Nonsteroidal anti-inflammatory drugs and back pain

Aceclofenac (Aceclofenac)

Film-coated tablets

Pharmachologic effect:

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

Indications for use:

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

[1], [2], [3], [4], [5], [6], [7],

Acetylsalicylic acid (Acetylsalicylic acid)

Tablets, tablets, effervescent

Pharmachologic effect

NSAIDs; has anti-inflammatory, analgesic and antipyretic effects associated with indiscriminate inhibition of the activity of COX1 and COX2, regulating the synthesis of Pg. As a result, Pg is not formed, which provides the formation of edema and hyperalgesia. Reduction of the content of Pg (predominantly E1) at the center of thermoregulation leads to a decrease in body temperature due to the expansion of the vessels of the skin and increased sweating. The analgesic effect is due to both central and peripheral action.

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

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

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

Blockage of COX1 in the gastric mucosa leads to inhibition of gastroprotective Pg, which can cause ulceration of the mucosa and subsequent bleeding. Less irritant to the mucosa of the gastrointestinal tract are medicinal forms containing buffer substances, enteric-soluble shell, as well as special "fizzy" forms of tablets.

Indications for use

Feverish syndrome with infectious and inflammatory diseases.

Weak or moderately expressed pain syndrome (of different genesis): headache (including associated with alcohol withdrawal syndrome), migraine, toothache, neuralgia, lumbago, radicular syndrome, myalgia, arthralgia, algodismenorea.

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

Paracetamol (Paracetamol)

Tablets, soluble tablets, effervescent tablets, capsules, solution for infusions, syrup, rectal suppositories

Pharmacological action

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

Indications for use

Feverish syndrome on the background of infectious diseases; pain syndrome (mild and moderate): arthralgia, myalgia. Neuralgia, migraine, dental and headache, algodismenorea.

Dexketoprofen (Dexketoprofen)

Solution for intravenous and intramuscular administration, coated tablets

Pharmachologic effect

NSAID, a derivative of propionic acid, has analgesic and antipyretic effects; the severity of the anti-inflammatory effect is insignificant. The mechanism of action is associated with P with indiscriminate inhibition of COX1 and COX2 and a violation of the synthesis of Pg. Analgesic effect occurs in 30 minutes and lasts 4-6 hours.

Indications for use

Pain syndrome of mild and moderate intensity (various genesis): acute and chronic diseases of the musculoskeletal system (including rheumatoid arthritis, arthrosis, osteochondrosis), algodismenorea, toothache. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

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

Diclofenac (Diclofenac)

Coated tablets, prolonged-release capsules, modified-release capsules, intravenous and intramuscular administration solution, rectal suppositories, sustained-release tablets

Pharmachologic effect:

NSAID, a phenylacetic acid derivative; has anti-inflammatory, analgesic and antipyretic effect. By indiscriminately inhibiting COX1 and COX2, it disrupts the metabolism of arachidonic acid, reduces the amount of Pg in the inflammation focus. The 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 (in case of an acute attack of gout, quick-acting dosage forms are preferred), bursitis, tenosynovitis. The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

Pain syndrome: headache (including migraine) and toothache, lumbago, sciatica. Ossalgia, neuralgia, myalgia. Arthralgia. Radiculitis, with oncological diseases, post-traumatic and postoperative pain syndrome, accompanied by inflammation.

Algodismenorea; inflammatory processes in the small pelvis, incl. Adnexitis

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

Feverish syndrome with "colds" and flu.

[17], [18], [19]

Indometacin (Indomethacin)

Capsules, solution for injections, rectal suppositories, coated tablets

Pharmachologic effect

NSAID, an indoleacetic acid derivative; has anti-inflammatory, analgesic and antipyretic effects associated with indiscriminate suppression of COX1 and COX2, regulating the synthesis of Pg. Has antiaggregant effect.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, psoriatic, juvenile chronic arthritis, arthritis in Pellet and Reuter's disease, neuralgic amyotrophy (Pursonage-Turner's disease), ankylosing spondylitis (Bechterew's disease), gouty arthritis (in case of acute gout attack, high-speed medicinal form), rheumatism.

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

Algodismenorea; Bartter's syndrome (secondary hyperaldosteronism); pericarditis (symptomatic treatment); childbirth (as an analgesic and tocolytic agent); inflammatory processes in the small pelvis, incl. Alnexit.

Non-growth of the botulinum duct.

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

Feverish syndrome (including with lymphogranulomatosis, other lymphomas and hepatic metastases of solid tumors) - in case of ineffectiveness of ASA and paracetamol. The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

Metamizole Sodium (Metamizole sodium)

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

Pharmachologic effect

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

It prevents painful extra- and proprioceptive pulses along the Gaull and Burdach beams, raises the threshold of excitability of thalamic centers of pain sensitivity, increases heat transfer.

A distinctive feature is the slight severity of the anti-inflammatory effect, which causes a weak effect on water-salt metabolism (Na + and water retention) and gastrointestinal mucosa. Has analgesic, antipyretic and some spasmolytic (with respect to the smooth muscles of the urinary and biliary tract) action.

The effect develops 20-40 minutes after ingestion and reaches a 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 to moderate): incl. Neuralgia, myalgia, arthralgia, biliary colic, intestinal colic, renal colic, trauma, burns, decompression sickness, shingles, orchitis, sciatica, myositis, postoperative pain syndrome, headache, toothache, algodismenorea

Celecoxib (Celecoxib)

Capsules

Pharmachologic effect

NSAIDs selectively block COX2. When administered in high doses, prolonged use or individual characteristics of the organism, the selectivity decreases. Has anti-inflammatory, antipyretic and analgesic effect, inhibits platelet aggregation. Inhibiting COX2, reduces the amount of Pg (mainly in the focus of inflammation), suppresses the exudative and proliferative phases of inflammation.

