Analgesic and anti-inflammatory injections for back pain

Complaints about back pain can be heard from people of any age. Statistics say that annually about ¾ of the world's population seek medical help with this problem. Such a symptom is characteristic of many diseases, and almost always have to resort to drug treatment. Shots for back pain should be prescribed by a doctor after examination and establishing the cause of its appearance. [1]

Indications

Analgesic drug therapy is prescribed first. Its purpose is to alleviate the patient's condition and return to the usual level of motor activity as soon as possible. With severe back pain, drugs of different groups are prescribed, based on the established diagnosis. If it is determined that the cause of 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 painful process, injectable forms are usually preferred, later, when the strength of the pain subsides, 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, with hepatic and renal colic, menstrual disorders. Nonsteroidal anti-inflammatory drugs, in turn, by action can be conditionally divided into two groups. Some drugs have a powerful anti-inflammatory effect and it is thanks to it that the pain syndrome is bought when inflammation is reduced. These include Diclofenac, Indomethacin, Ketoprofen, Meloxicam, which are indicated precisely in cases of pronounced inflammation. Drugs of the second group are more effectively analgesic 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 analgesics.

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

In joint pain rheumatism, arthritis, osteoarthritis NSAIDs are shown more as an analgesic and to achieve some anti-inflammatory effect, however, they do not have a significant impact on the pathogenesis of such diseases.

A more pronounced therapeutic effect in degenerative changes in the joints have chondroprotective drugs, which contain regulators of cartilage tissue metabolism - Chondroitin sulfate (Artradol, Chondrolon) or Aflutop. Analgesic effect of these drugs is not so fast and is provided by their therapeutic effect: restoration of cartilage tissue, slowing down their destruction, increasing joint mobility. The drugs are indicated for back pain in 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 a strong inflammatory process and allergic reactions. The analgesic effect is due to anti-inflammatory, anti-edema and antihistamine effects. Pain is reduced by reducing the pressure on muscle tissue. Injections are indicated both locally - directly into the joint, and having a general effect (intramuscular). The effect of synthetic hormonal drugs is usually powerful and long-lasting, but their side effects are impressive.

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

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

What shots help with back pain?

There is no one magic remedy that will quickly get rid of pain syndrome in all cases. Back pain is a symptom caused by different reasons. Therefore, effective and quick help is possible in cases where the cause of pain is identified. Such treatment will not only eliminate the pain, but also prevent further development of the disease.

The most widely used in acute and chronic back pain are non-steroidal anti-inflammatory drugs, because they in most cases are quite effective in eliminating the pain syndrome, while relieving the symptoms of the inflammatory process.

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

If a prescribed drug of this class does not work, it is not advisable to change to another drug or increase the dose. It is recommended to combine different forms with the same active ingredient, e.g. Injections and cream, for better efficacy.

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 hemorrhagic effects or dyspepsia, injections of NSAIDs 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 of 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, no convincing evidence of this fact has been found so far.

In combination with NSAIDs, and often as monotherapy, injections of vitamins of the B group (B1, B6, B12) are prescribed, and the last of them has the most pronounced analgesic activity. Vitamin therapy is considered effective in cases of acute pain. More often complex preparations are used: Vitaxon, Neurobion. Analgesic effect provides the ability of vitamins to restore damaged nerve fibers, their myelin sheaths. This affects the metabolic processes in nerve fibers, providing normalization of impulse transmission and muscle innervation. Complex vitamin preparations Milgamma, Kombilipen contain in their composition lidocaine, complementing and accelerating the onset of pain relief. In cases of chronic recurrent pain, vitamin therapy is not appropriate.

NSAIDs are also combined with glucocorticosteroids. The indication for such a combination is chronic pain in rheumatic diseases. Drugs are prescribed in high doses and used for a long course. But such treatment, in addition to effectiveness, has many disadvantages. Side effects, in particular, on the part of the digestive organs and the cardiovascular system are intensified. 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 nonsteroidal anti-inflammatory drug.

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

In severe pain, they also use the method of blockades with novocaine or lidocaine - an injection into points located as close as possible to the outputs of the nerve in order to "disconnect" it.

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 prolonged analgesic effect.

