramine also stops the excess activity of histamine, which accompanies pain and inflammation, relieves arousal, helping the exhausted patient to relax and fall asleep.

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

No-shpy injections have a relaxing effect. It is also a well-known antispasmodic, especially effective when combined with NSAIDs and anesthetics. The action 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 can not do without additional funds.

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

Sometimes a muscle relaxant of central action with an analgesic effect is prescribed Mydocalm - a complex preparation containing tolperisone hydrochloride, which relaxes the muscles, and anesthetic lidocaine. The drug relieves back pain after injuries and operations, with muscle spasms and radicular syndromes. It is administered intramuscularly twice a day, one ampoule. 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. Recently, they have become quite often addressed, since vitamin therapy is not fraught with such consequences as therapy with nonsteroidal drugs and hormones. B vitamins are known for their neurotropism - they participate in metabolic processes, help strengthen the myelin sheaths of nerve fibers, maintain their integrity and, accordingly, restore disturbed 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 metabolism reactions in nerve fibers, thereby stabilizing the work of the central and peripheral nervous system.

Thiamine, splitting in the body to di- and triphosphate, is involved in the reactions of carbohydrate assimilation. Its deficiency leads to the accumulation in the tissues of underoxidized carbohydrate metabolism metabolites that disrupt the function of nerve fibers. Injections of vitamin B1 normalize the metabolism of carbohydrates, which has a beneficial effect on the synaptic transmission of neurotransmitters and the further passage of nerve impulses to the periphery.

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

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.

In clinical studies, the role of these vitamins in the normalization of the nervous system at all levels, reducing the manifestations of inflammation and reducing the level of pain has been proven.

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

However, there are many complex preparations in ampoules, for example, Neurobion or Vitakson, containing only vitamins B1, B6, B12. They are also effective for back pain, however, most experts tend to separate the use of injectable forms of vitamins.

Vitamin complexes are often enhanced by the introduction of anesthetics into their composition, in particular, Lidocaine. Milgamma (Combilipen) contains, in addition to three neurotropic vitamins, the aforementioned anesthetic. Injections of this solution are indicated for myalgia, infringement and inflammation of nerve endings, and other disorders of nerve conduction in the musculoskeletal system of the body.

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

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

Injections of homeopathic preparations Traumeel S and Zeel T can also be prescribed for the relief of both acute back pain and the treatment of chronic diseases that manifest themselves as a pain syndrome of this localization. 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 origin. The complex agent has not only a quick analgesic, 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 mountain (Arnica montana), Aconite (Aconitum napellus) - an ambulance remedy for pain in bones and soft tissues of various origins, wounds and injuries, strengthens arterial and venous vessels. Chamomile officinalis (Chamomilla recutita) - relieves acute pain, especially relevant for neuralgia. Yarrow (Achillea millefolium) has a relaxing effect, relieves the effects of falls from a height, sprains, weight lifting, bruises in the form of sharp penetrating pains, Perennial daisy (Bellis perennis) relieves pain associated with physical overstrain. Calendula pharmacy (Calendula officinalis) accelerate healing, Echinacea (Echinacea) activates the body's defenses, St. John's wort (Hypericum perforatum) is used for lesions of the nervous system. Other vegetable components in combination with mineral - Soluble Mercury Hahnemann (Mercurius solubilis Hahnemanni) and Sulfur Liver (Hepar sulfuris) provide an effective solution for injection.

The drug is available in different forms, which are well combined with each other and cause a more powerful effect. Injections can be done by any known means: into the muscle, under the skin, intravenously, as well as segmentally and intraarticularly. For acute pain, the recommended dose is an ampoule per day. It practically does not have side effects, however, if you are allergic to plants of the Compositae 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 due to the presence of the herbal immunomodulator Echinacea.

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

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

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

May cause sensitization reactions in the form of skin rashes and myalgia in the first days of use. Caution must be exercised in the treatment of patients with autoimmune diseases. Children and pregnant women are not recommended due to the fact that the effect on this contingent has not been studied.

Aloe vera shots can also help with back pain. The effect is achieved due to the fact that this plant is a natural biostimulator and adaptogen. Its use activates the flow of metabolic processes in tissue cells, improves tissue blood supply and promotes the restoration of damaged areas, increasing its own defenses and the body's 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 injections of Aflutop. Such a course of treatment should be prescribed by a doctor familiar with the action of drugs.

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

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

Blockade for back pain is considered an effective method of pain relief. It affects the general condition of the body to a lesser extent, since the drug is applied locally. However, this manipulation must be performed in medical institutions, and not at home. Fully and with the least undesirable consequences for the patient, only a qualified specialist can carry out the blockade procedure.

The choice of a remedy for the treatment of back pain should be left to the doctor, informing him about not only where it hurts and how, but also about the tolerance of drugs, chronic diseases, the need to take other drugs at the same time and discussed with him your drug preferences.