Drug treatment of spinal hernia: review of drugs and the effect of use

It is perhaps impossible to recall a single case in which a proven intervertebral hernia in a patient did not require the use of medications sooner or later. Drug treatment using one or another means for a herniated disc is usually carried out at the initial stage of its occurrence, when the patient is suddenly constrained by severe and acute pain, as well as during periods of its exacerbation. What are the features of treating hernias with medications, and what are these medications needed for?

Cervical hernia on MRI.

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• Blockade of a spinal disc herniation: benefits
• Who carries out the treatment?
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• Expert opinion
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Pain levels

0 — 3

Mild pain

- does not interfere with everyday activities, but you can adapt to the pain.

4-6

Moderate pain

- prevents you from doing business, prevents you from concentrating, the patient remains independent

7-8

Strong pain

- it is impossible to carry out daily activities, it is difficult to think about anything other than pain, the patient cannot function independently

9-10

Unbearable pain

- requires urgent care, bed rest, disables the patient

Contraindications

Like any other type of physiotherapy that uses physical factors, there are also contraindications to shock wave therapy. First of all, this is high temperature and fever, the presence of infectious diseases, malignant neoplasms, hemorrhagic syndrome and blood clotting disorders, and especially increased fragility and fragility of blood vessels. Shock wave therapy is contraindicated in decompensated diabetes mellitus with high sugar levels, with intense acute inflammation of the superficial veins (in case of thrombophlebitis, it is necessary to first reduce the inflammation, and only then begin physical therapy). Sessions cannot be performed during a hypertensive crisis and high blood pressure, if the patient has a pacemaker, or any endoprostheses in the affected area (for example, an intervertebral disc has been replaced with an endoprosthesis in the corresponding segment), pregnancy and lactation.

You cannot direct the shock wave generator to the projection of intestinal loops, large vessels, heart and lung tissue. Shock wave therapy is also not prescribed to children, adolescents, boys and girls under 18 years of age, when bone tissue is still being synthesized and skeletal growth continues.

There are also special contraindications. So, if the patient has a large hernia, reaching 5 mm in size or more, with compression of the dural sac, located dorsally, then shock therapy is contraindicated. If the patient has a sequestered hernia, then shock wave therapy cannot be performed either, since the hernia can compress the sac and cause an exacerbation, and the sequester can displace and lead to severe radicular symptoms. In case of large hernias, surgical treatment is recommended.

Blockade of a spinal disc herniation: benefits

Drug blockade is the administration of a drug to the site of compression of the nerve root in order to quickly relieve pain. The most important advantage of blockades is the speed of the drug’s effect on the body. Usually the patient feels relief immediately after the procedure, which lasts for a long time. If necessary, the procedure can be repeated several times - sometimes one is enough, and sometimes you have to do a course of 5-7 blockades.

The blockade also helps relieve inflammation and swelling of the nerve root, normalizes blood circulation and eliminates painful muscle spasms in the back.

To obtain the best effect, the drug is injected into 2,3 or 4 painful points, sometimes on both sides of the spine.

What is shock wave therapy?

This type of hardware treatment was introduced into clinical practice in the last decade of the last century by specialists from Switzerland and Germany. The essence of the method is a short exposure to the affected area of ​​a shock sound wave, which is characterized by high energy and low frequency. This effect allows energy to freely penetrate through the skin and underlying soft tissues, affecting denser tissues at the site of the disease without injury or complications. If there are indications and there are no contraindications for treatment with shock wave therapy, 90% of patients experience lasting improvement.

The physical principle of the effect is cavitation, or the formation of bubbles in the liquid medium of the body. If a certain amount of energy from a narrowly focused area is applied to such a liquid environment of the body, then the integrity of the liquid is disrupted, and special microcavities containing high-energy vapor are formed inside it. This cavity is called a phase void, or cavitation bubble.

Hernia on MRI.

The gas that is intensively released inside such a bubble, due to the reduced pressure, has high energy and can heat up this miniature bubble to several hundred degrees Celsius. And when such a bubble collapses, a local surge of energy occurs in the liquid in a small volume, and a powerful shock wave arises in this place of the former bubble.

Spontaneous and uncontrolled cavitation is generally considered a harmful phenomenon because it destroys ship propellers, machine parts immersed in water, and so on. However, cavitation is widely used in the national economy. This is ultrasonic cleaning, the process of homogenizing liquids such as dairy products or paints. Cavitation is also indispensable for fuel processing and for crushing various solids in liquids.

What kind of blockades are used for vertebral hernia?

Depending on the injection site, two types can be distinguished:

• Paravertebral - the medicine is injected into the area where the nerve passes under the transverse process of the vertebra.
• Transforaminal - the medicine is injected deeper into the intervertebral foramen to the site of root formation in the spinal cord.

