When there is severe pain in the back, in the lower back, joints, of course, first of all it is necessary to determine the cause of its occurrence. If this is a chamber from hypothermia, lumbago, or a pinch of the sciatic nerve, an intervertebral hernia, etc., it is necessary to undergo a examination with a neurologist, an osteopath, possibly a gynecologist, urologist, gastroenterologist, because back pain can be not only from spasm of muscles and ligaments , but also with certain diseases of internal organs. After careful diagnosis, the doctor can prescribe as part of a complex therapy - NSAIDs, B group vitamins in pricks from back pain.
What are the tools that relieve back pain in injections?
Today, in the treatment of acute pain in the lumbar region, back, medicine finds new principles and algorithms, rather than 50 years ago. The main emphasis in the fight against pain is done to eliminate pain with NSAIDs - non-steroidal anti-inflammatory drugs that suppress inflammation, and reduce pain, as well as carrying out muscle blockages.
And after the removal of severe spasms, it is recommended that the patient be immobilized, that is, exercise physical therapy exercises, massage. Most doctors insist that a person during pain syndromes in the back area does not limit his activity as much as possible.
Also, the appointment of combined vitamin complexes that can have a moderate analgesic effect, vitamins B12, B6, and B1 has become popular and effective. It is believed that vitamin B12 has a more significant analgesic property. Why these vitamins?
Since recently, these drugs have been treated in medicine as mild analgesics, since they are neurotropic - they normalize the innervation of the muscles, participate in the transmission of excitation, in the metabolism of mediators, influence metabolism, processes in the nervous system, and contribute to the repair of damaged nerves.
Over 90 different studies have proved that the use of B vitamins in clinical practice led to a significant reduction in the pain syndrome in acute phases of inflammation in complex treatment. Therefore, they can be used either individually or in the form of complex preparations of group B vitamins.
As a part of the majority of complex preparations of this group, an anesthetic of lidocaine is contained, which strengthens the local analgesic effect. However, it should be remembered that the use of this group of vitamins makes sense only with acute pain in the back, joints, alcoholic polyneuropathy, myasthenia B12 for 10-14 days, and with chronic relapsing diseases they are already becoming ineffective.
In cases where anesthetics do not help, specialists can offer the patient a method of injection and stretching. It consists in the following: after the patient lies on the stomach, the muscles find the most painful seals or points where the pain is the most intense, and they do exactly perpendicular injection with a solution of novocaine.
Immediately after the injection, passive stretching of the muscle is made, after which a hot compress is placed on this place. Then, when the compress is removed, the patient must make active movements, maximizing the painful muscle movements.
The goal of the Novocain blockade is to "disconnect" the nerve. Therefore, the points of the injection should be as close as possible to the exit points of the nerves, for example, the sciatic - at the large trochanter of the thigh, with intercostal neuralgia - in the corresponding intercostal space, with osteochondrosis - at the outer edge of the extensor of the back, etc. It is also advisable to carry out epidural blockades in case of chronic pain, for example, with herniated intervertebral discs.
Below is a list of drugs that are prescribed by the attending physician according to the indications. Only a doctor determines the advisability of using B vitamins, NSAIDs, muscle relaxants, and hondoprotectors. The information below is only for reference, the treatment and dosage are determined by a specialist.
When the back or joint pains of the B group vitamins hurts should help
Vitamins of group B can be taken in tableted form, but naturally, intramuscular administration of drugs is considered more effective. Let's consider what medicines of this group exist in the modern pharmaceutical market, their general indications, contraindications, side effects, methods of application and comparative prices in pharmacies:
The composition of all these drugs is the same: Lidocaine, Thiamine, Pyridoxine Cyanocobalamin.
Indications: It is used for neurological diseases and syndromes of nervous system disorders in complex therapy:
- Neuritis, paresis of the facial nerve, neuralgia of the trigeminal nerve
- Back pain caused by diseases of the spine, neurological manifestations (radiculopathy, lumboschialgia, muscle-tonic lumbar, cervical, cervico-brachial syndromes, intercostal neuralgia, radicular syndrome due to degenerative spine changes)
- Nocturnal muscle cramps, alcoholic, diabetic polyneuropathy, shingles.
Contraindications: Do not administer if:
- Pregnancy, lactation
- Acute, severe types of heart failure
- Hypersensitivity to the components of the combined vitamins of group B
- In connection with the lack of research - children's age
Side effects: Tachycardia, increased sweating, rarely - allergic reactions - rash, itching, urticaria, skin reactions, shortness of breath, anaphylactic shock. When an overdose - nausea, vomiting, dizziness, tachycardia.
Usage: All listed injections of back pain are injected deep intramuscularly at 2 ml 1 / day for 5-10 days, then it should be switched to 2-3 r / week for 14-21 days. or to take vitamins inside.
Effectiveness, contraindications and side effects of NSAIDs
The pain relievers, of course, are used only as symptomatic therapy, they help to eliminate pain in the joints, back, but do not eliminate the cause of its appearance, in addition, 50% of patients may experience various side effects.
In carrying out more than 50 studies aimed at identifying the best painkiller, the researchers found that none of the NSAID products showed higher efficacy than other painkillers, and some of them are very expensive drugs. The only thing to pay attention to when choosing - some generics (Russian diclofenac, for example) are much inferior in effectiveness to the original drugs (European Diclofenac).
Also, these studies were aimed at determining the drug with the least side effects. As a result, it was found that Ibuprofen is the least toxic of all NSAIDs.
Manufacturers of the new Cox-2 inhibitor-Celebrex stated that it had the least side effects, but no convincing evidence of this fact was found during the studies.
