What injections, injection and infusion to do with osteochondrosis
Injections (injections and drips) in osteochondrosis are assigned when severe pain syndrome that does not resolve spontaneously. Based therapy of degenerative diseases is correction of complex changes in the intervertebral discs, vascular, muscular and osteo-articular system.
The Basic parts of the medical treatment of osteoarthritis and pain associated with it, include the appointment of several groups of drugs:
- Muscle relaxants and antispasmodics.
- b Vitamins
- block with local injection of novocaine, trimecaine, of bupivacaine (anesthetic), corticosteroids or NSAIDs.
- Less chondroprotectors (only in some cases) and vascular preparations in the form of infusions.
It Should be remembered that at the present time under the diagnosis "osteochondrosis" are often hidden nonspecific back pain (e.g., myofascial syndrome), arthropathy bootastic and other joints of the spine. This material does not describe how to treat compressive radiculopathy on the background of the herniated discs and spinal stenosis. What anti-inflammatory drugs are prescribed for back pain?
Anti-inflammatories – one of the most important parts of the treatment of pain (and reflex muscular-tonic with cervical, thoracic, lumbar osteochondrosis). As drugs of this group can be used of NSAIDs and glucocorticosteroids (GCS). Corticosteroids are usually appointed by the ineffectiveness of NSAIDs or proven autoimmune nature of the disease (e.g., ankylosing spondylitis), and osteoarthritis of the joints of the spine in the form of para-articular injection.
However, it is usually as anti-inflammatory agents during exacerbation used NSAIDs. Among the large number of preparations of this group the most studied and effective are as follows:
Base usually are celecoxib (trade name "celebrex"), meloxicam ("Movalis"), nimesulide ("Nimesil", "Nise", "Nimica"). All these drugs have only tablets, capsules or powder form for admission through the mouth. The effect becomes most pronounced around the third day after admission. So in the first 5 days (peak pain) can be assigned such injections as diclofenac, Ketorolac, Ketoprofen. Subsequently the patient is transferred to the underlying funds.
As used injectable form (injections) NSAIDs? You need to look at the table below.
All NSAIDs, shown in the table, have a selective effect, and therefore, have a significant impact on the gastro-intestinal tract (GIT) and can lead to bleeding.
Therefore, if you have patients with pain syndrome in the back of contraindications (chronic diseases of the stomach or duodenum, the disorder) these drugs should not use, and immediately move on to selective (meloxicam, celecoxib).
The Efficacy of different NSAIDs in treating the pain syndrome has been studied in the IMPROVE study (1), the results presented in the table below. Nimesulide in this study did not participate. However, in another clinical study of nimesulide is not inferior in its efficiency (the analgesic effect and incidence of side effects) celecoxib.
Thus, a range of NSAIDs on the efficacy and safety can be: meloxicam-nimesulide (celecoxib)-aceclofenac-diclofenac. It should be understood that the analgesic effect in the acute phase is usually more pronounced in the injection forms of Ketorolac and diclofenac.
|Name / trading name||% successful cases therapy|
|Meloxicam ("Movalis")||representing 86.8|
|Diclofenac ("Ortofen", "Voltaren")||42,4|
Muscle relaxants and antispasmodics
Muscle relaxants are almost always added to the treatment regimen for pain in osteochondrosis, especially when their duration is more than 6 weeks.
As osteochondrosis of the spine in everyday life is usually considered the presence of myofascial pain syndrome, or other nonspecific pain, muscle relaxants have their direct therapeutic effect, namely cropped pain and relaxes the back muscles and spine. What are muscle relaxants are usually prescribed for back pain?
The Main muscle,used to treat are listed below:
- Mydocalm ("Comparison") is injectable and tablet form.
- Sirdalud ("Titanyl", "Tizanidine", "Chiseled") – oral medication in the form of tablets, capsules and powders.
- Baclofen on the territory of the Russian Federation only in the form of tablets, abroad is available in injectable form (the"Galopin").
Muscle relaxants in Russia are mostly the kind of tablets, injectable form in this group has only mydocalm ("Comparison"). Mydocalm has as advantages over other drugs in this group the following features (3):
- does Not Express sedative effect.
- does Not cause muscle weakness.
Pregnant and lactating women with contraindications to the intake of muscle relaxants may be prescribed antispasmodics, although the effect is more associated with relaxation of smooth muscle. The most frequently prescribed:
Also antispasmodics can be assigned as injections with cervical osteochondrosis, severe headaches and dizziness.
The Basic scheme of application of these preparations are given in the table below.
