Areas of application of Trental (pentoxifylline) in neurology

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Shock wave therapy (SWT) is an excellent treatment for cervical osteochondrosis. It quickly stops the manifestations of the disease by reducing bone growths, accelerating metabolic processes, blood circulation, and tissue regeneration. The patient notices an improvement in well-being after one or two sessions. At the end of the course, he feels practically healthy, and if he follows the doctor’s recommendations, remission lasts for several years and even decades.

The essence of the method

The impact is carried out by a low-frequency acoustic wave, which has a high pulse pressure, the ability to create a rarefaction zone, and fast speed. Thanks to these characteristics, it does not damage soft tissues, working only in the desired area.

There are 3 stages of impact:

1. calm - no radiation;
2. high pressure, which can reach 500 bar;
3. rarefaction - that is, negative pressure after the wave subsides.

First, the sound wave compresses the cells in the area of ​​effect, and then they stretch under the influence of vacuum. The cells receive mechanical stimulation, come to life, and begin to synthesize useful substances. At the same time, angiogenesis and microcirculation improve.

Table 1. Effect of shock wave therapy for osteochondrosis of the cervical spine

As a result of the complex effect of shockwave therapy on the body, adhesions, fibrosis, and calcium deposits characteristic of cervical osteochondrosis decrease or disappear. The main action occurs in the area of ​​inflammation, the affected cells are destroyed.

The principle of action of the medicine

Trental is the commercial name. The international nonproprietary name of this medicine (INN) is pentoxifylline, and it refers to vasodilators, or vasodilators. Vasodilators reduce the thickness, or viscosity, of blood and also increase its fluidity. Pentoxifylline prevents red blood cells and platelets from sticking together into clots, or reduces their ability to aggregate. Under its influence, the activity of leukocytes decreases, their potential for adhesion to the internal vascular wall decreases. The level of fibrinogen in the blood plasma, which is the first plasma coagulation factor, decreases.

According to the chemical structure, pentoxifylline is a xanthine derivative, and the mechanism of action is associated with inhibition of the phosphodiesterase enzyme (PDE) in vascular smooth muscle cells, as well as in blood cellular elements. In addition to its effect on the blood, Trental slightly dilates the blood vessels, and all this ultimately leads to an improvement in capillary circulation, or to a more active functioning of the microvasculature.

When is shock wave therapy prescribed for osteochondrosis?

With osteochondrosis, the intervertebral discs become thinner. Their degeneration is accompanied by a whole complex of symptoms, especially if an intervertebral hernia has already formed.

• Dizziness.
• Pain in the neck, head.
• Ringing or noise in the ears.
• Periodic feeling of lack of air.
• Nausea that occurs when turning the head suddenly.
• Visual impairment: decreased visual acuity, floaters, fog before the eyes.
• Blood pressure surges.
• Fainting with a tendency to become more frequent.
• Feeling of a lump in the throat.
• Shoulder pain.
• Numbness in fingers.

Table 2. Characteristic syndromes of cervical osteochondrosis

Osteochondrosis of the cervical spine develops slowly over several years. The disease goes through several stages in succession.

1. Mild discomfort in the neck after a long stay in an uncomfortable position.
2. Pain may be present at rest, but stiffness may occur – difficulty moving the neck.
3. Other signs of damage to the cervical spine are added.
4. Turning the neck is almost impossible, the pain becomes exhausting, the patient often consults doctors due to a sharp deterioration in the quality of life, a pronounced dysfunction of the musculoskeletal system.

Indications for use

For what diseases is it necessary to improve microcirculation? Of course, first of all - in case of circulatory disorders in the periphery. These are severe atherosclerosis, obliterating endarteritis, vascular disorders associated with long-term diabetes. Of these, diabetic angiopathy is the best known. Pentoxifylline is also indicated in complex therapy in the treatment of chronic trophic ulcers, diabetic foot, and chronic venous insufficiency with symptoms of phlebitis and periphlebitis. Pentoxifylline is used for ischemic cerebral circulatory disorders, chronic retinal ischemia, and also for otosclerosis, when the patient develops signs of sensorineural hearing loss due to vascular disorders.

All this is wonderful, but where in the indications are herniated intervertebral discs and protrusion, or at least a more general diagnosis - osteochondrosis and its complications?

Treatment of neck osteochondrosis with shock wave therapy

UVT is effective at all stages of the disease. The procedure for cervical osteochondrosis lasts no more than 30 minutes. The patient lies face down on a couch or sits on a chair, resting his elbows and head on a high bolster. The doctor lubricates the skin at the site of exposure with sound-conducting gel - this makes the penetration of acoustic waves more effective.

Then he places the nozzle on the patient’s body and turns on the device. All settings are pre-selected individually, taking into account the patient’s characteristics.

You may experience some pain or discomfort during the first two sessions. In this case, the effect is interrupted. After the pain reaction subsides, it continues again. A total of 5–9 sessions are required with intervals between them of 3–10 days.