Indications for use

Rheumatoid arthritis, reactive synovitis. Osteoarthritis. Ankylosing spondylitis, articular syndrome with exacerbation of gout, psoriatic arthritis. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

[20], [21], [22], [23], [24], [25],

Etoricoxib (Etoricoxib)

Film-coated tablets

Pharmachologic effect:

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

Indications for use

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

[26], [27], [28],

Ketoprofen (Ketoprofen)

Tablets, modified-release capsules

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

Rectal suppositories

Pharmachologic effect

NSAIDs have anti-inflammatory, analgesic and antipyretic effects associated with inhibition of COX1 and COX2 activity regulating the synthesis of Pg. Anti-inflammatory effect occurs at the end of 1 week of admission.

The lysine salt of ketoprofen has an equally pronounced anti-inflammatory, analgesic. Antipyretic action. Has no catabolic effect on articular cartilage.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, psoriatic arthritis, Bechterew's disease (ankylosing spondylitis), gouty arthritis (in case of an acute attack of gout, quick-acting dosage forms are preferred), osteoarthritis. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

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

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

Ibuprofen (Ibuprofen)

Coated tablets, capsules, rectal suppositories (for children), oral suspension, effervescent tablets, intravenous solution

Pharmachologic effect

NSAIDs; has analgesic, antipyretic and anti-inflammatory effects due to the indiscriminate blockade of COX1 and COX2 and have an inhibitory effect on the synthesis of Pg. Analgesic effect is most pronounced for inflammatory pains. Like all NSAIDs, ibuprofen displays antiaggregant activity.

Indications for use

Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, juvenile chronic, psoriatic arthritis, osteochondrosis, neuralgic amyotrophy (Pursonage-Turner's disease), arthritis with SLE (as part of complex therapy), gouty arthritis (in case of an acute gout attack, high-speed dosage forms are preferred) , ankylosing spondylitis (Bekhterev's disease).

Pain syndrome: myalgia, arthralgia, ossalgia, arthritis, sciatica, migraine, headache (including menstrual syndrome) and toothache, with oncological diseases, neuralgia, tendonitis, tendovaginitis, bursitis, neuralgic amyotrophy (Personeige-Turner's disease) , post-traumatic and post-acute painful syndrome, accompanied by inflammation.

Algodismenorea, inflammation in the small pelvis, incl. Adnexitis, childbirth (as an analgesic and tocolytic agent).

Feverish syndrome with "colds" and infectious diseases.

It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

Ketorolac (Ketorolac)

Coated tablets, solution for intravenous and intramuscular administration, solution for intramuscular administration

Pharmachologic effect

NSAIDs have a pronounced analgesic effect, it also has an anti-inflammatory and moderate heat-reducing effect. The mechanism of action is associated with nonselective inhibition of the activity of COX1 and COX2, which catalyzes the formation of Pg from arachidic acid, which play an important role in the pathogenesis of pain, inflammation, and fever. By the strength of the analgesic effect comparable to morphine, it significantly exceeds other NSAIDs.

After intravenous administration and oral administration, the onset of analgesic action is observed 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 strong and moderate severity: trauma, toothache, pain in the postpartum and postoperative period, oncological diseases, myalgia, arthralgia, neuralgia, sciatica, dislocations, sprains, rheumatic diseases. It is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.

Lornoxicam (Lornoxicam)

Coated tablets, lyophilizate for the preparation of a solution for intravenous and intramuscular administration

Pharmachologic effect

NSAIDs of the class of oxycam; has anti-inflammatory, analgesic, antipyretic and antiplatelet effect. Suppresses inflammatory factors, reduces platelet aggregation; suppressing COX1 and COX2, disrupts the metabolism of arachidonic acid, 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, osteoarthrosis, ankylosing spondylitis, articular syndrome with exacerbation of gout, bursitis, tendovaginitis.

Pain syndrome (weak and moderate intensity): arthralgia, myalgia, neuralgia, lumbago, sciatica, migraine, dental and headache, algodismenorea, pain with injuries, burns.

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

Vleloxicam (Meloxicam)

Gablet, intramuscular solution, rectal suppositories, oral suspension

Pharmachologic effect

NSAIDs have anti-inflammatory, antipyretic, analgesic effects. Refers to the class of oxycomams; a derivative of enolic acid.

The mechanism of action is the inhibition of Pg synthesis as a result of selective suppression of the enzymatic activity of COX2. With the appointment in high doses, long-term use and individual features of the organism, COX2, the selectivity decreases. Suppresses the synthesis of Pg in the inflammatory region to a greater extent than in the gastric mucosa or kidneys, which is due to the relatively selective inhibition of COX2. Less often causes erosive and ulcerative diseases of the digestive tract

Indications for use

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

Nimesulide (Nimesulide)

Tablets, suspension for oral administration, tablets, dispersible

Pharmachologic effect

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

Indications for use

Rheumatism, ankylosing spondylitis (Bechterew's disease), osteoarthritis, synovitis, tendonitis, tendovaginitis, bursitis, pain syndrome (algodismenorea, post-traumatic pains); pain in the spine, neuralgia, myalgia, traumatic inflammation of soft tissues and the musculoskeletal system.

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