Medicines and tablets in the treatment of degenerative disc disease of the cervical, lumbar and thoracic spine

Speaking about degenerative disc disease, a person usually has in mind the presence of pain in the back area – in any of the spine. However according to modern degenerative changes in the spinal column and are found in healthy subjects without such pain.

Therefore, in recent years more speak not about medical treatment of degenerative disc disease, and about treatment of the following conditions:

1. Nonspecific pain in the back and neck, for example, myofascial pain syndrome in the lumbar area (square muscle of the loin). "Nonspecific" in this case means not associated with any significant pathology of the spine, muscles and ligaments of the back, such as injury, infection, etc.
2. Osteoarthritis of the joints of the spine, for example, bootastic, uncovertebral newartriot. The phenomenon is quite frequent and painful.
3. Compression radiculopathy – patient with back pain symptoms of compression. Often occurs on the background of intervertebral hernias. And compression-ischemic syndrome. In the cervical compression can be not only nerve fibers but also blood vessels (vertebral artery).
4. Spondylolisthesis – degenerative changes in the spine or other reasons, leading to displacement of the vertebrae in any of divisions (usually cervical, lumbar).
5. spinal Stenosis.
6. Osteoporosis, compression fractures at its background and other specific causes of pain.

So, speaking of the treatment of degenerative disc disease, most often people mean the first three points as the most common. Alone is very difficult to correctly choose the means for the treatment of degenerative-dystrophic diseases of the spine, so the tablet from degenerative disc disease to drink at home only after consultation with your doctor.

To Decide which pills to take, the doctor does not have long. There are several groups of drugs that have proven effective in clinical studies. Chondroprotectors and antibiotics in this list are not included.

Anti-inflammatories

In the first place in the treatment of pain are anti-inflammatories. Their effects are the relief of the inflammatory process under the influence of different mechanisms. To anti-inflammatory drugs include corticosteroids (glucocorticosteroids) and NSAIDs (non-steroidal anti-inflammatory drugs).

Corticosteroids are usually prescribed in the following cases:

1. Autoimmune nature of the disease – causes of back pain and neck. Commonly used injection in the region of the joint, or paravertebral, as well as oral form (tablets). Engaged in this kind of pathology rheumatologist.
2. arthritis of the joints of the spine.
3. the Ineffectiveness of NSAIDs.

The First step in pharmacological treatment of osteoarthritis are NSAIDs. Conditionally they can be divided into three groups:

1. are more analgesic effect.
2. are more anti-inflammatory effect.
3. Both effects are about the same.

The table below summarizes these groups, and it presents the most popular medications and information about how to take them.

Groups and names	application Diagram
NSAIDs, primarily since the analgesic effect
Ketorolac ("Ketorol", "CATHALAC", "Ketanov")	Optimal/m 10-30 mg/day. for 3-5 days followed by transfer to a tableted form of nimesulide, meloxicam, or celecoxib. Scheme possible in individuals without any pathology of the intestine and risk of bleeding
Metamizol (Analgin, "Baralgin", "OPTALIGN")	optimized for 1 amp. (500 mg) 1 times a day for no more than 5 days with subsequent transfer to the pill form of nimesulide, meloxicam, celecoxib. Precautions and side effects the same as that of Ketorolac
Ketoprofen ("Ketonal")	100 mg (1 amp.) 1-2 times daily, duration is 3-5 days with subsequent transition to tablets
NSAIDs, primarily with anti-inflammatory effect
Indomethacin ("Indolene", "Indomethacin")	reagirovanie Optimally in the form of 75 mg 1-2 times a day, a negative influence on the gastrointestinal tract, is currently assigned to, very rare
Naproxen (the"Napomene", "Eprinex", "Nepios")	250-500 mg 1-2 times a day, severe side effects from the blood, now rarely used
Diclofenac	75 mg 2 times a day, optimally in the form of injections in the first 5 days of the acute period, then translate to safer products
NSAIDs (force effects are the same)
Meloxicam ("Movalis",Nuclear fuel pellets in production, "Melbeck", "Amelotex")	7.5-15 mg 1 time per day, the risk of gastrointestinal complications and bleeding are much lower than those listed above in the table drugs. Can be used long-term (up to 2-3 weeks)
Nimesulide ("Nimesil", "Nise", "Nimike", "Emulex")	100 mg 2 times a day after meals, the course can be long (2-3 weeks), since the drug is safer than nonselective NSAIDs
Celecoxib ("celebrex", "Coxim", "Deluxe")	200 mg/day., if necessary, can be increased to 400 mg. Selective drug can be used long-term (up to 2-3 weeks)

