The leading symptom of an intervertebral hernia is episodic or persistent pain. It occurs in response to infringement of the spinal roots, and its severity is significantly enhanced with muscle cramps. Therefore, the use of painkillers in the form of injection solutions, tablets or ointments with intervertebral hernia cannot be dispensed with. When they are prescribed, the doctor takes into account the localization of the protrusion, its size, the complications that have arisen.
- First aid
- Dosage Forms
- Solutions for injections
- Ointments and Gels
- Types of Painkillers
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Narcotic and non-narcotic analgesics
- Muscle relaxants
- Hormonal preparations
- Sedatives, antidepressants
- Folk remedies
- B vitamins
- Complex therapy
- What can not be used with intervertebral hernia
When squeezing a hernial protrusion of the sensitive nerve endings, severe back pain occurs. Especially acute, piercing it happens with lesions of the lumbar discs. A lumbago attack can trigger one awkward movement – tilting or turning the body. Pain in the lower back makes a person freeze in one position of the body, as when trying to straighten it intensifies many times. You need to help a person get to bed or fall to the floor. To improve well-being, place a thin pillow under your stomach or back. Then it is necessary to give the patient a tablet of any non-steroidal anti-inflammatory drug (Nise, Nurofen, Ketorol) and call the Ambulance team.
When choosing a dosage form, the doctor focuses on the intensity of the pain syndrome. It takes into account the age of the patient, the type of hernial protrusion, the presence of a history of chronic pathologies of the liver, kidneys, and gastrointestinal tract.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Anesthetics in tablets are prescribed to patients to eliminate moderate pain or after parenteral administration of analgesics to consolidate the therapeutic result. The advantages of this dosage form are ease of dosing and administration, relatively high bioavailability, and long-term action. Disadvantages – a wide range of contraindications.
Often tablets are not used in the treatment of patients with kidney disease, gastritis, ulcerative lesions of the stomach and duodenum.
Solutions for injections
Anesthetics in the form of injection solutions are intended for the relief of acute pain, characteristic of large hernial protrusions. Most often, they are injected intramuscularly or into connective tissue structures located near displaced intervertebral discs. The duration of the therapeutic course rarely exceeds 3-5 days due to severe side effects of injectable drugs. But this dosage form also has advantages, for example, a quick analgesic effect. Sometimes with a cervical or chest hernia, the swallowing reflex is frustrated, so it is possible to eliminate the pain only by injections.
This is the name of the medical device in the form of a device that delivers the solution in drops. This method of drug administration is rarely used to relieve pain in herniated discs. The main indication for installing the dropper is a persistent radicular syndrome, which cannot be eliminated by other methods. Drip intravenous infusion is practiced when the patient is co-administered with drugs from various clinical and pharmacological groups, for example, vitamins and blood circulation improvers.
Drug blockages are used to relieve acute pain, often occurring in the lower back, less often – the neck. First, the injection site is anesthetized, and then the doctor proceeds directly to the procedure. For blockade, Novocaine or its combination with glucocorticosteroids is usually used. After the introduction of a solution of steroid drugs, the analgesic effect lasts several days. Only Novocaine anesthetizes just 1-3 hours. But doctors try to use glucocorticosteroids as rarely as possible, despite their high clinical effectiveness: these drugs have a negative effect on all vertebral structures.
Ointments and Gels
Means for local application to the pain area are prescribed to patients to eliminate weak discomfort. They are included in treatment regimens to reduce the doses of systemic analgesics and reduce the pharmacological load on the body. External agents are characterized by low bioavailability. Only a small amount of active ingredients penetrate the hernial protrusion. But such dosage forms have their advantages. Firstly, they rarely cause systemic adverse reactions. Secondly, many ointments, gels, creams, balms are suitable for long-term course therapy.
Transdermal drugs cope with aching, pulling pains that occur at the initial stage of the formation of an intervertebral hernia. The patches are a sticky paper base coated with an anesthetic ingredient. The principles of action of such drugs vary significantly. Ketotop contains the non-steroidal anti-inflammatory ingredient ketoprofen with powerful analgesic activity. A pepper patch eliminates pain due to the locally irritating and distracting effect of capsaicin. Rare-earth metals (Ketonal, Nanoplast) are popular, which increase the temperature in damaged tissues, stimulating blood circulation.
Types of Painkillers
Not only the intensity of the pain syndrome is taken into account by the doctor when prescribing an anesthetic drug when diagnosing an intervertebral hernia. Often the patient’s health status is important. Hormones are often contraindicated for elderly people and old people due to the presence of chronic pathologies. And during pregnancy and breastfeeding, most systemic drugs are prohibited, so ointments and gels are recommended for women. But not all, but only those that do not contain components that penetrate into breast milk or cross the placental barrier.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Drugs from this group are prescribed for patient complaints of pain in the area of displaced intervertebral discs. Only when they are ineffective are other means used. NSAIDs exhibit powerful analgesic, anti-inflammatory and antiexudative activity due to a decrease in the production of pain mediators and the febrile state of prostaglandins.
One of the side effects of NSAIDs is damage to the mucous membranes of the digestive tract. Therefore, they are always combined with proton pump inhibitors Ultopom, Pantoprazole, Esomeprazole.
|Forms of non-steroidal anti-inflammatory drugs used in the treatment of intervertebral hernias||Names of drugs|
|Injection solutions||Diclofenac, Ortofen, Ketonal, Movalis, Ketorolac, Xefokam, Meloxicam|
|Pills, capsules, dragees||Nimesulide, Nise, Ketorol, Celecoxib, Ketoprofen, Nurofen, Ibuprofen, Etoricoxib|
|Ointments, gels, creams, balms||Voltaren, Fastum, Indomethacin, Arthrosilen, Diclovit, Ketonal, Nise, Nurofen|
Narcotic and non-narcotic analgesics
Narcotic analgesics are used in the treatment of intervertebral hernia in exceptional cases when a pain attack cannot be stopped even with drug blockages. The reason is the rapid formation of physical and psychological dependence on their active ingredients. This group of funds does not apply for more than a few days. In acute radicular syndrome, the patient is prepared for surgery.