Vitamins b and PP
Quite often as an auxiliary therapy of pain syndrome is assigned the b vitamins, generally, complex, and nicotinic acid (PP). Some authors recognize the fact that injections of vitamins In osteochondrosis of the lumbar spine contribute to a significant reduction in the duration of painful period (2), especially with combination preformed or injectable NSAIDs.
The optimal effect in the treatment has a joint appointment vitamins B1, B6, B12, therefore the most successful form are a combination of drugs, for example, "Milgamma".
The Main drugs and their applications are shown in the table below.
Chondroprotectors is quite a controversial group of drugs prescribed in osteochondrosis. At the present time their effectiveness has only been studied in relation to osteoarthritis, so treatment of this disease chondroprotectors present. Possibility of the use of chondroprotectors in osteochondrosis exists only when degenerative changes include osteoarthritis of the facet joints of the spine (CFC).
In this case, at the initial stage of the CFC chondroprotectors can be assigned. For other cases the efficiency of the use of chondroprotectors is not proven and is still under study and testing. The most commonly used protective agents that:
- "teraflex" – oral medication that contain glucosamine hydrochloride and chondroitin sulfate.
- "don" – in the composition as the main active ingredient glucosamine sulphate.
- "Structum" – the main active ingredient is chondroitin sulfate.
- "Alflutop" – composed of concentrate from different species of fish (chondroitin sulfate), amino acids, etc.
research has shown this group of drugs, the best way to apply them in osteoarthritis joints of the spine and paravertebral periartikulyarno (i.e. near the spine and the joints). Oral ingestion and intramuscular injection (injections at lumbar and thoracic osteochondrosis) less effective.
The Possible scheme of application according to the authors is given in the table below.
|Name||route of administration||Schema therapy what to expect from the application|
|"Alflutop" (1%, 1 ml)||Intramuscularly, periartikulyarno||1 ml once a day, a course – 20 days, can be combined with oral medication|
|"Dona" (0.4 g in 2 ml ampoule of solvent)||Intramuscularly, periartikulyarno after dilution with solvent contents of the ampoule||3 times weekly, duration about 1-1,5 month, can be combined with oral medication. Reduces pain, increases mobility in the affected joints, slows down the progression of osteoarthritis|
|"Structum" (0.1 grams per amp. And ampoule of solvent)||Intramuscularly, periartikulyarno after dilution in solvent||Stabbing after a day or 100 mg, 4-second injection 200 mg, only 25-35 per course. Repeat the procedure after 6 months. Combined with oral drugs. Slightly reduces pain, increases mobility in the affected joints|
Intravenous infusion of vascular drugs
Despite the fact that drips with osteochondrosis are not a mandatory component of treatment and usually do not occur, standards of therapy, often prescribed in medical practice.
Is usually performed if there are problems in the cervical spine accompanied by dizziness and headaches. In addition, vasoactive drugs is indicated for compression radiculopathy, but here it istreatment is not considered.
Among the major cardiovascular drugs, which are prescribed in the form of infusions and injections from degenerative disc disease of the cervical spine can be distinguished:
- Pentoxifylline ("Trental").
- Ksantinola nicotinate or sodium nicotinate (Niacin).
It is worth noting that these drugs in General are medicines with unproven efficacy. Trental (or cheaper pentoxifylline), as well as nicotinic acid and its salts have a vasodilating action, predominantly peripheral vessels (extremities, brain), so they prescribed for symptoms of vascular disease, sometimes accompanies the degenerative processes in the cervical spine.
Actovegin and Berlition related more to the angioprotectors and focused on improving metabolic processes in tissues. This actually Berlition was initially studied and designed for the treatment of diabetic angiopathy and neuropathy. Actovegin was also used in obstetrics.
In conclusion, it should be noted that any therapy, particularly medical, must be approved by your doctor. All injections are optimally performed in the conditions of the treatment room, which created a special environment is necessary for safety and prevention of complications postinjection.
- a Modern approach to the diagnosis and treatment of back pain. Barinov A. N. Russian medical journal.
- non-Steroidal anti-inflammatory drugs and b vitamins in patients with low back pain. Umarov Kh. Ya., Kamchatnov P. R., Z. H. Osmayev Russian medical journal.
- back Pain: painful muscle spasm and its treatment with muscle relaxants. V. A. Parfenov, T. T. Batyshev. The magazine "doctor", No. 4, 2003.
- Rational use of combined preparations of diclofenac with b vitamins in the treatment of dorsopathies. Badalian L. O., Savenkov A. A. Russian medical journal.