Practice and comparative studies of different drugs, the most successful for the treatment of back pain in osteochondrosis are:

• Meloxicam ("Movalis");
• Celecoxib ("celebrex");
• Nimesulide ("Nimesil", "Nise");
• Aceclofenac ("Aantal");
• Diclofenac ("Voltaren", "Ortofen");
• Ketorolac ("Ketorol").

While diclofenac and Ketorolac optimal use in the acute phase for fast reduction or relief of pain by injection during the first 5 days and then switch to safer products from the point of view of pathology of the gastrointestinal tract and the risk of bleeding in tablet form. These include meloxicam, celecoxib and nimesulide.

some authors (1) also notes chondroprotective effect of nimesulide, what are its additional plus. Similar schemes are used for pain in the lumbar spine, with medical treatment of thoracic osteochondrosis and pain in the neck, associated with degenerative processes or with non-specific character.

Muscle relaxants

Drugs in this group are intended to relieve (reduce) spasm of the back muscles and spine, in addition, their own action produces the analgesic pain relieving effects of NSAIDs. Together with the previous group drugs muscle relaxants make up a great combination for the treatment of acute pain in the back area (neck).

Muscle relaxants are usually in the form of tablets, in our country (Russia, 2015) only "Mydocalm" has the injectable form. The muscle relaxants include:

• Tolperizon ("Mydocalm");
• Tizanidine ("Sirdalud", "Titanyl", "Titanic");
• of Baclofen ("Gebleven", "Baclosan").

The Advantage of "Mydocalm" over other drugs in this group is the absence of sedation and muscle weakness.

The Basic scheme of the use of muscle relaxants is shown in the table below.

Katadolon

Flupirtine ("Katadolon") is a medical product registered in the Russian Federation as a non-narcotic analgesic, has a specific action. Analgesic effect is associated with activation of K+ channels of neurons, so in essence it is the drug with Central action. However, it has muscle relaxing effect, so can be used as a monotherapy drug for back pain.

The Basic nuances of the use of this drug:

1. to be Used only as directed by your healthcare practitioner.
2. is Used to relieve or reduce acute back pain, ineffective for chronic pain.
3. Can be used as monotherapy.
4. is Assigned with contraindications to NSAIDs.

You Cannot use when driving a car, is contraindicated in pregnancy and guards.

product Name / trade name	application Diagram
Flupirtine ("Katadolon", caps. 100 mg)	100 mg (1 capsule) 3-4 times daily, may increase to maximum dose (600 mg/day). Dose adjustments be performed under medical supervision

Vascular (vasoactive) drugs

Vasoactive drugs may be given in identifying the symptoms of compression, and compression-ischemic syndrome, especially in the treatment of cervical degenerative disc disease medical. Thus, not all patients with back pain or neck shown this group of drugs.

Among the vasoactive drugs, as a rule, are appointed:

1. Tools to improve microcirculation and rheological properties of blood, – pentoxifylline ("Trental"), "Stugeron", "reverse", "Teonikol".
2. Venotonics – "Aescusan", "Caffeine", rarely "Aminophylline".
3. Drugs that normalize metabolism in damaged tissues, reparants and antihypoxants – lipoic acid ("Actovegin", "Berlition").

Most Often, these medicinal products are prescribed in the conditions of a day hospital in the form of infusion in saline or 5% glucose, after these drugs the patient may be left in maintenance doses in pill form (tablets from osteoarthritis of the neck).