A little less often remembered about the anti-pain activity of injections of herbal biostimulants and homeopathic preparations. Such remedies, contrary to the widespread opinion of many representatives of official medicine, are not placebos and quite effectively relieve pain syndrome, while having 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 shots for back pain

Suppression of severe pain sensations and return of mobility to the patient, is the first priority in acute diseases and exacerbations of chronic diseases. Adequate pain relief is possible only when prescribing 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 pain relief, they made the patient sleepy, passive, depressed psychomotor functions and were addictive.

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

Currently, the main drugs used in the occurrence 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. These drugs quickly relieve pain syndrome, without causing lethargy and returning mobility to the patient, which is more consistent with modern treatment tactics.

The most commonly prescribed for back pain are traditional (not selectively blocking the enzymatic activity of cyclooxygenases): Diclofenac, Ketorolac, Ibuprofen, Ketoprofen, Indomethacin; and - blocking mainly COX-2 Meloxicam. Highly selective blockers of cyclooxygenase-2 - coxibs (Celebrex, Vioxx) are prescribed less frequently, because their effect is not yet fully studied, their advertised safety is not 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 blockades. This method of treatment should be practiced by a specialist who is well versed in the technique of its performance. 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 painful irritation by disabling peripheral innervation, and also helps to improve tissue trophism. [5]

Cortisone injections and other glucocorticosteroids, such as Diprospan, are also used for blockades. Hormonal blockades are justified in cases of severe inflammation and swelling of tissues that compress nerve endings and thus cause intense pain syndrome.

To relieve muscle and vascular spasms in prolonged acute pain syndrome, relaxing injections for back pain are prescribed, such as injections of No-shpa, Midocalm, trochatka.

Quite often recently, vitamins in injections are prescribed for back pain. Milgamma, Vitaxon, Neurobion and other complexes can really eliminate moderate back pain, and sometimes - to cope with severe pain. However, 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 Traumel C and Cel T are used both systemically and locally - injections are made into the joint and acupuncture points.

From herbal remedies for back pain with spinal herniation can help aloe injections in combination with B vitamins (you can use Milgamma).

Brief characterization 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 for back pain are needed, then the drug of choice can be considered drugs with the active ingredient - ketorolac tromethamine. They are produced under different trade names Ketorol, Ketanov, Ketorolak, Toradol, Relac, etc.

Ketorol and its synonyms cope with moderate and severe pain syndrome of various origins after surgery and trauma, overstrain, with degenerative-dystrophic changes in tissues. Suppress muscle and neurological pain in the back, 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 many times superior to anti-inflammatory and antipyretic, so ketorolac preparations are used mainly as analgesics, and the origin of pain does not matter. The anti-pain efficacy of this active substance exceeds all known drugs of its group and is comparable to analgesics of central action (narcotic). But Ketorol and its synonyms, unlike them, does not depress psychomotor functions and the respiratory center of the brain, does not significantly affect the state of the heart muscle and does not cause serious hemodynamic disorders. It (like other NSAIDs) thins blood, however, it has no effect on ATP-induced platelet aggregation, increasing bleeding, but not reducing the platelet count and prothrombin index.

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

Quite often there is a need to prescribe a patient anti-inflammatory injections for back pain. In this case, preference is given to NSAIDs with a predominant ability to control the inflammatory process. In diseases of rheumatic origin, they help restore lost mobility - remove swelling of joint and soft tissues, which contributes to the elimination of morning stiffness and pain reduction. In addition, they have a pronounced analgesic effect. Some - comparable in strength with anti-inflammatory.

Ketonal (ketoprofen) is in second place in the effectiveness of pain relief after ketorolac, however, its anti-inflammatory activity is much higher, so in inflammatory-degenerative diseases: arthritis of the joints of the spine of various genesis (rheumatoid, psoriatic, reactive), sciatica, lumbago and others, its appointment will be more justified. Ketonal injections are prescribed intramuscularly with a frequency of one to three per day. The single dose is one ampoule (100mg). In parallel, suppositories or tablets can be used. Intravenous administration is carried out only in hospital conditions. Undesirable effects are rarely observed and correspond to those of other NSAIDs.