Table 3 Pros and cons of shockwave therapy for osteochondrosis

Does Trental help with protrusions and hernias?

The official instructions for the drug Trentala do not include such indications as protrusions and hernias, complications of osteochondrosis. Moreover: the instructions do not mention pathology of the musculoskeletal system at all. Trental is not used for these purposes. Why is Trental not able to help a patient with exacerbation of osteochondrosis, with symptoms of discogenic compression radiculopathy? Yes, simply because it affects completely different structures and processes that do not take part in the mechanism of development of spasm, swelling and pain during a hernia.

Almost sequestration.

Let us recall that a protrusion turns into a hernia under the influence of high pressure on the intervertebral disc. The resulting hernial protrusion exerts simple mechanical pressure on the surrounding structures. These are ligaments, nerve endings, and muscles. As a result of chronic irritation, swelling and an inflammatory reaction occurs in the corresponding segment, as well as in the tissues adjacent to the intervertebral disc.

Inflammation in the patient causes severe pain, and dysfunction of the nerve roots appears. They can be expressed in impaired sensitivity or movement; shooting pains appear at the slightest movement, similar to an electric shock. Additionally, the deep back muscles adjacent to the site of the lesion experience constant irritation, and react to it in the only way they know: contraction. Prolonged and intense tonic muscle contraction gradually disrupts the blood supply to the muscle, including the removal of waste products from it, primarily lactic acid.

The accumulation of lactic acid in the muscles again stimulates its spasm, thus forming a vicious circle. As a result, the patient, in addition to acute pain, also develops a chronic pain component. This chronic, aching pain. It is not sharp and shooting, but such muscle or myofascial pain is constant. It significantly reduces the quality of life and leads to persistent limitation of mobility in the back.

How to treat a hernia?

For drug treatment of an acute condition with a herniated disc, non-steroidal anti-inflammatory drugs, which reduce swelling and relieve pain, as well as centrally acting muscle relaxants, which reduce muscle tone by regulating nerve tone, are primarily indicated. Muscle relaxants affect neurons located in the spinal cord and responsible for the regulation of tonic muscle tension.

It may seem that using Trental or Pentoxifylline will improve muscle blood flow and relieve muscle spasm. Accordingly, the patient’s chronic back pain associated with myofascial syndrome will disappear. But, alas, in fact this opinion is wrong. Even if pentoxifylline makes the blood more fluid and the formed elements less active, capillary blood flow in the muscles will still remain impaired. After all, disorders of vascular tone and poor blood flow are not to blame for the spasm. It’s just that the muscle itself is intensely tense, and this mechanically narrows the lumen of small blood vessels, including capillaries. Therefore, it is primarily necessary to influence the regulation of muscle tone.

At the acute stage, the use of anti-inflammatory drugs, painkillers and muscle relaxants is quite sufficient. It is also possible to use blockades. The only thing you need to remember is the fact that warming procedures can be added to the treatment only after a day or two, when the intense back pain begins to recede and the patient can more or less move. This will mean that the inflammatory edema in the area of ​​protrusion or hernia is reduced, and then heating will contribute to the rapid resorption of this edema. If you prescribe thermal procedures immediately, on the first day, it will have the opposite effect and the pain will intensify. After all, swelling and inflammation are only growing, and heating only increases it.

If you open the website of the US National Library of Medicine, about 5,000 articles will be devoted to pentoxifylline. And almost all of them are about vascular disorders, diabetes mellitus, circulatory disorders in the heart muscle and kidneys, and various diseases associated with pathology of peripheral circulation. Trental is not used to treat a hernia in world medical practice.

Contraindications, side effects, overdose

However, since in our country Trental is sometimes prescribed for osteochondrosis, even if incorrectly, the patient should be warned about the dangers. Pentoxifylline is contraindicated in the following cases:

• decreased blood clotting;
• various hemorrhages;
• acute myocardial infarction, and other heart attacks (kidney, lung);
• pregnancy,
• in children under 18 years of age;
• breastfeeding.

It should be prescribed with caution in case of cardiac arrhythmias, low blood pressure and chronic heart failure. Long-term therapy with pentoxifylline may increase the risk of gastrointestinal bleeding in the presence of gastric and duodenal ulcers.

You need to be especially careful if Trental is prescribed after recent operations, against the background of the use of anticoagulants, in case of combined treatment with platelet aggregation inhibitors. A typical representative of this family of drugs is Clopidogrel, or Ticlopidine, as well as acetylsalicylic acid.

Trental, despite its effect on the peripheral capillary bed, may have various side effects. These are tachycardia, arrhythmia, rush of blood to the skin, dry mouth, leukopenia, skin itching, bronchospasm and even anaphylactic reactions. Therefore, even if the doctor prescribed Trental, then during the first days of taking it, dynamic observation is necessary, and all side effects should be taken into account. It should be remembered that Trental can “drop” blood pressure, especially if the patient is on antihypertensive therapy. If the patient is taking antithrombotic drugs, pentoxifylline may enhance their effect and, accordingly, increase the risk of bleeding.