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The use of narcotic analgesics in the treatment of back pain
Last reviewed: 23.04.2024
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Fentanyl (Fentanyl)
Injection, transdermal therapeutic system
Pharmachologic effect
Narcotic analgesic, an agonist of opiate receptors (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 an effect on the respiratory center, slows the heart rate, excites the n.vagus centers and the vomiting center, raises the smooth muscle of the bile ducts, sphincters (including the urethra, bladder and sphincter of Oddi), improves the absorption of water from the digestive tract. Reduces blood pressure, intestinal peristalsis and kidney blood flow. Increases the concentration of amylase and lipase in the blood; reduces the concentration of STH, catecholamines, ADH, cortisol, prolactin.
Promotes the onset of sleep (mainly in connection with the removal of the pain syndrome). Causes euphoria. The rate of development of drug dependence and tolerance to analgesic effect has significant individual differences.
Unlike other opioid analgesics, histamine reactions are much less likely to occur.
The maximum analgesic effect with IV introduction is 3-5 minutes, with IM in 20-30 minutes; duration of action of the drug with a single intravenous administration up to 100 mkg - 0.5-1 h, with / m introduction as additional doses - 1-2 h, with the use of TTS - 72 h.
Indications for use
Solution for injection - pain syndrome of strong and medium intensity (angina, myocardial infarction, pain in cancer patients, trauma, postoperative pain); Premedication with different types of general anesthesia in combination with droperidol; Neuroleptanalgesia (including during operations on the thoracic and abdominal organs, large vessels, in neurosurgery, gynecological, orthopedic and other operations).
TTS - chronic pain syndrome of strong and medium severity: pain caused by cancer; pain syndrome of another genesis, requiring analgesia with narcotic analgesics (for example, neuropathy, arthritis, Varicella zoster infections, etc.).
[Tramadol (Tramadol)
Tablets, drops for ingestion, capsules, prolonged-action capsules, injection solution, rectal suppositories, prolonged-release tablets, prolonged-coated tablets coated with a coating
Pharmachologic effect
Opioid synthetic analgesic, which has a central effect and action on the spinal cord (contributes to the discovery of K + and Ca2 + -channels, causes hyperpolarization of membranes and inhibits pain impulses), enhances the action of sedatives. Activates opiate receptors (mu, delta, kappa) on the pre- and postsynaptic membranes of the afferent fibers of the nociceptive system in the brain and GI tract.
Slows down the destruction of catecholamines, stabilizes their concentration in the central nervous system.
It is a racemic mixture of 2 enantiomers - dextrorotatory (+) and levorotatory (-), each of which exhibits a different receptor affinity.
(+) Tramadol is a selective agonist of mu-opioid receptors, and selectively inhibits reverse neuronal seizure of serotonin.
(-) Tramadol inhibits the reverse neuronal seizure of norepinephrine. Mono-O-desmethyltramadol (Ml metabolite) also selectively stimulates mu-opioid receptors.
The affinity of tramadol for opioid receptors is ten times weaker than that of codeine, and 6000 times weaker than morphine. Expression of analgesic effect is 5-10 times weaker than morphine.
Analgesic effect is due to a decrease in nociceptive activity and an increase in the antinociceptive systems of the body.
In therapeutic doses, it does not significantly affect haemodynamics and breathing, does not change the pressure in the pulmonary artery, slightly slows down the intestinal motility without causing constipation. Has some antitussive and sedative effect. Oppresses the respiratory center, excites the start zone of the vomiting center, the nucleus of the oculomotor nerve.
With prolonged use, the development of tolerance is possible.
Analgesic effect develops 15-30 minutes after ingestion and lasts up to 6 hours.
Indications for use
Pain syndrome (strong and moderate intensity, including inflammatory, traumatic, vascular origin).
Anesthesia in the conduct of painful diagnostic or therapeutic measures.
Attention!
To simplify the perception of information, this instruction for use of the drug "The 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.