Causes of pain
There is a division of causes that cause pain - they are natural and pathological.
Natural causes include muscle fatigue resulting from physical activity.
The list of pathological causes is much wider:
- osteochondrosis - can be lumbar, cervical, thoracic;
- presence of intervertebral hernia;
- damage to the joints of the spine;
- radiculitis;
- rheumatism;
- osteoarthritis.
The most common cause of back pain is damage to the skeletal muscles in acute and chronic forms. The development of the disease occurs due to pinching, squeezing and hypothermia in the cold season.
Indications for use of ointments
Ointments for back and lower back pain are used as individual therapy when feeling discomfort, expressed in varying degrees of pain.
Problems appear during the period of exacerbation of chronic pathological disorders when weather conditions change and the body becomes hypothermic. Moderate pain is characterized by minor muscle inflammation and pinched nerve endings.
When choosing an ointment for an individual prescription to a patient, the doctor must take into account the circumstances that caused the discomfort:
- homeopathic medicines with anti-inflammatory effects are prescribed to treat the inflammatory process;
- drugs that have a warming effect are prescribed for the treatment of osteochondrosis and spondyloarthrosis;
- ointments with the effect of local irritation - used to treat pathological changes with moderate pain.
To prescribe a specific drug, it is important to make the correct diagnosis.
Gel and ointment for gums - application diagram
The standard course of anti-inflammatory therapy for gingivitis and periodontitis takes 10 days.
This course should include - 1) antiseptic rinses, 2) gel applications on the gums, 3) anti-inflammatory toothpaste. Usually 10 days is enough if you went to the dentist and had dental plaque removed. Remember that it is supra- and subgingival dental plaque (consisting of pathogenic bacteria) that causes gum inflammation. Therefore, the most important thing you can do before starting a course of gum gel applications is to go for ultrasonic teeth cleaning. If you use the gel for gum inflammation without removing plaque, then such anti-inflammatory therapy will only have a short-term effect. Carrying out a course of antiseptic rinses and gel applications on the gums is quite simple, using our recommendations. Let us remind you that the author of the article is a dentist with 20 years of experience, of which at least 10 years were devoted to periodontal treatment (treatment of gum inflammation, open curettage and flap operations).
Anti-inflammatory therapy regimen –
Gum treatment is carried out 2 times a day (morning and evening). It looks like this: first you have breakfast, then you need to brush your teeth and after oral hygiene, perform an antiseptic rinse. You need to rinse your mouth with chlorhexidine for 1 minute, but if you use “Parodontocid mouthwash” with anti-inflammatory components, then you can do it for 2-3 minutes (after rinsing your mouth, do not rinse your mouth with water under any circumstances).
If you rinsed your mouth with chlorhexidine, then the gel can be applied to the gums immediately, but if you rinsed your mouth with periodonticide, it is better after 5-10 minutes. This is due to the fact that after rinsing with chlorhexidine, a layer of chlorhexidine bigluconate is formed on the teeth and gums, which cannot be washed off by saliva, which will be effective for up to 7 hours. And after rinsing with periodonticide, such a layer does not form, but after spitting the solution in the oral cavity, its high residual concentration still remains for some time (and you need to give it time to act on the gums).
Next, we proceed to applying the gel to the gums -
The gel should be applied to the marginal gum around the necks of the teeth and interdental (gingival) papillae. The gel should be applied to the gums - both from the front surface of the teeth and from the side of the tongue/palate. It would be optimal if you dry the gums with a dry gauze pad before applying the gel, because in this case, the gel will adhere better to the mucous membrane. Next, there are 2 options for applying the gel.
Firstly, you simply squeeze out portions of the gel onto your finger and apply them to the gums around the necks of the teeth. Or the second option - you first rub a small portion of the gel into the gum, and then re-apply another portion of the gel onto it and leave it alone (without massaging). During the application of the gel, as well as after treatment, you will produce saliva - no need to accumulate it or spit it out. Behave as usual, swallowing a portion of saliva, as it happens in normal life (swallowing part of the gel is absolutely harmless).
