The best drugs for osteochondrosis: what to choose?

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

Old age cannot be defeated, but you can make it more comfortable

Modern pharmaceuticals, not to mention cosmetics, accompany a person from his first birthday to the last day of his life. And if he has no diseases, he is not shown any medications, then there is always something for prevention. So, aspirin prevents heart attacks and strokes, hepatoprotectors help protect liver cells from stress in the modern world, chondroprotectors are designed to protect cartilage tissue.

For a long time this state of affairs seems familiar. There are a variety of diseases, or conditions, which it is beneficial for manufacturers to consider diseases. With some of them, people have long been accustomed to, and takes them for granted. Of course, we are not talking about serious illnesses, such as heart attack and stroke, but about safer conditions. Perhaps the most famous of these is osteochondrosis.

Our story today is devoted to osteochondrosis, we will try to consider this nosological unit from all sides, and draw a conclusion: whether it is necessary to treat osteochondrosis, what can you spend your money on, and which popular medicines or supplements do not make sense to purchase. We will try to present information in such a way that there are no ambiguities left, and we will begin with a definition of what osteochondrosis is.

What is considered osteochondrosis?

Title diagnoses are subject to strict law. All inflammations end in '-it', for example, bronchitis, thrombophlebitis. On '-oz' diagnoses end, which speak of proliferation, increase of any tissue in the body. For example, phlebothrombosis is a condition in which there are many blood clots in the veins, amyloidosis is the accumulation of the pathological amyloid protein in the tissues, and chondrosis is a pathological change in cartilage tissue, including in the places of its contact with bones. After all, the cartilage along the edges is attached to the bones, ensuring their mobility and forming joints. Osteochondrosis of the spine is understood as pathological changes in numerous intervertebral discs, which serve as cartilaginous spacers between the vertebrae, providing shock absorption and comfort of movement in the back.

What happens to the cartilage in osteochondrosis? Foci of dehydration and calcification appear in them, the discs gradually become more fragile, thin and brittle, the range of motion in the back gradually decreases with age, and as a result, in an elderly person, even the growth becomes a little lower than in youth. The areas of the spongy bone substance of the vertebrae adjacent to the cartilage also undergo changes: due to the increased load that irritates the growth zones of the bone, so-called osteophytes, or coracoid growths along the edges of the vertebrae, are formed.

The further osteochondrosis goes in its development, the more changes the vertebrae experience. Osteochondrosis among diseases is not inflammatory, but dystrophic and degenerative, that is, associated with a gradual deterioration in the nutrition of cartilage tissue, and a deterioration in their function. But let's ask ourselves: is the gradual, inevitably age-related deterioration in the function of a tissue always a disease?

Is osteochondrosis a disease?

If you come to the Institute of Physical Education and ask students who cannot be called sick people to go to the clinic and take an X-ray of the spine, what will be found? It will be found that in every person who has reached the age of at least 23-24 years, the roentgenogram will show certain, still very delicate signs of spinal osteochondrosis.

The older the person, the more such signs are: first on the X-ray, and then in the clinic, that is, actual complaints appear. In old age, you can rarely find such a person who would not complain of back pain, a feeling of stiffness, or at least the fact that he became not as flexible as in his youth, this is natural. Therefore, osteochondrosis can be considered not a disease, but a natural aging process of the musculoskeletal system. Why does osteochondrosis of the cartilage of the elbow, shoulder and wrist joints not occur, but basically everyone is talking about the spine? Dystrophy and degeneration affects all things, but those that have the greatest stress wear out the most. And here we are talking primarily about the ankle joints, knee, hip, and small joints between the vertebrae.

But not only the level of load determines the risk of changes in cartilage and surrounding bone tissue. For example, the ankle joint experiences the maximum load. While running, it carries the entire weight of the whole body, with the exception of the weight of the supporting foot. But at the same time, the ankle joint is block-shaped, and makes movement only in one frontal axis, only its flexion or extension is possible. This 'narrow' specialization allows him to maintain his function throughout his life.

The intervertebral discs already have three degrees of freedom, and a person can bend the back forward and backward, as well as perform lateral tilts. In addition, you can turn around the vertical axis while standing in one place. Thus, each intervertebral disc can have an uneven load on its edges, which, in the end, when exposed to a critical force, will lead to its destruction, a protrusion or herniated disc will form.

