An important part of the treatment of degenerative-dystrophic diseases of the spine is the use of pharmacological preparations. Most often, systemic and local agents are prescribed to patients with exacerbation of cervical, thoracic, lumbosacral osteochondrosis. At the stage of remission, the use of drugs to prevent relapse of the pathology is practiced. In the process of drug treatment of osteochondrosis, the severity of the pain syndrome decreases, edema is eliminated, the mobility of various parts of the spinal column is restored. Due to the stimulation of blood circulation and metabolism, the functional activity of cartilage and soft tissues, of the ligament-tendon apparatus increases.
Depending on the stage of the disease, drugs may be used in the form of injection solutions, tablets, ointments. Some drugs are intended for 2-3-fold use, while others are indicated for use over several months, and sometimes years.
General principles of therapy
Doctors include drugs from various clinical and pharmacological groups in the therapeutic regimen of osteochondrosis. This combination has a multifaceted positive effect on the vertebrae, intervertebral discs, muscles, ligaments, tendons and soft tissues. The main objectives of the drug treatment of osteochondrosis:
- elimination of clinical manifestations during exacerbation of the disease;
- improvement of blood circulation in damaged vertebrae, discs, connective tissue structures;
- normalization of cellular nutrition, ensuring the preservation of the structure and function of the tissue;
- identification and elimination of the causes of the degenerative-dystrophic process;
- prevention of possible complications of osteochondrosis.
Doctors warn that monotherapy with drugs will only worsen the condition of the spine. During taking the pills, the back muscle corset does not strengthen, metabolic processes are not accelerated. Do not forget about the expressed side effects of medications. Their constant use has a toxic effect on the kidneys, liver, and gastrointestinal tract.
Groups of drugs for the treatment of osteochondrosis
No pharmacological preparation has been synthesized, the administration of which would help reverse pathological processes and restore damaged vertebrae. But conducting a comprehensive, gradual and adequate medication for osteochondrosis under medical supervision will stop destructive degenerative changes in the cartilage and bone tissues. In the treatment of the disease, the following groups of drugs are used:
- analgesics that have analgesic effects for the relief of acute, aching, dull pain;
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- muscle relaxants, antispasmodics, relaxing skeletal muscles, preventing compression of the vertebrae of sensitive nerve endings;
- chondroprotectors, stimulating the partial restoration of affected tissues by improving their trophism;
For the medical treatment of osteochondrosis at the initial stage, therapeutic regimens include funds for local application with analgesic, anti-inflammatory and anti-edematous effects. Strong, acute, piercing pains in the neck or lower back can be eliminated by parenteral administration of drugs. They quickly create the maximum therapeutic concentration in the systemic circulation due to their high bioavailability. Tablets are prescribed much less often due to the frequent manifestation of adverse reactions.
In the rehabilitation period, course medication is indicated that contributes to the normalization of blood circulation and the regeneration of damaged connective tissue structures. These are vitamin complexes with a high content of B vitamins, chondroprotectors, immunostimulants. Even such “harmless” drugs should only be used as prescribed by an orthopedist, vertebrologist or neurologist.
Drugs used during exacerbations
Drug treatment of osteochondrosis is usually carried out with its relapses, the leading symptom of which is acute pain. This protective reaction of the body signals a malfunction that needs immediate repair. Therefore, for the relief of pain, injection drugs are most often used to improve the well-being of a person in 5-15 minutes.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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In the treatment of osteochondrosis, various groups of painkillers are used. To reduce the severity of acute pain, patients are recommended to take opioid analgesics: Tramal, Tramadol, Promedol. Means are shown only for 1-3-fold administration, as they quickly cause physical and mental addiction, and an overdose can cause death.
To relieve painful sensations of moderate severity, tablet analgesics are used: Paracetamol (imported analogues – Panadol and Efferalgan), Baralgin, Analgin. After their reception, the transmission of nerve impulses to the brain is blocked. This alleviates the symptoms, but the cause of the pain remains.
Nonsteroidal anti-inflammatory drugs
The most commonly used group of drugs in the treatment of osteochondrosis of any localization. NSAIDs block the biosynthesis of prostaglandins, which provoke the onset of pain, edema and hyperthermia. After parenteral administration of drugs, almost all the symptoms of the disease are weakened. Usually, for the relief of acute pain syndrome, solutions of Diclofenac, Ketorol, Voltaren are administered intramuscularly.