Other drugs

As the primary treatment, the patient may be offered an injection of local anesthetics (novocaine, trimekain, etc.) paravertebralna andcombination with corticosteroids and NSAIDs paravertebral or periartikulyarno (in the area of the damaged joints).

In Addition to the above-described drugs can be a prescribed medicine three groups:

1. Anticonvulsants.
2. Opioid analgesics.
3. Antidepressants.

The Preparations of these groups are appointed by the attending neurologist, are prescription and in any case they cannot be taken independently. How and when these medicinal products are prescribed, consider the below.

According to the modern approach to the treatment of pain in severe pain may be added opioid analgesics short course. "Severe" means a significant limitation of normal life: sleep disturbance, inability to "forget" about the pain, get distracted, do the usual things, throwing.

Among opioid analgesics tramadol more often prescribed in the initial dose of 50 mg 1-2 times daily, increasing the dose is recommended under medical supervision approximately every 4-7 days. Studies show that the likelihood of developing addiction and there is a need in this drug are much lower than those of the opioids as a whole.

In the presence of a radicular syndrome may be prescribed anticonvulsants, namely gabapentin and pregabalin. These drugs in research and development have proven to be highly effective in the relief of pain. In addition to reducing the intensity of pain they normalize sleep, improve the quality of life.

The Basic scheme of the use of anticonvulsants in the table below.

Name / trading name	application Diagram
Gabapentin ("Gametek", "Katana", "Corvalis", "Neurontin", "Tebantin")	day 1 – 300 mg 1 times/day., Day 2 – 600 mg (in 2 doses), 3rd day 900 mg in 3 doses, 4th day – 1 200 mg, gradually increasing to 1 800 mg/day. Titration of dose is performed under the supervision of a physician according to the severity of side effects and symptoms
Pregabalin ("Pregabalin Richter")	Starting dose of 150 mg/day. In 2 divided doses, gradually increased to 300-600 mg/day. (average every week), the titration is performed under medical supervision according to the severity of side effects and symptoms

Drug treatment of osteoarthritis involves also the elimination of secondary symptoms such as depression. The prescription of antidepressants becomes necessary in people with chronic back pain, the duration of which exceeds 12 weeks. At this time, the patient is often the question arises: "When will it all end?", and there is fear of "serious illness", anxiety and a depressed mood.

Among the antidepressants in chronic back pain often is prescribed:

• amitriptyline
• clomipramine
• imipramine
• fluoxetine
• paroxetine;
• sertraline.

All medications are prescription, can be assigned only to the attending physician and monitored for their effectiveness. Thus, as a rule, the first three drugs from the above list have a more pronounced effect eliminate the pain, but the side effects are also significant. Fluoxetine, paroxetine, sertraline good in reducing the anxiety, fear, normalization of sleep, but their analgesic effect is much less pronounced.

In conclusion, we note that, in addition to pharmacological treatment of osteoarthritis, the patient must be offered physiotherapy, exercise therapy, manual therapy and osteopathy. Indications and contraindications to these methods of treatment determined by the attending neurologist.

Thus, only an integrated approach to treatment of degenerative diseases and nonspecific pain in the neck and back can bring relief to the patient.

Sources:

1. assessment of the efficacy, tolerability and safety of nimesulide in children with chronic arthritis. E. I. Alekseeva, S. I. Valieva. Scientific centre of children health RAMS, Moscow. "Current Pediatrics", vol. 6; No. 6; 2007; Pp. 84-88.
2. common pain syndromes in neurological practice: causes, diagnosis and treatment of back pain and neck. Oleg V. Kotov Russian medical journal.
3. for Celecoxib in acute pain. Karateev A. E. Russian medical journal.
4. NSAIDs in the twenty-first century: the place of nimesulide. Karateev A. E. Russian medical journal.
5. neck Pain: causes and treatment approaches. Pilipovic, A. A., Danilov A. B., Simonov S. G. Russian medical journal.
6. Myofascial pain syndrome: from pathogenesis to treatment. Pilipovic, A. A., Danilov A. B. Russian medical journal.