If we consider osteochondrosis a disease, then this disease will turn out to be very interesting: only a person is always sick, and the older he is, the more often he suffers from 'chondrosis'. It is impossible to study osteochondrosis in laboratory animals, since they do not get sick with it. Other mammals do not have such signs of osteochondrosis. This is due to the fact that almost all of them use four limbs for movement. Even the great apes do not always walk on two legs, this is done only by humans, making upright walking the only way to move.

Walking upright is a unique adaptation of the human body, which had its task to free the hands and make them a tool of labor. Now, on one side of the scales – progress, civilization, and on the second – osteochondrosis. Therefore, osteochondrosis, and varicose veins of the lower extremities, flat feet, and poor posture can also be considered purely human diseases, a payback for civilization. After all, marine mammals, our closest relatives – dolphins, whales and killer whales do not have any signs of osteochondrosis at all, since they have no load on the axial skeleton. In predators – lions, tigers and cheetahs, the spine is also practically not loaded, but sags, and only at the moment of an attack or a jump, the intervertebral discs use increased pressure, but it does not last long.

It turns out that we cannot find analogues of osteochondrosis in wildlife. Therefore, osteochondrosis can be considered a unique manifestation of aging of the musculoskeletal system, inherent exclusively in humans, which is a consequence of prolonged upright posture. If you don't want osteochondrosis, crawl on all fours your whole life, or live in the sea like Ichthyander.

What then to treat?

But this does not mean at all that osteochondrosis and its manifestations do not need to be treated and prevented. The patient has acute and chronic back pain, limited range of motion, and reduced quality of life. All these unfavorable signs can be significantly alleviated, and if you set yourself the task of maintaining activity for many years, then prevent it. Therefore, you need to immediately correctly name the object of treatment: this is not a person suffering from osteochondrosis, the doctor does not treat osteochondrosis, but the consequences caused by it.

Medicines can relieve pain syndrome, secondary muscle spasm of the deep muscles of the back, eliminate acute radicular symptoms when edema and shooting pains occur. It is possible to successfully fight against aseptic inflammation, but it is impossible to eliminate osteochondrosis as an aging process. In addition, it is impossible with the help of chondroprotectors to reverse the wheel of history and make the 'ancient' intervertebral discs elastic and resilient again. This is about the same as trying to turn the minced meat back and get a piece of meat again at the exit from the meat grinder. It's impossible. Nevertheless, there is a giant pharmaceutical industry that 'serves' osteochondrosis from all sides, and first of all – this is a huge number of various chondroprotectors that are very successfully sold.

About drug aggression

Osteochondrosis is a very 'tasty' and profitable disease, in which manufacturers literally produce a huge number of various nutritional supplements and drugs that are not drugs. Why is osteochondrosis very beneficial for pharmaceutical companies? First of all:

1. it flows for a very long time, for tens of years, the first signs appear at a mature, sometimes young age, and almost until the very death a person can acquire one or another product;
2. there are no serious complications and emergencies that can end in death, and which really need to be treated with real medicines. Osteochondrosis of the spine is not intestinal bleeding, not peritonitis, and not extensive heart attack, so it is much safer to deal with it;
3. It is impossible in principle to cure osteochondrosis and return youth to the cartilage, just as it is impossible for an elderly person to put new vessels free of cholesterol plaques, therefore the success of constant purchases and 'eternal' treatment, and most importantly – financial investments are guaranteed '
4. safety: chondroprotectors are harmless, since they consist of chondroitin sulfate and glucosamine, these agents can be considered 'concentrated jellied', or aspic meat from pork legs in capsules or tablets. There will not be much harm even from their overdose. This means that there will be no lawsuits for side effects;
5. the medicine must not be strong and must be sold without a prescription;
6. the product must be cheap to manufacture;
7. Finally, it is very important that there is no quantitative assessment of the effectiveness of these drugs. If we are taking a medicine for blood pressure, then the criterion of effectiveness will be a decrease in pressure numbers, if we are treating hyperthyroidism, then as a result of taking a good drug, the level of thyroid hormones will decrease to normal values, and so on. In the case of osteochondrosis, the main criterion is to increase comfort, freedom of movement, and relief of pain.

But the severity of the pain syndrome is a subjective feeling. It cannot be measured. In two patients with the same intensity of pain syndrome, the sensations of pain may be different. If one receives the good news that a long-awaited addition has arisen in his family, the pain will become easier to endure against the background of a good mood. If, on the contrary, the second patient was sent the bad news that his house was robbed, then one can imagine that in the first patient the emotional coloring of pain will lead to a decrease in its intensity, and in the second patient – to a significant deterioration.