Diclofenac (synonyms: Voltaren, Diclac, Diclobene, Naclofen, Orthofen, etc.) has enjoyed well-deserved popularity for more than half a century. Despite the emergence of many new non-steroidal anti-inflammatory drugs, Diclofenac injection for back pain is a classic treatment option for patients without contraindications to this remedy. Intramuscular injection of this drug to relieve inflammation and pain syndrome is widely practiced in surgery, orthopedics, rheumatology, neurology, gynecology, oncology. Diclofenac injections help relieve pain in sports and household injuries - sprains, dislocations, fractures, bruises, manage renal and hepatic colic, and often acute and intense pain is controlled literally by a single injection, then the patient is transferred to the reception of other forms of the drug - tablets, suppositories, ointments. This remedy is inferior to the two mentioned above in analgesic activity. Its ability to inhibit inflammatory mediators is also weaker than, for example, Indomethacin. However, the drug is well tolerated and relatively safe. Diclofenac less often causes ulcerogenic side effects than Ibuprofen and Naproxen, because it inhibits COX-1 enzymatic activity more weakly. It blocks the second isoform of the enzyme to a greater extent, however, weaker than coxibs, due to which it has lower cardiotoxicity. At the same time, its action is sufficient to achieve 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 injections are prescribed - deep into different buttocks with an interval of several hours. Injection treatment is continued for no more than two days. Then 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) belongs to NSAIDs that inhibit mainly the enzymatic activity of COX-2, formed only in inflamed organs, so it should have less pronounced undesirable effects on the digestive organs than non-selective NSAIDs, however, for cardiac patients it may be even more dangerous than them.

This medicine is good for relieving pain and inflammation in the back. Meloxicam has a more prolonged effect than traditional drugs, such as Diclofenac. It binds almost completely 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 in a quarter of an hour and lasts long enough. Injection treatment is indicated in the first days, later switching to other forms and in chronic arthritis, long-term treatment at the lowest possible effective dose is possible.

Xefocam (lornoxicam) is a drug related to the previous one. It is used as a symptomatic agent for pain relief, which also has a rather high anti-inflammatory activity. It is not selective in relation to cyclooxygenase, inhibits enzymatic activity of both isoforms. Injection is used after injuries and surgeries, for the treatment of attacks of lumbar pain (lumbago, sciatica, radicular syndromes in osteochondrosis). Outpatient intramuscular injections are prescribed, in hospital conditions - intravenous. At first, 8mg of the drug is injected deeply into the muscle, if necessary, an additional 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 must be prescribed by a doctor. In injections, they are used for a short period of time, often only once. The drug is selected on the basis of several prerequisites: tolerance, age of the patient, the presence of chronic diseases that cause the need to combine injections for back pain with the intake of other medications.

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. The most common is a disorder of the digestive organs, and the ability of NSAIDs to thin the blood provokes the development of gastrointestinal bleeding, sometimes asymptomatic. Also for drugs of this group are characterized by cardiovascular complications.

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

Novocaine and Lidocaine, local anesthesia preparations, also have predominantly anti-pain and moderate anti-inflammatory activity. These injectable solutions are used for blockades directly at the sites of pain in osteochondrosis, herniated discs 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 injected solution and the penetration of only a small amount of it into the systemic bloodstream, the risk of undesirable effects is significantly reduced.

Novocain injections are given directly into the periarticular tissues or channels through which nerves run (localized blockades).

Another method of blockade is segmental blockade. In this method, anesthetic injections 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.

Novocaine is most often used for blockades in 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 entering the systemic bloodstream, it has a central anesthetic effect by interfering with the synthesis of acetylcholine and blocking its release. The disadvantage of Novocaine is the short duration of its action (about an hour). Other anesthetics and solutions are added to novocaine solution to prolong and enhance its action.

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

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

These drugs are usually well tolerated, but may cause allergic reactions in the form of edema, pruritic rashes, hypotension and breathing difficulties in some people. Central toxic effects include dizziness and migraine-like pain, drowsiness, tachycardia, nausea, vomiting, involuntary bladder or bowel emptying, and blood disorders.

In addition to medications, blockades can have traumatic side complications in the form of bruising, inflammation, necrosis, and localized sensory disturbances. [6], [7]

Steroid hormones have a pronounced anti-inflammatory effect. Due to it, an analgesic effect is also achieved, and it is quite long-lasting, lasting for weeks. Injections of corticosteroids are made by inserting a needle between the vertebrae and outside the spinal cord sheath, that is, in the epidural area, joints connecting the vertebrae (facet joints), trigger zones - places in the ligaments or muscles sensitive to pain. This treatment is justified only in the case of pronounced inflammation and swelling of tissues, is used, as a rule, to control significant pain caused by chronic collagenosis. In 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 of eliminating the problem of compression pain. The first corticosteroid injections help well, then their effectiveness begins to decrease from case to case.