Next, it is very important - you should not rinse your mouth or eat food for several hours (it is advisable not to even drink for at least 30 minutes). The second session of applying the gel to the gums is carried out in the evening - according to the same scheme, i.e. after eating and oral hygiene, after which it is already carried out - first rinsing the mouth with an antiseptic, and it all ends with applying the gel to the gums. And so on for 10 days.
Important: in parallel, there must be very good proper oral hygiene, which should include not only toothbrush and toothpaste, but also, ideally, dental floss. If teeth are brushed irregularly or poorly, there will still be a lot of microbial plaque on them, and there will also be food residues in the interdental spaces. And in this case, treatment will be ineffective. For the rules of oral hygiene, see the link below, but if you are not ready for such rules, gum inflammation will be your constant companion.
→ How to brush your teeth properly
Contraindications for use
Absolute contraindications for the use of anesthetic ointments include sensitivity to the constituent components of the drug.
A large proportion of anesthetic ointments for back pain are contraindicated for children and adolescents, pregnant and lactating women.
The presence of injuries, damage or violations of the integrity of the skin (burns, scratches, cuts, dermatitis) on the skin is a contraindication for applying an external product.
Local irritation preparations with a warming effect are approved for use during the period of reducing the exacerbation of the inflammatory process in order to avoid increased pain with further spread to healthy tissues.
Warming ointments contain red pepper extract, as well as bee and snake venoms. Therefore, the use of such an ointment for dry, thin and sensitive skin is contraindicated, as a chemical burn may occur. A replacement for such drugs are drugs with an analgesic or cooling effect.
To relieve discomfort in the back or lower back, pregnant women are prescribed painkillers only after examination by a doctor. The safety of drugs for expectant mothers is determined taking into account the threshold of susceptibility to the individual components included in the ointments or gels.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are analgesics that exhibit three effects: analgesic, antipyretic and anti-inflammatory. At the same time, the notoriety about the bad effect of these drugs on the stomach literally haunts them.
We will understand the features of the principle of action, indications and, of course, the safety of NSAIDs in the second article in the series on analgesic drugs.
NSAIDs include:
- salicylates - acetylsalicylic acid;
- pyrazolones - analgin;
- derivatives of organic acids - ibuprofen, naproxen, ketoprofen, indomethacin, ketorolac, aceclofenac, diclofenac, piroxicam, meloxicam, mefenamic acid, etc.;
- coxibs - celecoxib, rofecoxib, parecoxib, etoricoxib.
Acetylsalicylic acid: an analgesic with experience
Few people know that the very first NSAID, acetylsalicylic acid, is of plant origin - its predecessor was obtained from meadowsweet, or meadowsweet. The drug was created by Bayer pharmacists at the end of the 19th century and named it after the Latin name for the meadowsweet Spiraea ulmaria aspirin.
The principle of action of aspirin, like all other NSAIDs, is to block the enzyme cyclooxygenase (COX). There are two types of COX in the body. The first, COX-1, is a necessary, “good” enzyme: it performs many important functions, including protecting the gastric mucosa. The second, COX-2, is responsible for the production of prostaglandins, triggering the mechanism of pain and inflammation.
Acetylsalicylic acid blocks both types of COX, with the first type of enzyme to a greater extent than the second. Therefore, the list of its side effects is considerable, and the leader in it is damage to the gastric mucosa, which can lead to the development of gastritis and even peptic ulcers. Aspirin is strictly contraindicated in children under 15 years of age due to the risk of developing Reye's syndrome - severe damage to the brain and liver.
Adults can take the drug as an antipyretic and mild pain reliever. However, in recent years, acetylsalicylic acid in this field has given way to safer NSAIDs and has become a cardiac drug due to its property of preventing platelet aggregation and thus “thinning” the blood.
Doubtful analgin?
Metamizole sodium, or analgin, is a fairly active pain reliever and a very weak anti-inflammatory drug. It is loyal to the stomach, directing all its negative influence on the blood. A serious side effect of analgin is the ability to change the blood picture and lead to the development of aplastic anemia, agranulocytosis and other hematological troubles.