Therefore, all these tricks, associated with the assessment of pain in an arbitrary way, allow pharmaceutical companies to catch fish in troubled waters, add non-steroidal anti-inflammatory compounds to chondroprotectors. They certainly relieve pain and reduce inflammation, and no one is going to abandon this market, since the inflated problem of osteochondrosis is billions of dollars in revenue for pharmaceutical companies, and, moreover, completely safe.

Osteochondrosis and vitamins – these are two whales, due to which pharmaceutical companies can exist, and completely comfortably. There is no need for modern expensive research, multibillion-dollar spending on pharmaceutical factories, on molecular genetic technologies.

Such an impressive preface was necessary in order for the reader to fully appreciate the taste of the problem of osteochondrosis, and its exorbitant significance. Before moving on to a small group of drugs that really work, let us recall what are the real causes of this suffering, and how this pathology manifests itself.

Causes and symptoms

Since we now know that osteochondrosis as aging of discs is an inevitable process, we will not talk about the causes of osteochondrosis as a disease, but about the reasons that accelerate the onset of old age of intervertebral discs, and make this old age uncomfortable. This is the presence of flat feet, a large overweight, a sedentary lifestyle and lack of physical activity, restriction of clean water in the diet, the wrong set of food. If a person does not receive fiber, fish, meat, vitamins, but tries to eat fast food, sweet fizzy carbonated drinks, refined foods, including canned ones, then this not only disrupts cartilage trophism, but also leads to suffering of the whole organism.

Bad habits, improper carrying of weights, hypothermia also accelerates disc aging. Of course, one cannot discount congenital disorders, changes in the structure of bones and cartilage tissue, scoliotic deformity, stoop, which lead to premature wear of the intervertebral discs. But if we talk about the average person, then the onset of osteochondrosis is entirely on his conscience, since he himself is to blame for this, and the wrong way of life. Anyone who tries to eat right, does gymnastics, goes in for swimming, has every chance of a long and active life.

How is 'chondrosis' manifested?

And now, when we know that osteochondrosis is the aging of the spine and its auxiliary apparatus, it will not be difficult for us to name all the main symptoms ourselves. First of all, these are:

1. limitation of mobility, this is the need to 'disperse' in the morning and after sleep. In the morning, especially in old age, it is difficult for the patient to get out of bed and start moving, and after 2-3 hours he gradually gets into shape;
2. chronic, aching back pain, most often in the lower back, which leads to limited range of motion. These are more intensified and provoked after a sudden movement and especially after hypothermia. The cause will be chronic muscle spasm.

Perhaps these are the main signs of such a sluggish process. It can be argued that there are still sharp, shooting pains when a person can neither breathe nor turn, resembling an electric shock.

It can be said that with osteochondrosis 'quite often' patients are worried about headaches, attacks of dizziness, nausea and vomiting, there is a violation of sensitivity, crawling 'creeps' and numbness of fingers and toes, and even progressive muscle weakness, that is, lethargy, or peripheral paralysis.

Yes, all these symptoms can also occur, but only with complications. This is the presence of protrusions and hernias with compression of the nerve roots, damage to the spinal cord, or myelopathy, cauda equina syndrome, which causes numbness of the perineum, urinary disorders and erectile dysfunction.

But all these conditions are no longer normal, calm aging of the spinal apparatus, but complications. Such patients need the advice of a neurosurgeon regarding the need for surgery. Indeed, with the progression of neurological symptoms, all conservative therapy, all medications, physio, exercise therapy will be ineffective. Moreover, if the above-described progressive symptoms bother you, then you need to contact a neurosurgeon first of all, after the MRI of the spine.

Now consider a few of the medicines that can help a patient with acute and chronic back pain. This will be more correct than looking for a panacea for a hypothetical osteochondrosis as a disease.

Treatment

It is known that non-steroidal anti-inflammatory drugs play the main role in the treatment of diseases of the musculoskeletal system with the help of drugs. In osteochondrosis, inflammation does not primarily lie at the basis of the pathological process, but it completely joins, so to speak, in the course of action. Changes in the configuration of cartilage, the appearance of protrusions, the proliferation of osteophytes lead to compression of the nerve roots, the appearance of an inflammatory focus, edema and the appearance of classic signs of inflammation. Therefore, it is NSAIDs, in the form of tablets, injections, in the form of local preparations, ointments, creams and gels that are used in the first place.

