The use of nonsteroidal anti-inflammatory drugs (NSAID, NSAID) in osteochondrosis
non-Steroidal anti-inflammatory drug (NSAID, NSAID) in osteochondrosis were opened in 1829 after selecting the first representative of the group of willow bark is salicylic acid. Medication to eliminate inflammation, eliminate the pain.
The Long reception (more than a week or two) most NSAIDs is not recommended due to side effects, however, in patients with degenerative-dystrophic diseases of the spine, there is a need in long period of anti-inflammatory therapy.
The Pharmaceutical industry has long been engaged in searching for medicines from the NSAID group, which have fewer side effects.
The Mechanism of action of NSAIDs is inhibition of the enzyme cyclooxygenase. Without going into details, suffice it to say that the cyclooxygenase blocks the inflammatory response due to prevent the release of mediators of Allergy from mast cells and basophils.
Note that for the discovery of these substances John vane received the Nobel prize.
To the readers to explain in detail what is nonsteroidal anti-inflammatory drugs and how to apply them in osteochondrosis, we propose to consider the classification.
- Acid compounds: pyrazolidone, salicylates (aspirin), derivatives of phenyl - and endolysosomal acids (diclofenac, indomethacin, aceclofenac, sulindac), oxicam (lornoxicam, tenoxicam, meloxicam), propionic acid derivatives (Ketoprofen, naproxen).
- non-acidic substances: sulfonamide (nimesulide), alkane (nabumeton).
strength anti-inflammatory action in moderate doses, you can position these funds in the following order from highest to lowest: indomethacin, flurbiprofen, piroxicam, diclofenac, Ketoprofen, aspirin.
On analgesic effect of NSAIDs can be placed in the following order: Ketoprofen, indomethacin, piroxicam, naproxen, ibuprofen, aspirin.
"When analyzing the effectiveness of the above, we note that this non-steroidal anti-inflammatory medication, like aspirin, has mild analgesic and anti-inflammatory action. In connection with its toxic effects almost never used for back pain associated with degenerative processes of the spine."
Any of the above funds has a pronounced adverse effect on the gastro-intestinal tract. As a result, the pharmaceutical industry is engaged in the search for selective drugs with reduced side effects. As a result of these developments have been created selective NSAIDs. Their mechanism of action is blocking the cyclooxygenase second type.
drugs in this category include:
Their use is permitted in osteochondrosis and other degenerative spine diseases.
What drugs to choose and how to apply them
To apply NSAIDs in osteochondrosis and other degenerative changes of the spine, you should carefully select drugs in this group. In their review, it becomes apparent that some of the more pronounced anti-inflammatory effect, while the other is an anesthetic.
"to optimally pick up the drug, it is necessary to know the mechanisms of its effects on the human body and the pathologic changes of the spinal column for a specific patient."
In any case, drugs with pronounced action and side effects can be used only on doctor's prescription.
Among the most popular representatives of the group of NSAIDs used for the treatment of osteoarthritis, can be called nimesulide, meloxicam, Ketorolac, and diclofenac (aceclofenac). They appoint physicians and neurologists in the treatment of pain or compression of reflex origin.
Usually the start of therapy of the pain syndrome in osteochondrosis and other degenerative diseases of the spine associated with the prescription of diclofenac, aceclofenac or Ketorolac fast start thanks to their actions and good analgesic effect. It is important to remember that the maximum number of injections of these drugs is 5 days.
A week Later, the patient is usually transferred in tablet formulations with less impact on the digestive tract and anti-inflammatory effect, for example, nimesulide, meloxicam. Coxibe highly selective yet poorly studied due to their adverse effect on the cardiovascular system and less frequently assigned.
Patterns of use the most popular NSAIDs in osteochondrosis with pain syndrome is given in the table below.
|Name of medication (trade names)||application Diagram|
|Diclofenac ("Voltaren", "Diclobene", "Ortofen", "Naklofen")|
|Aceclofenac ("Aantal")||100 mg/tab. 2 times a day, fairly quick effect, the period of use not more than a week|
|Nimesulide ("Nise", "Nimesil", "Nimica")||100 mg 1 time per day, the optimal effect on the second or third day, under cover of omeprazole can be administered for a long time|
|Ketorolac ("Ketorol")||30 mg/amp. 2-3 times a day, no more than 5 days, then switch to meloxicam or nimesulide, a quick effect, a pronounced analgesic effect|
|Meloxicam ("Movalis")||15 mg/tab. 1 time/day, the effect is gradual, cumulative; the side effects from the gastrointestinal tract and the risk of bleeding is much lower|
|Celecoxib ("celebrex")||200 mg/tab. 2 times a day, possible long reception provided good endurance, cardio-vascular and nervous system|
Remember that you cannot apply multiple anesthetics of one group together. In such a situation increases not so much an analgesic effect, much increases the likelihood of side effects and ulceration of the duodenum (stomach) bleeding.
Which drug would you choose, it cannot be used for a long time! All medications in this group are appointed for a period not exceeding 14 days, even those that are sold in pharmacies without a prescription.
To reduce the negative effects of diclofenac, nimesulide and voltaren on gastrointestinal tract your doctor may recommend medications to protect the stomach from damage, such as omeprazole ("Ultop", "Omez").
It is Not advised to combine painkillers with alcohol. This combination significantly increases the risk of negative influence of drugs on the kidneys and liver.
Review of medications on the effectiveness and mechanism of action
representatives of the group of diclofenac ("Voltaren", "Naklofen", "Rapten rapid") have a strong analgesic effect and are used for pain in the joints and back. They cannot be taken long-term because of sideeffects. Medications contraindicated with aspirin asthma, blood disorders and pathology of blood coagulation processes.
Comparative studies conducted to evaluate the efficacy of aceclofenac and diclofenac showed more rapid improvement and pain relief when taking aceclofenac. The same frequency of side effects was slightly lower tolerability was assessed better.
Ketoprofen derivatives ("Artrosilene", "Bystronic", "Ketonal", "Flomax") possess a pronounced analgesic effect. They do not have a negative impact on the intervertebral discs, therefore, are the preferred tools in osteochondrosis.
Nimesulide ("Nise", "Nimesil") refers to a group disconecting of medications used to pain in back and joints. The ongoing studies (F. Bradbury) efficiency in comparison with diclofenac and Ketoprofen proved its greater safety and lower frequency of lesions of the gastrointestinal tract (gastritis, nausea, diarrhea, pain). Moreover, in another study the risk factor of the shock syndrome of nimesulide was as small as that of the highly selective coxibs.
do Not be afraid of appointing anti-inflammatory drugs in osteochondrosis with pain syndrome. Despite the negative impact of NSAIDs on the body, alternatives in the treatment of this disease is not found!
- Diclofenac in the treatment of pain. Danilov A. B. The Magazine "doctor", № 5, 2009.
- back Pain: differential diagnosis and rational pharmacotherapy. Kolokolov O. V., Salina E. A., Sidali I. V., Kolokolov A. M., Lukina E. V. Russian medical journal.
- Aceclofenac in the treatment of osteoarthritis. Sharapova E. P., Tuskin E. A., Raskina T. A., Vinogradova I. B., Menshikova L. V., Alekseeva L. I., Ivanova O. N. The magazine "doctor", No. 8, 2012.