Most often, narcotic analgesics are prescribed Tramal, Fentanyl, drugs that include codeine. Non-narcotic drugs (Baralgin, Maksigan, Trigan) are rarely used due to their weak analgesic effect in pathologies of the musculoskeletal system.
Pain in the intervertebral hernia occurs not only with infringement of the spinal roots, but also as a result of muscle cramps that restrict movement. In such cases, drugs that relax skeletal muscle – muscle relaxants are indicated. For severe pain, Medocalm is usually used, containing tolperisone, which exhibits muscle relaxant activity. The drug also includes lidocaine, which has an analgesic effect. Then, treatment is continued with 1-2-week intake of muscle relaxants in tablets:
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Despite the high efficiency, they are not used for a long time due to severe side effects. Often (especially in violation of the dosing regimen), the use of muscle relaxants becomes the cause of physical addiction, anorexia, arterial hypotension, dyspeptic and neurological disorders.
Glucocorticosteroids in the treatment of intervertebral hernias are rarely used in the form of solutions for intramuscular administration or tablets. Most often, they are prescribed to patients for medical blockades. Hormonal drugs are characterized by powerful analgesic, anti-inflammatory and decongestant properties. Even a single introduction to the area of hernial protrusion permanently eliminates almost all the symptoms. The doctor may prescribe the following hormonal drugs to the patient:
Contraindications to the use of glucocorticosteroids are pregnancy, breastfeeding, osteoporosis, septic and infectious lesions of the vertebral structures, diverticulitis, peptic ulcer of the digestive system, gastritis, liver and kidney pathologies. The list of possible side effects, including manic-depressive psychosis, is no less wide in hormonal preparations. Therefore, hernia therapy with glucocorticosteroids takes place only in dosages calculated by the doctor with careful monitoring of laboratory parameters.
A person with an intervertebral hernia of any localization constantly expects the appearance of pain. He doesn’t even deliberately make inclinations, body turns to avoid discomfort. This condition becomes the cause of neurosis, depression, psycho-emotional instability. A person is often irritated, quick-tempered, and sometimes, on the contrary, lethargic, lethargic. He often listens to his feelings, it seems to him that pain in the spine is constantly present. In such cases, doctors recommend a course of sedatives:
- alcohol tinctures or water infusions of St. John’s wort, valerian, motherwort, oregano, mint, lemon balm;
- Novo-Passita, Persen, Tenoten.
The drugs have a mild soothing, relaxing effect, contribute to rapid falling asleep. If their use is ineffective with anxiety and nervous excitability, then neuroleptics, tranquilizers, antidepressants – Phenazepam, Deprim, Adepress, Seroquel, Neuleptil, Sonapaks are included in the treatment schemes.
Many doctors have nothing against the use of prescription drugs. But only after the main conservative or surgical treatment. Even acute hormonal drugs sometimes do not help from acute pains in the back and neck, and folk remedies can not cope at all. It is advisable to use them after therapy, when there are weak discomfort during exercise or weather changes. What can be prepared for pain relief at home:
- warming, distracting, locally irritating ointment. In a mortar, mix 50 g of medical vaseline and fat baby cream, add a teaspoon of turpentine oil, 2 drops of pine and thyme essential oils. Transfer the ointment to a jar with a lid, store in the refrigerator, rub in pain;
- warming, improving blood circulation tincture. Tightly put any fresh vegetable medicinal raw materials in a 0,5-liter glass container – dandelion, St. John’s wort, plantain, burdock, calendula, thyme, chamomile, and elecampane. Pour vodka or ethyl alcohol diluted with the same amount of water. Insist in a warm dark place for 2-3 months, rub with pain.
You can get rid of weak painful sensations with the help of compresses. You should grind a couple of large leaves of horseradish and add a tablespoon of honey to the mass. Then evenly distribute the mass on the pain area, cover with a film and a dense tissue, hold for 1-2 hours.
Many drugs from various clinical and pharmacological groups do not eliminate severe pain, but treatment of intervertebral hernias is not without them. The progression of the pathology leads to a gradual deterioration of the condition of the spinal roots, an innervation disorder, and a decrease in sensitivity. To restore the functioning of nerve tissues, preparations containing B vitamins are used:
Some injectable solutions include anesthetic lidocaine, which has pronounced analgesic properties. Therapy of hernias begins with parenteral administration of drugs for 2-4 weeks, and then the achieved result is fixed by the course of taking tablets.
In therapeutic regimens, muscle relaxants are combined with analgesics, glucocorticosteroids, NSAIDs, prolonging and enhancing their effect. Therapy is supplemented by the intake of balanced complexes of vitamins and minerals and sedatives. Intervertebral hernias are often diagnosed, so the choice of treatment tactics is not difficult for doctors. The active ingredients of the prescribed drugs do not enter into chemical interaction with each other, do not reduce or slow down the pharmacological actions of each other.
What can not be used with intervertebral hernia
If the doctor has not prescribed any medicine to the patient, then its use can cause serious complications. Do not exceed the recommended dosage in the hope of quickly getting rid of the discomfort. Treatment should not be stopped immediately after their disappearance, considering themselves to have recovered. Pain is only a symptom, its elimination will not in any way slow down the progression of the pathology.
Often, doctors do not prescribe to patients popular warming ointments with an analgesic effect. You can not independently include them in treatment regimens. If squeezing the roots led to the development of inflammation, then under the influence of heat it will intensify many times.