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Then, tabletted forms of NSAIDs are included in the treatment regimen: Nimesulide, Ibuprofen, Ketoprofen, Celecoxib, Ortofen, Ketorolac.
Taking medications eliminates edema, compressing the sensitive nerve endings, blood and lymph vessels. This is especially true in the treatment of cervical osteochondrosis, often occurring against the background of vertebral artery syndrome. As a result of its squeezing, a number of disorders of the vestibular, vascular and vegetative nature arise.
At the final stage of therapy, external forms of NSAIDs are prescribed. To eliminate uncomfortable sensations and a residual inflammatory process, Fastum, Voltaren, Nise gels, Indomethacin ointment, Dolgit cream are used.
In the acute stage of osteochondrosis, muscles located near the spine are often spasmodic. Excessive tension of muscle fibers provokes nerve roots, which are compressed by intervertebral discs or overgrown edges of bone plates. Extraneous effects on the nerve endings are the cause of acute pain and at the same time intense muscle contractions. In turn, they provoke even greater compression of the roots. A peculiar vicious circle arises, because muscle cramps are a protective reaction of the body. In this way, he tries to immobilize a certain part of the spine in order to reduce the intensity of the pain.
Break the vicious circle allows the use of drugs from the group of muscle relaxants (Sirdalud, Tizanidin). Their parenteral administration is practiced for several days, and then taking the tablets for 1-2 weeks. The therapeutic course is limited, as some muscle relaxants (Baclofen and its structural analogue Baclosan) cause mental and physical dependence.
Heavy artillery in medical treatment of osteochondrosis. For drugs Triamcinolone, Diprospan, Dexamethasone, Hydrocortisone, Kenalog is characterized by a powerful anti-inflammatory, decongestant, analgesic effect. Glucocorticosteroids are included in treatment regimens in the absence of a sustained healing clinical effect of NSAIDs. These synthetic analogues of adrenal hormones quickly stop the most intense pain, but at the same time negatively affect the kidneys, liver, and gastrointestinal tract. Therapy of osteochondrosis with glucocorticosteroids rarely lasts longer than a week. Longer use leads to a decrease in bone mass, provokes the development of osteoporosis.
An effective method of reducing the intensity of the pain syndrome is blockade, reminiscent of local anesthesia in action. Medicines are administered in the cervical, thoracic or lumbar spine, in those areas where the pain is felt most. This method of therapy can reduce the pharmacological load on the gastrointestinal tract and skin. Active ingredients penetrate immediately into inflammatory foci or tissues that have undergone degenerative changes.
For the treatment procedure, drugs are used that block the transmission of pain impulses to the central nervous system – analgesics, anesthetics, HS, anti-inflammatory drugs. At the final stages of treatment, vitamins and chondroprotectors are used to improve blood flow and speed up metabolism. Blockade, or injection injection of drugs, can be carried out in several ways:
- paravertebral – subcutaneous or intramuscular injection into tissues located near the vertebrae, disks;
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Lidocaine, Novocaine, Dexamethasone, Diprospan, Kenalog, Hydrocortisone, adenosine triphosphoric acid, Lidase, and B vitamins are used as blockade drugs. The analgesic effect lasts for 2-3 days.
The medical treatment of osteochondrosis in the acute stage can hardly be called effective. Pain, swelling, inflammation are eliminated, but not the cause of the pathology itself – the gradual destruction of hyaline cartilage, causing thinning of the intervertebral discs and protrusion of the vertebrae. Chondroprotectors are the only group of drugs that can stimulate the restoration of cartilage. But this is possible only with prolonged course medication for 3-24 months. The greatest therapeutic efficacy is characteristic for drugs with glucosamine and (or) chondroitin:
The deterioration of blood circulation, the constant expectation of a painful relapse can cause neurological disorders and even depressive conditions. Women are especially prone to this. To eliminate depression, psycho-emotional instability, patients are recommended to take antidepressants, antipsychotics, tranquilizers, sedatives.
The use of drugs is only part of the treatment of the disease. A lasting healing effect can be achieved only with a combination of medical treatment with physiotherapy, massage, gymnastics and physical education, diet therapy. It is not enough just to take pills to repair damaged tissue and prevent the spread of pathology.