Steroid hormone injections are contraindicated in children, pregnant and lactating women, people with congenital vertebral pathologies, patients with operated spine and infectious diseases. The process of blood coagulation in the patient should not be disturbed. Hormonal injections are not given to diabetics, people with decompensated severe cardiovascular pathologies, hepatic and renal failure.

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

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

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

Glucocorticosteroids can cause many unwanted complications, however, they are prescribed short-term for back pain, which avoids such effects in most cases.

For painful sensations in the back are still used intramuscular injections of triplets: analgin, dimedrol and papaverine, mixed in one syringe. Analgin is a long-known non-narcotic analgesic drug, NSAID, at one time, widely used for any pain, it could be found in any home medicine cabinet. Dimedrol - antihistamine drug with a pronounced sedative effect. Papaverine - antispasmodic. The complex of drugs has an analgesic effect quickly enough, relieves inflammation, muscle spasms and dilates blood vessels, providing a more active blood flow to the site of the lesion. Also Dimedrol stops excessive activity of histamine, which accompanies pain and inflammation, relieves agitation, helping the exhausted patient to relax and sleep.

However, modern NSAIDs, in general, have no less effective action, and triplet contains such components as analgin and dimedrol, which are used less and less often these days, because from the point of view of modern research these drugs are unsafe. Yes, and the duration of action of the triplet is not long. Users periodically ask the question about 3 shots for back pain, apparently referring to the injection of triplets. The drugs are three, and the injection is one. And against the background of modern drugs is far from the most effective, and harmless it can not be called. Analgin is banned in many countries of the world (USA, Germany, Sweden, etc.) because of the serious complications caused by its active ingredient, in particular, agranulocytosis. Dimedrol is a prescription drug due to its pronounced sedation. Of course, a single injection will probably not lead to a fatal change in the blood picture and will not make you a drug addict, but its effect will be moderate, and you should not use the triple therapy often.

No-shpa injections have a relaxing effect. This is also a well-known antispasmodic, especially effective in combination with NSAIDs and anesthetics. The action of such a complex is longer. In addition, No-shpa removes only the spastic part of the pain. Sometimes this is enough if the cause is a muscle spasm. If there is edema and inflammation, then additional means are needed.

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

Sometimes prescribed muscle relaxant of central action with analgesic effect Midocalm - a complex drug containing muscle relaxant tolperisone hydrochloride and anesthetic lidocaine. The drug relieves back pain after injuries and surgeries, with muscle spasms and radicular syndromes. It is administered intramuscularly twice a day in one ampoule. When used in combination with NSAIDs, it is usually necessary to reduce the dosage of the latter.

Vitamins in injections for acute back pain can be a good alternative to the above-described drugs. Turn to them recently have become quite common, because vitamin therapy is not fraught with such consequences as therapy with non-steroidal drugs and hormones. B vitamins are known for their neurotropicity - they participate in metabolic processes, contribute to the strengthening of myelin sheaths of nerve fibers, preserving 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 the reactions of intermediate metabolism in nerve fibers, thereby stabilizing the central and peripheral nervous system.

Thiamine, being broken down in the body to di- and triphosphate, participates in the reactions of carbohydrate assimilation. Its deficiency leads to the accumulation of underoxidized metabolites of carbohydrate metabolism in the tissues, impairing the function of nerve fibers. Injections of vitamin B1 normalize carbohydrate metabolism, which has a beneficial effect on the synaptic transmission of neurotransmitters and further passage of nerve impulses to the periphery.

Pyridoxine hydrochloride phosphorylation products are coenzymes of almost all reactions of amino acid decarboxylation resulting 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.

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

Vitamins in injections are prescribed by a doctor, as a rule, one vitamin is injected once a day, one at a time. For example, on the first day - an ampoule of B1, on the second - B6, on the third - B12. Injection of the same-name vitamin preparation is repeated after two days on the third. Such a scheme is followed because these vitamins are incompatible with each other. Thus, pyridoxine depresses the transition of thiamine into 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 danger of sensitization increases.

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

Vitamin complexes are often strengthened by the introduction of anesthetics, in particular, Lidocaine. Milgamma (Combilipen) contains, in addition to the three neurotropic vitamins, the above-mentioned anesthetic. Injections of this solution are indicated for myalgias, impingement and inflammation of nerve endings, 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 may cause various allergic reactions. Failure to comply with the dosage or administration regimen prescribed by the doctor may lead to systemic reactions in the form of weakness, bradycardia, hypotension, seizures.