In many countries of the world, including the USA, analgin is prohibited for sale. But in Germany, for example, it is widely used and is even considered the drug of choice for the treatment of postoperative pain. In Russia, they know, love and drink analgin, and, frankly, there is nothing wrong with it - the main thing is not to consume it regularly (that is, day after day) and not to exceed the recommended doses.
Diclofenac associates
The group of acid derivatives amazes even specialists with their choice, but each drug included in it still has its own “face”. Derivatives of organic acids are distinguished by pronounced anti-inflammatory properties, often overshadowing the analgesic and antipyretic effect. The exception is ibuprofen, which is still most often used to combat pain and fever, rather than inflammation.
Indomethacin and diclofenac are considered one of the most powerful anti-inflammatory drugs in this subgroup. The first has an adverse effect on the stomach and blood, and is rarely used today. Diclofenac is much safer, which, coupled with high activity and cost-effectiveness, ensures extremely high popularity in rheumatic diseases.
However, in terms of analgesic effect, diclofenac is significantly inferior to many drugs, in particular naproxen, which is successfully used to combat various types of intense pain, including dental, headache, periodic, etc. Naproxen is sold without a prescription and is in demand as quite safe, an affordable and yet powerful analgesic.
Another NSAID used for pain relief is ketorolac, known by the trade name Ketanov. It is distinguished by its speed, strength and duration of analgesic action in combination with gastrointestinal side effects traditional for NSAIDs. Therefore, ketorolac is used only with a doctor’s prescription to relieve postoperative pain, pain due to cancer and in other difficult cases.
Mefenamic acid is much more innocent than ketorolac, but is not as effective. Its reputation as an effective antipyretic agent is somewhat exaggerated: the drug is slightly more active than acetylsalicylic acid.
And another representative of NSAIDs that cannot be ignored is meloxicam, which combines a rather gentle effect on the stomach with a powerful anti-inflammatory effect, due to which it is often used in rheumatology.
Coxibs: the last word in pharmacology
Coxibs are the youngest group of NSAIDs, the first representative of which, celecoxib, went on sale in the late 1990s. Coxibs have almost no effect on COX-1, and therefore have virtually no gastrointestinal side effects traditional for this group. They adequately fight pain and inflammation in arthritis and other rheumatoid diseases, but they did not live up to the initial expectations that specialists had when the first coxib appeared.
Drugs in this group are still not without side effects (in particular, experts are still discussing the possible effect of coxibs on increasing the risk of heart attack and stroke) and, moreover, have a rather high price, which can pull the rug out from under already unhealthy legs. The decision to prescribe them should only be made by a doctor, and self-medication with coxibs, as well as most other NSAIDs, should not be done.
To readers who are still tormented by the agony of choice, I would like to say: do not be tormented. Get rid of this stone on your soul by placing it on the shoulders of your doctor. Trust him with your pain and inflammation and don’t test your stomach trying to hit the roof and find the “best” NSAID from dozens of medications.
Marina Pozdeeva
Photo thinkstockphotos.com
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Carrying out treatment
The algorithm is as follows:
- before applying ointments, the skin should be washed and dried;
- ointments are applied in an even layer to the painful area;
- rub in with light pressure, using massaging movements, excess is removed with a napkin.
It is recommended to apply ointments at night; in the evening, the effect of medicinal components is more active. The use of therapy at night promotes restful sleep without pain.
Options for quick pain relief
The onset of the disease is accompanied by acute, piercing pain in the spine or lower back. Painful sensations often deprive a person of the ability to move; the slightest movement provokes the appearance of sharp pain. In this situation, it is important to choose a position in which pain symptoms will decrease:
- Lower back pain – lie on your back with your legs on a pillow.
- Pain in the thoracic region - lie down on your side. It is recommended to use a pillow or cushion under the lower back or between the legs, bent at the knees.
- Pain in the cervicothoracic region - sit in a semi-sitting position, place a pillow between the shoulder blades.
The best ointments for lower back pain
List of the best ointments for back pain
The versatility of an effective ointment for back pain helps to provide an analgesic effect, as well as prevent relapse of the disease.
These drugs help reduce inflammation and stimulate the resorption of edema.
The selection of good ointments should be focused on treatment, and not provoke local adverse reactions.