Also, to remove the secondary muscle component – spasm and improve blood circulation, a group of centrally acting muscle relaxants, a complex of B vitamins, which are called neurotropic, and other drugs are used. We have already described many representatives of these groups many times, so we will limit ourselves only to such drugs that have not yet been mentioned.

The best drugs for osteochondrosis: what to choose?

Nomination	a place	Name of product	price
Coxibs	1	Arcoxia	439 r
Local NSAIDs	1	Dimexide	RUB 71
Muscle relaxants	1	Tolperisone (Midocalm)	353 r
	2	Tizanidine (Sirdalud)	RUB 185

Coxibs

Arcoxia

Rating: 4.9

Arcoxia is not only a modern NSAID, a selective inhibitor of type 2 cyclooxygenase, but the drug also exhibits a high degree of selectivity. Almost 95% is a bond with the desired enzyme isoform (COX-2). That is why this drug is safe, and can be used even in patients with compromised mucous membranes of the stomach and duodenum, that is, in patients with various forms of gastritis and even gastric ulcer, albeit in remission and covered with certain drugs (Omeprazole). Etoricoxib, or Arcoxia, is capable of inhibiting cyclooxygenase in a dose-dependent manner. However, it has no effect on the first type of enzyme, which is influenced by very 'ancient' drugs, such as Diclofenac.

After taking a standard dose of Arcoxia, the maximum plasma concentration occurs in an hour. The drug is processed or metabolized in the liver, and even its metabolites do not affect type 1 cyclooxygenase.

Like other drugs from the NSAID group, etoricoxib is indicated for the treatment of pathology of the musculoskeletal system. These are various forms of osteoarthritis, pronounced inflammation in systemic pathology (rheumatoid and ankylosing spondylitis). Arkoksia is also shown as a symptomatic treatment of pain syndrome associated with inflammation in gouty arthritis and complicated forms of osteochondrosis.

Arcoxia copes with pain and inflammation, but breaking the inflammation mechanism and easing symptoms does not mean eliminating the cause of the inflammation. Therefore, this drug should be prescribed best of all in short courses, in the first days after the onset of acute pain in the back, or in the lumbar spine. A therapeutic dose that relieves pain in intervertebral hernias well is no more than 90 mg once a day, and after the relief of acute pain, the drug is prescribed at a dosage of 60 mg once a day. The duration of therapy with the drug Arcoxia should not exceed a week.

An immutable law applies to this drug, which can be applied to all drugs from the NSAID group. The dose should be as small as possible and the treatment course should be as short as possible.

It should be mentioned that Arcoxia, as well as other drugs from the coxib group, are not available in ampoules for parenteral administration. Therefore, in the case of acute back pain, especially on the first and second days, that is, during the onset of an intervertebral hernia, or its pronounced exacerbation, injectables can be used first, the same Movalis or even Ketanov.

After two to three days of using injectable drugs, you can switch to pills, and here etoricoxib will be both a powerful and safe drug at the same time.

Contraindications

1. Contraindication to use is:
2. a universal combination of bronchial asthma, sinus polyposis and aspirin intolerance;
3. a history of ulcerative bleeding;
4. active state of erosive gastritis or gastric ulcer and duodenal ulcer;
5. exacerbation of inflammatory bowel diseases such as Crohn's disease or ulcerative colitis;
6. hemorrhagic syndrome and hemophilia, decreased blood clotting;
7. severe renal and hepatic impairment;
8. high blood pressure numbers.

The drug Arkoksia is contraindicated during pregnancy and during breastfeeding, as well as for children and adolescents, boys and girls under the age of 16. The drug can be used, but carefully if there is a history of ulcers, Helicobacter pylori infection, in persons with diabetes mellitus and chronic alcoholism, as well as in persons taking anticoagulants, such as Warfarin, or antiplatelet agents, such as Curantil, clopidogrel or acetylsalicylic acid.

Local NSAIDs

Dimexide

Rating: 4.9

Dimexide, or dimethyl sulfoxide, has been known to science for over 150 years. Industrial production of dimexide began in 1960, when chemists became interested in it, since it is a very good non-protic bipolar solvent. Accordingly, the number of publications in scientific journals increased, and the newly discovered beneficial properties of Dimexidum began to be widely used in medicine.