Injections of homeopathic preparations Traumel C and Cel T can also be prescribed for the management of both acute back pain and treatment of chronic diseases that manifest themselves with pain syndrome of this localization. The drugs should be prescribed by a doctor familiar with the specifics of complex homeopathic medicines.

Traumel C injections are indicated for back pain of inflammatory and traumatic genesis. Complex remedy has not only a quick analgesic, but also therapeutic, aimed at restoring damaged tissue action by activating the body's own reserves. Each component of the drug is presented in homeopathic dilution and provides it with a specific action. Arnica mountain (Arnica montana), Aconite (Aconitum napellus) - an emergency remedy for bone pain and soft tissue of various origins, wounds and injuries, strengthen arterial and venous vessels. Medicinal chamomile (Chamomilla recutita) - relieves acute pain, especially relevant in neuralgia. Yarrow (Achillea millefolium) has a relaxing effect, relieves the consequences of falls from heights, sprains, lifting weights, bruises in the form of sharp piercing pain, perennial daisy (Bellis perennis) well relieves pain syndrome associated with physical overstrain. Calendula (Calendula officinalis) accelerate healing, Echinacea (Echinacea) activates the body's defenses, Hypericum perforatum (Hypericum perforatum) is used in lesions of the nervous system. Other herbal components in combination with mineral components - Hahnemann's Soluble Mercury (Mercurius solubilis Hahnemanni) and Sulphuric Liver (Hepar sulfuris) provide effective action of the solution for injection.

The drug is available in different forms, which combine well with each other and make its action more powerful. Injections can be made in any known ways: into the muscle, under the skin, intravenously, as well as segmentally and intra-articularly. In acute pain, the recommended dose is an ampoule per day. Virtually no side effects, however, if you are allergic to plants of the complexion family, it is desirable not to use the drug. Also, Traumel injections should not be given to people with tuberculosis, leukemia, autoimmune diseases, HIV-infected due to the presence of plant immunomodulator Echinacea.

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

In pain syndrome caused by degenerative changes in the joints and cartilage of the spine, in particular, spondyloarthritis, osteochondrosis, arthritis, myalgia and neuralgia may be prescribed injections of the drug Target T. This complex homeopathic remedy has analgesic and chondroprotective effect, contributing to the removal of inflammation and restoration of joint tissue. The drug normalizes metabolism and redox processes, improves tissue respiration and blood supply. Other forms of the drug - ointment of the same name and sublingual tablets - can enhance the effect of the injectable form.

Bioactive chondroprotector Aflutop stops destructive processes in the intercellular matrix of articular cartilage and activates the process of its repair. The active ingredient of the injected 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, myoinotisol and so on. Injections are made for 20 days, one ampoule per day. Pain goes away due to the therapeutic action, 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 during the first days of use. Caution should be exercised when treating patients with autoimmune diseases. It is not recommended for children and pregnant women due to the fact that 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 the flow of metabolic processes in tissue cells, improves tissue blood supply and promotes the recovery of damaged areas, increasing the body's own defenses and resistance to damaging factors. There are reports that aloe shots can help with pain caused not only by inflammatory processes, but also by degeneration of the spine. Aloe shots have been used in combination with an injectable 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 the drugs.

Of course, side effects from the use of biostimulants and homeopathic remedies, as well as vitamins do not compare to the effects of NSAIDs and corticosteroids.

Nevertheless, according to the statistics of medical prescriptions and sales, the best and most effective injections for back pain are non-steroidal anti-inflammatory drugs. They are prescribed by more than 80% of practicing doctors when dealing with this problem. These drugs, despite the side effects, are considered the gold standard for the elimination of pain syndrome. However, not all specialists favor the injectable form of NSAIDs, although there is an opinion that injections are more effective than tablets and less damaging to the gastrointestinal tract. In fact, the systemic use of tablet forms and suppositories is effective to the same extent as injections. Side effects on the alimentary canal are due to the overall effect on the body, not the presence of the pill 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.

Blockade for back pain is considered an effective method of pain management. It affects the general condition of the body to a lesser extent, 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 remedy for back pain should be left to the doctor, informing him/her not only about where it hurts and how, but also about the tolerance of medications, chronic diseases, the need to take other medications at the same time and discussing with him/her your medication preferences.