Painkillers are divided into groups according to their effect.
Ointments with a warming effect
The use of these ointments is effective and safe for the treatment of back pain. When applied, a feeling of warmth appears and pain decreases. There is a rush of saturated blood, which helps reduce the inflammatory process.
A number of external effective and fast-acting remedies:
- "Capsicam" - composition: natural and synthetic ingredients. Used for pain in joints and muscles.
- “Finalgon” – pain is eliminated 5 minutes after use. Used for osteochondrosis.
Ointments for external use have a warming effect and help relieve muscle spasms. It is not recommended to use for diseases in the neck area, since the skin on the neck is thin and there is a possibility of burns.
Reddened skin is a characteristic sign when rubbed with warming ointments, but it is better to discontinue or replace the drug.
Ointments with analgesic effect
Used to reduce severe discomfort. The feeling of pain is eliminated within a few minutes after rubbing with the ointment.
The analgesic effect is characteristic of the following drugs:
- “Voltaren” – helps relieve pain, eliminates inflammation, and is completely absorbed into the skin.
- “Ibuprofen” is used even for children due to the fact that it is not absorbed into the blood.
Anesthetic ointments for back pain are suitable for quickly eliminating pain.
Ointments with anti-inflammatory effect
They influence the long-term improvement of a person’s well-being. Frequently used drugs in medical practice:
- "Fastum Gel" - has an analgesic effect and a cooling effect.
- "Diclofenac" - eliminates inflammation, swelling, pain. Due to its safe properties, it is approved for use by children and adolescents. Used for rubbing the back in the treatment of pathological disorders in the musculoskeletal system.
Ointments with local irritation effect
Famous for their strong analgesic and restorative properties. When rubbed with the ointment, a feeling of warmth and slight tingling appears.
Drugs with the greatest effect:
- “Nayatox” - the ointment contains cobra venom, which helps stimulate vasodilation. It is used for diseases such as lumbago, sciatica, rheumatism.
- “Apizartron” is an ointment based on bee venom that helps stimulate blood flow to damaged areas. Due to its anti-inflammatory effectiveness, it reduces the activity of pathogenic bacteria. Actively affects pain reduction and causes a feeling of coolness.
Chondroprotectors
Helps restore intervertebral discs and articular cartilage. Used for hernia and osteochondrosis.
These means include:
- "Chondroitin-Acos" - renews cartilage tissue.
- Teraflex – preserves bone mass, improves mobility of the spinal column.
The use of chondroprotectors is intended for a long period of treatment therapy (from a month to a year or more); they are characterized by accumulative properties.
Ointments with a combined effect
The different components complement each other, enhancing the therapeutic effect. The best products for frequent use:
- “Dolobene” – main actions: anti-inflammatory, decongestant, analgesic.
- “Indovazin” - its use will eliminate pain, reduce swelling, and restore damaged tissue.
The use of these ointments is recommended for use in men and women to strengthen blood vessels and improve their penetrating properties.
Homeopathic ointments
Homeopathic medicines - due to the low concentration of ingredients, are prescribed for mild discomfort:
- “Target T” – helps restore damaged tissues, has a weak analgesic and anti-inflammatory effect.
- "Traumeel S" - affects the localization of the source of pain. It is used for the inflammatory process in the musculoskeletal system.
These drugs have a cumulative effect.
Share in the comments which of these ointments you used, what the effect was, were you satisfied with the result?
Can I take NSAID tablets and use the topical form at the same time?
This is not directly prohibited by the instructions for use, but it is not recommended, and, apparently, does not make sense. According to the only credible study on this topic, there was no significant increase in the analgesic effect when combining local and systemic forms of NSAIDs. At the same time, this use of drugs slightly increased the frequency of rectal bleeding. In clinical trials, oral administration of diclofenac and ibuprofen at doses 2 and 3 times higher than recommended also did not lead to increased pain relief. The effect of a combination of tablets and a topical form of NSAIDs will most likely not be pronounced. At the same time, the likelihood of unwanted reactions slightly increases. Therefore, this combination is not recommended. Usually, if a local remedy does not help, the doctor cancels it and transfers the patient to oral administration [12, 13].