Dimexide is used only externally, and is a completely separate anti-inflammatory agent, not belonging to the well-known group of NSAIDs. The action of Dimexidum is a local mild anesthetic, mild antiseptic (antimicrobial), and fibrinolytic, which promotes the resorption of hematomas and bruises.

With the application of Dimexidum, inflammatory tissue edema decreases, due to an increase in microcirculation and an improvement in outflow from small veins. The fact is that Dimexide has a local irritant effect, and increases blood flow to the capillaries, and, accordingly, outflow. Dimexide also improves the activity of neutrophils, which destroy harmful microorganisms (in tissues they are called macrophages), and reduces the content of immune complexes in the peripheral blood.

It is very important that Dimexide is not toxic and does not accumulate in the body, that is, it is not capable of cumulation. If you moisten a napkin with Dimexide and apply it to the skin, that is, apply the drug, then after 10 minutes Dimexide appears in the blood serum, and reaches its maximum concentration peak, on average, after 6 hours. After two days, Dimexide is completely excreted from the body without residue, through the kidneys.

An interesting feature of Dimexide can be considered its release through the lungs, with exhaled air. We all know the unpleasant smell of 'fumes' from people who have consumed large quantities of alcohol the day before. This is because ethanol is metabolized in the body and also excreted by the lungs. Dimexide also leaves the body with exhaled air, but only in the form of a restored form, and therefore, if the patient is intensively treated with Dimexide, then it smells of garlic. This is due to the presence of sulfhydryl groups, which provide a specific smell in both cases.

Indications for use

The solvent properties allow Dimexide to penetrate many tissues, which are biological barriers, through membranes, and it is absorbed deep into the skin. That is why it is most indicated in the treatment of diseases of muscles and joints, that is, in the pathology of the musculoskeletal system. The analgesic and anti-inflammatory effect, the improvement of microcirculation, the decrease in the release of biogenic amines, such as histamine and bradykinin in the inflammation focus, as well as the antiseptic and fibrinolytic effect – made it irreplaceable in the treatment of other diseases of the musculoskeletal system. The combined use of Dimexide with other drugs, for example, with electrophoresis, leads to an increase in their effect. Dimexide in this case is a conductor through the skin of many drugs.

The main indications for topical use of dimethyl sulfoxide are:

1. rheumatoid arthritis;
2. injury to tendons, ligaments and soft tissues, bruises, accompanied by edema;
3. ankylosing spondylitis (ankylosing spondylitis);
4. radiculitis and intercostal neuralgia, sciatica;
5. discogenic complications of osteochondrosis (protrusion and hernia).

It should be especially emphasized the effectiveness of the use of Dimexidum for infectious and inflammatory skin diseases, such as erysipelas, furunculosis, streptoderma.

Dimexide for complications of osteochondrosis

Rating: 4.8

Of course, Dimexide does not cause any disappearance of hernia. How to immediately and permanently cure a disc herniation is described at the end of the article. Dimexide acts in the same way as injections and tablets. Let's recall a little pathological physiology.

With the development of protrusion, and especially a herniated disc, it begins to exert pressure on the surrounding ligaments, muscles, and nerve roots. Due to the fact that a person tilts, turns, bends the spine, the hernial protrusion begins to produce not only static pressure, but also mechanical constant irritation of soft structures in the same way as hard shoes do, leading to the appearance of calluses.

In the case of a hernia, aseptic, that is, non-microbial inflammation develops, associated with a physical traumatic factor. Edema of the soft tissues appears, there is a deterioration in the blood circulation of the deep muscles of the back in this segment, their spasm occurs, and persistent and prolonged secondary muscle pain appears. You can even feel the hardened tubercles of the spasmodic muscles, and this phenomenon is called myofascial-tonic syndrome. It is he who causes chronic back pain.

In addition, edema compresses the nerve roots, which leads to the development of neurological symptoms: acute attacks of back pain, similar to electric shocks, such as lumbago, as well as conduction disorders, such as radicular-type sensory disturbances: 'creeping in the legs' and numbness in stripes like stripes.

In this case, the effect of using this agent will be exactly the same as that of taking non-steroidal anti-inflammatory drugs. The main effects of Dimexide are as follows: reduction of inflammatory manifestations, reduction of edema. Reducing edema leads to the elimination of lumbago, since the nerve roots cease to experience excessive compression.