Therefore, when choosing a non-steroidal anti-inflammatory drug, it should be remembered that they have almost the same anesthetic property, the same side effects, but different frequency, intensity, severity of side effects, harmful effects, and that is not unimportant - different prices. For example, Meloxicam has less effect on the stomach and intestines than aceclofenac (Aertal). Indomethacin gives a pronounced anesthetic effect, but it destroys the cartilage with prolonged use and is now used less and less.
And doubling the dose does not reduce the intensity of pain, and in the case where one non-steroid drug does not help (if it is not a fake), replacing it with another one does not make sense. Moreover, based on research, it can also be concluded that they are not much more effective than conventional paracetamol. Details of all ointments from back pain can be found in our article.
Selection of pain medication
In chronic pain before prescribing an anesthetic, the doctor determines the causes and nature of chronic pain - reflected, neuropathic or central, and prescribes appropriate treatment.
If the pain is acute, the doctor determines the risk of side effects on the gastrointestinal tract, cardiovascular complications, if the risks are not great, and: there is no dyspepsia - then any NSAID, dyspepsia is - better ibuprofen (or diclofenac, naproxen), nimesulide (or milixicam).
If the risk of cardiovascular complications is high, then NSAIDs should be avoided, and Paracetamol, opioids should be used. With a moderate risk, nimesulide can be administered, provided that there is adequate correction for BP (amlodipine, see drugs to reduce blood pressure).
If the risk of GI bleeding is high - NSAIDs + necessarily proton pump inhibitors (omeprazole). It is understood that the administration of NSAIDs is in itself a sufficient risk even for a single dose, therefore, according to the standard, all NSAIDs are taken in combination with proton pump blockers, regardless of the risk of gastroduodenal bleeding.
When combined with the risks of gastrointestinal side effects and complications of CAS - Nimesulide + acetylsalicylic acid + omeprazole.
If within 5-7 days the pain subsides, then continue the treatment until it is completely docked.
If the acute pain does not subside within a week, then muscle relaxants, local anesthetics are prescribed. Local administration of corticosteroids is possible with the exclusion of the diagnosis - tuberculosis of the joints or spine. With very severe pain and no effect on painkillers, the infectious nature of pain should be excluded (tuberculosis pathology - consultation and examination in an anti-TB dispensary), joint pain in gonorrhea, syphilis or other infection.
Overview of painkillers in injections
All known NSAIDs in injections, with their general contraindications and side effects, average prices in pharmacies are presented in the table:
Indications for use NSAIDs: Symptomatic treatment of ankylosing spondylitis, osteoarthrosis, rheumatoid arthritis, removal of pain - musculoskeletal, back pain of any etiology, postoperative and other painful sensations.
Contraindications: Hypersensitivity to any component of the drug, heart failure, pregnancy and lactation, severe hepatic or renal failure, bronchial asthma, aspirin, children up to 16-18 years of age, inflammatory bowel disease, peptic ulcer, gastrointestinal bleeding. Cerebrovascular diseases, ischemic heart disease, any severe diseases of the cardiovascular system, joint administration of antiplatelet agents (clopidogrel, acetylsalicylic acid) prednisolone, a violation of liver function, severe somatic diseases.
With caution: GI disease, presence of Helicobacter pylori infection, edema, fluid retention, diabetes mellitus, prolonged use of NSAIDs.
Application: The solution for injections from back pain should be injected deeply intramuscularly in a dosage matched by the doctor depending on the patient's age, intensity of pain. Up to 65 years, appoint a single dose of 10-30 mg. in / m every 4-6 hours. Persons with renal dysfunction or older than 65 years in a dose of 10-15 mg IM once, or every 4-6 hours. The maximum daily dose should not be more than 60-90 mg. and the duration of therapy is not more than 5 days.
Side effects: Digestive system: often - diarrhea, gastralgia, constipation, vomiting, nausea, heartburn, hepatitis, acute pancreatitis. Urinary system: frequent urination, nephritis, edema, acute renal failure. Respiratory system: dyspnea, laryngeal edema, allergic rhinitis, difficulty breathing. CNS: dizziness, headache, drowsiness, hyperactivity, psychosis, hearing loss, depression, impaired vision. CCC: syncope, increased blood pressure, pulmonary edema. Organs of hematopoiesis: eosinophilia, anemia, leukopenia. Blood coagulation: rectal, nasal, gastric bleeding, from a postoperative wound. Dermatological manifestations: urticaria, skin rash, skin peeling, Lyell syndrome, Stevens-Johnson syndrome. Allergic reactions: swelling of the eyelids, wheezing, shortness of breath, discoloration of the face, itching of the skin, rash, heaviness in the chest. Other: often - weight gain, swelling of the ankles, face, fingers, shins, excessive sweating.
Overdose: vomiting, nausea, abdominal pain, the occurrence of peptic ulcers of the stomach, metabolic acidosis, impaired renal function.
Interaction: Simultaneous use of NSAIDs with acetylsalicylic acid or other non-steroidal analgesics, as well as corticosteroids, calcium preparations, ethanol, can lead to gastrointestinal bleeding and the formation of gastrointestinal ulcers. Simultaneous administration of c with paracetamol increases the risk of nephrotoxicity.
Painkillers in tablets
When the back is badly hurt, the doctor can prescribe anti-inflammatory, analgesic agents in tablets, it was previously believed that oral administration slows down the onset of action, reduces effectiveness and leads to stronger side effects on the part of the gastrointestinal tract. To date, it is believed that intramuscular injection and oral administration give the same bioavailability of the drug. Side effects from the gastrointestinal tract are realized through suppression of the arachidonic acid system, that is, not with direct contact with the mucosa, but after absorption into the blood. Therefore, the side effects are almost identical when administered orally and when injected.