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Use of narcotic analgesics in the treatment of back pain
Last reviewed: 08.07.2025
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Fentanyl
Injection solution, transdermal therapeutic system
Pharmacological action
Narcotic analgesic, opiate receptor agonist (mainly mu receptors) of the central nervous system, spinal cord and peripheral tissues. Increases the activity of the antinociceptive system, increases the threshold of pain sensitivity.
The main therapeutic effects of the drug are analgesic and sedative. It has a depressant effect on the respiratory center, slows the heart rate, excites the n.vagus and vomiting centers, increases the gonus of the smooth muscles of the biliary tract, sphincters (including the urethra, bladder and sphincter of Oddi), improves the absorption of water from the gastrointestinal tract. Reduces blood pressure, intestinal peristalsis and renal blood flow. In the blood, it increases the concentration of amylase and lipase; reduces the concentration of STH, catecholamines, ADH, cortisol, prolactin.
Promotes sleep (mainly due to pain relief). Causes euphoria. The rate of development of drug dependence and tolerance to the analgesic effect has significant individual differences.
Unlike other opioid analgesics, it causes histamine reactions much less frequently.
The maximum analgesic effect with intravenous administration develops in 3-5 minutes, with intramuscular administration - in 20-30 minutes; the duration of action of the drug with a single intravenous administration of up to 100 mcg is 0.5-1 hour, with intramuscular administration as additional doses - 1-2 hours, when using TTS - 72 hours.
Indications for use
Injection solution - pain syndrome of strong and moderate intensity (angina pectoris, myocardial infarction, pain in cancer patients, trauma, postoperative pain); premedication for various types of general anesthesia in combination with droperidol; neuroleptanalgesia (including during operations on the organs of the chest and abdominal cavity, large vessels, in neurosurgery, during gynecological, orthopedic and other operations).
TTS - chronic pain syndrome of severe and moderate severity: pain caused by oncological disease; pain syndrome of other genesis requiring pain relief with narcotic analgesics (for example, neuropathy, arthritis, Varicella zoster infections, etc.).
[ Tramadol
Tablets, drops for oral administration, capsules, prolonged-release capsules, injection solution, rectal suppositories, prolonged-release tablets, film-coated prolonged-release tablets
Pharmacological action
An opioid synthetic analgesic with central action and action on the spinal cord (promotes the opening of K+ and Ca2+ channels, causes membrane hyperpolarization and inhibits the conduction of pain impulses), enhances the effect of sedatives. Activates opiate receptors (mu-, delta-, kappa-) on the pre- and postsynaptic membranes of afferent fibers of the nociceptive system in the brain and gastrointestinal tract.
Slows down the destruction of catecholamines, stabilizes their concentration in the central nervous system.
It is a racemic mixture of two enantiomers - dextrorotatory (+) and levorotatory (-), each of which exhibits a different receptor affinity from the other.
(+)Tramadol is a selective mu-opioid receptor agonist and also selectively inhibits the reuptake of neuronal serotonin.
(-)Tramadol inhibits the reuptake of norepinephrine by neurons. Mono-O-desmethyltramadol (Ml metabolite) also selectively stimulates mu-opioid receptors.
The affinity of tramadol for opioid receptors is 10 times weaker than that of codeine and 6000 times weaker than that of morphine. The intensity of analgesic action is 5-10 times weaker than that of morphine.
The analgesic effect is due to a decrease in the activity of the nociceptive and an increase in the antinociceptive systems of the body.
In therapeutic doses, it does not significantly affect hemodynamics and respiration, does not change the pressure in the pulmonary artery, slightly slows down intestinal peristalsis without causing constipation. It has some antitussive and sedative effects. It inhibits the respiratory center, excites the trigger zone of the vomiting center, and the nuclei of the oculomotor nerve.
With prolonged use, tolerance may develop.
The analgesic effect develops 15-30 minutes after oral administration and lasts up to 6 hours.
Indications for use
Pain syndrome (severe and moderate intensity, including inflammatory, traumatic, vascular origin).
Pain relief during painful diagnostic or therapeutic procedures.
Attention!
To simplify the perception of information, this instruction for use of the drug "Use of narcotic analgesics in the treatment of back pain" translated and presented in a special form on the basis of the official instructions for medical use of the drug. Before use read the annotation that came directly to medicines.
Description provided for informational purposes and is not a guide to self-healing. The need for this drug, the purpose of the treatment regimen, methods and dose of the drug is determined solely by the attending physician. Self-medication is dangerous for your health.