But the main effect of Dimexidum is the effect on the deep muscles of the back. Secondary myofascial syndrome resolves, muscle microcirculation is restored, and muscle spasm disappears. This improves the quality of life and increases the range of motion in the back. In addition, Dimexide slightly warms up the deep layers of the skin, and this is also an additional therapeutic effect.

How to apply?

Dimexide can be used only locally, in the form of lotions, compression bandages, and it is applied only to the skin, and not to mucous membranes. Pure Dimexide cannot be applied immediately, and most often a 50% solution diluted in half with water is used. In the event that we are talking about sensitive areas of the skin, then Dimexide should be diluted even more.

First, before the first treatment, it is necessary to check the skin for sensitivity. To do this, it is necessary to apply Dimexide, diluted in half with water, to the area of ​​the wrist or elbow bend and wait 10-15 minutes. If there is no reaction in the form of itching, intense redness and irritation, then treatment can begin.

Dimexide, diluted in half with water, is moistened with a gauze napkin, or a clean small cotton towel. It is applied on the back, in the area of ​​the affected disc with the capture of adjacent vertebrae. Usually, a square napkin of 2020 cm is enough. Above the moistened napkin, cover with a waterproof cellophane or plastic wrap, and put a dry towel even higher. Thus, conditions are created for the accumulation of heat and a more effective effect of Dimexide. The duration of the application is from 20 to 30 minutes, the procedures are carried out daily, for 1-2 weeks. Since the skin of the back, and especially the lower back, is thick and insensitive, some patients can dilute Dimexide in the amount of 1 part of the drug in 0.5 parts of water, or use an even stronger solution, up to a pure preparation without dilution, but you always need to start with half concentration, observing gradualness.

Contraindications and side effects

Dimexide has a fairly large number of side effects and contraindications. It is forbidden to use it in children under 12 years old, pregnant and lactating women. It is forbidden to use it for strokes, and especially in the acute period. Contraindications include ischemic heart disease, myocardial infarction, angina pectoris, and severe hepatic and renal failure.

When prescribing, it should be remembered that Dimexide can enhance the effect of local drugs, and not only their effect, but also their toxicity, if any. In some cases, there may be redness of the skin after removing the bandage, and even the phenomenon of contact dermatitis. In the treatment area, pigmentation may gradually increase and the skin may become dry. The patient may experience a slight burning sensation. The air exhaled by the patient will smell of garlic, and in some cases, with poor tolerance, there may be bronchospasm and difficulty in exhaling. Naturally, there are patients who simply do not like the smell of this product, and it seems to them nauseous.

Release form, vacation, shelf life, price, analogues

Dimexide is currently available in pharmacies in two forms, both for topical use. The most famous and long-established form is a concentrate for solution preparation in 100 ml and 50 ml vials. The price of a large bottle ranges from 33 to 50 rubles, and the cost of a small bottle ranges from 35 to 75 rubles. Here's an interesting pricing policy. There is also a second form, Dimexide in the form of a gel. It is more convenient to apply, and one tube weighing 30 grams, containing 25% Dimexide, costs from 140 to 178 rubles in pharmacies.

These prices are relevant for pharmacies of all forms of ownership in large cities of the Russian Federation as of November 2019.

As for any analogues, Dimexidum does not have them. This means that this tool has no other names, and it will not work to get confused, or by mistake to buy something wrong. Dimexidum is produced in vials by the domestic Tula pharmaceutical factory, as well as by JSC Tatkhimpharmpreparaty, Iodine Technologies and Marketing, and some other manufacturers. Dimexidum form in the form of a gel is produced by the Russian pharmaceutical company Pharmamed LLC, as well as by a number of other manufacturers. There are no import manufacturers of Dimexidum in Russia. Any Dimexidum is of domestic production. You can buy Dimexide without a prescription, it is stored at room temperature, but no longer than 2 years.

Muscle relaxants

Treatment of acute back pain will not be complete without prescribing muscle relaxants. By eliminating secondary muscle spasm, they improve blood circulation, and help to reduce the severity of chronic back pain, which often accompanies to a greater or lesser degree even a state of remission with protrusions and hernias.

Currently, the following muscle relaxants are most often used: Mydocalm and Sirdalud. The advantage of Mydocalm is that it can be used in the first days of the development of acute pain, since it is available not only in tablets, but also in ampoules for intramuscular injections. This form of release is called 'Midocalm – Richter'. Tizanidine, or Sirdalud, is not prescribed in the acute period, since it is available only in tablets. Other drugs that have a strong and rough effect, such as Baclofen, are not used to treat acute back pain with protrusions and hernias.

Tolperisone (Midocalm)

Rating: 4.9

Tolperisone is the original drug Midocalm, produced by the Hungarian pharmaceutical company Gedeon Richter, in packs of 5 ampoules (1 ml). In addition to tolperisone, lidocaine was added to the solution to relieve pain, since tolperisone alone is painful enough when injected intramuscularly. This package costs 475 rubles.

Lidocaine belongs to the group of central muscle relaxants, and affects the special reflexes of the spinal cord. As a result, reflex readiness in the reticulospinal tract decreases and peripheral blood circulation in the muscles increases. Along the way, tolperisone has a slight antiadrenergic and antispasmodic effect.

This drug is indicated for all conditions in which there is a spasm and increased tone of the striated muscles. This is not only acute and chronic back pain, but also stroke, multiple sclerosis, muscle spasticity in arthrosis of large joints. It is also used in complex treatment after traumatological operations. It is necessary to apply Mydocalm intramuscularly, one milliliter twice a day. Contraindicated Mydocalm in severe forms of myasthenia gravis, during pregnancy, breastfeeding, as well as in children up to 18 years of age.

Tizanidine (Sirdalud)

Rating: 4.8

Sirdalud is available only in tablets, which means that it is undesirable to use it in the first days with a particularly severe pain syndrome. Its task is soft, supportive therapy during a period of damping exacerbation, when the pain is no longer so strong, and the secondary myofascial syndrome is still preserved.

Sirdalud produces a noticeable side effect: it is advisable not to apply it to people who drive a car, since Sirdalud causes drowsiness, and very often. But if it is assigned to those for whom back pain prevents sleep, then this is a fairly effective solution.

It must be remembered that tizanidine should be withdrawn slowly, especially if the treatment has been prolonged. If it is abruptly canceled, then the patient may have an increase in blood pressure, and an attack of tachycardia may develop. If you know about these features of the drug, then it can be used for protrusions and hernias for 10-12 days, and then transfer the patient to hardware, or manual physiotherapy and swimming. Sirdalud is produced by Novartis, and a pack of 30 4 mg tablets costs 300 rubles.

What is not treated with osteochondrosis, protrusion and hernia?

It should be clarified right away that in the Russian Federation there is no way to treat even very severe acute back pain caused by a hernia with narcotic analgesics, for example, by applying a Durogesic plaster. What is used in developed countries, such as the USA, Great Britain, Israel, where hernia treatment is carried out according to modern standards and with great efficiency, is practically impossible in Russia. A doctor who has prescribed Durogesic for acute and intractable back pain at least runs the risk of being unemployed, and, in extreme cases, draws the close attention of the relevant authorities.

It is also not customary to treat intervertebral hernias and osteochondrosis with drugs called antispasmodics. For example, Baralgin or No-shpa will be ineffective, since they mainly relax the smooth muscles of the internal organs, and have nothing to do with the muscles of the back, although they relieve spasms in case of cholelithiasis.

It is useless to 'treat' an intervertebral hernia with analgin, and other 'ancient' drugs. Aspirin, all types of acetylsalicylic acid, and paracetamol will not have any effect on pain. Their task is to lower the temperature. By the way, with an exacerbation of osteochondrosis and the appearance of back pain due to protrusions and hernias, the temperature never rises.

If fever occurs against the background of back pain, then this is possibly a serious sign of exacerbation of pyelonephritis, the presence of atypical forms of cholecystitis and appendicitis with irradiation to the back, and other serious diseases.

Do not treat osteochondrosis, protrusions and hernias using various angioprotectors such as pentoxifylline, trental and others. Their task is to improve capillary microcirculation in diseases such as diabetes mellitus, Raynaud's syndrome, and so on. Since the intervertebral cartilage is generally devoid of any vessels, it makes no sense to use them. And it makes no sense to improve microcirculation in spasmodic muscles, since at first the muscle spasm should be relieved (using muscle relaxants), and then the muscle itself will cope without additional funds.

Various 'droppers' or intravenous infusions are not shown: after all, the primary task is to relieve inflammation and remove swelling, and the addition of fluid to the body prevents this, and can only increase the pain. True, in some cases on the first day with acute back pain, you can additionally relieve swelling by prescribing mild diuretics that will not harm the heart and retain potassium in the body. So, the patient can be prescribed spironolactone (or Veroshpiron) for one or two days for this purpose.

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