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Depending on the drugs used during the procedure, we can distinguish:

• Anti-inflammatory

  . For example, when blocking an intervertebral hernia, Diprospan is used, a drug with powerful anti-inflammatory properties.

• Painkillers

  . Novocaine spinal blockade or lidocaine blockade for spinal hernia, a local anesthetic instantly blocks the transmission of pain impulses along the nerve.

• Mixed blockades

  - used most often. The injection includes 2-3 components - anti-inflammatory + painkillers, this “cocktail” allows you to get the greatest effect from the blockade.

Paravertebral blockade is most often used.

Possible complications

Failure to comply with the procedure technology for administering anesthetics or the patient ignoring medical recommendations can lead to serious complications.

Complications of the procedure

As a rule, people suffering from a hernia in the lumbar region may encounter the following consequences:

• allergic reactions;
• the development of an inflammatory process that affects tissue in the area of ​​injury;
• the appearance of a hematoma;
• development of an infectious disease;
• dysfunction of the bladder;
• attacks of headache;
• anaphylactic shock or anaphylaxis (inadequate reaction of the body to a certain allergen);
• impaired mobility of the spine up to complete paralysis.

Inflammation of tissue in the lower back

If you want to learn in more detail how a blockade is made for lower back pain, and also find out what types of blockades are divided into, you can read an article about it on our portal.

If nerve endings are damaged during manipulation, there is a risk of loss of mobility. In this case, a long and grueling rehabilitation is required. Therefore, to avoid negative consequences, you need to seek help only from qualified specialists.

Injections for a hernia in the back: Blockade technique

The paravertebral block procedure is performed with the patient lying on his stomach. The points of greatest pain on both sides of the spine are determined. Having retreated 3-4 cm from the line of the spinous processes of the vertebrae (central line), after preliminary anesthesia of the skin, the medicine is injected into the area of ​​the inflamed nerve to a depth of 5-7 cm. On average, to achieve the desired result, it may take from 3 to 7 injections, with an interval of 1 to 7 days.

The effect after paravertebral blockade can last up to several weeks. It is recommended to use it in combination with other treatment methods.

Orthopedic surgeon Timur Vyacheslavovich Kholikov comments:

Epidural anesthesia is carried out following the same steps, only the injection is made deeper, piercing the hard shell of the spinal cord. This blockade is done in a hospital setting. A similar technique is used for injections for hernia of the cervical spine.

You can find out the price of injections for the spine for a hernia or blocks for a hernia of the lumbar spine, read reviews, and also make an appointment with a specialist directly on our website.

Drugs from the NSAID group

Drugs from the NSAID group have three important medicinal qualities: they reduce inflammation, reduce pain and reduce fever, or temperature. For the latter, we are not interested in the quality of protrusions and hernias.

It is important to know that all NSAID drugs, without exception, have contraindications, and the oldest first-generation drugs, such as Diclofenac or Voltaren, generally cannot be used for more than two to three days. All of them can aggravate the course of gastric and duodenal ulcers, and in exceptional cases even cause ulcerative bleeding. They lead to exacerbation of erosive gastritis, and with prolonged uncontrolled use for several weeks they can lead to drug-induced toxic hepatitis.

Despite the very low safety profile, Diclofenac, although an “ancient” drug, is still considered one of the most effective and potent. Other drugs, such as meloxicam and ketoprofen, are already second-generation drugs; they are safer to use, although the same rules apply to intramuscular injections: no longer than 3 to 5 days.

Meloxicam (Movalis, Amelotex, Artrosan, Mirlox, Revmart)

Movalis, or the original drug meloxicam, first produced by the German company Boehringer Ingelheim, is one of the best in its group. In addition to relieving acute back pain, it is indicated for various forms of arthritis, joint pain, rheumatological diseases, and other inflammatory lesions of the musculoskeletal system.

Meloxicam has a strong anti-inflammatory effect, you need to inject it 1.5 ml intramuscularly daily for 3 days. Then it is used in tablets, one 7.5 mg tablet once a day. But taking even the tablet form should not be long-term. The medicine is contraindicated in patients with bronchial asthma, nasal polyposis, with exacerbation of erosive gastritis and gastric ulcer, with severe hepatic renal failure, during pregnancy, breastfeeding, and under 12 years of age.

Movalis is produced by Boehringer Ingelheim, and a package of 3 ampoules (for a short course) of 1.5 ml each costs, on average, 610 rubles.

Ketoprofen (Ketonal, Artrosilene, Flamax)

The drug ketoprofen, of which Ketonal is a representative, is also very popular, and is available not only in a solution for intramuscular administration, but also in the form of a gel for topical use, which will be described below, in tablets, as well as in the form of rectal suppositories.

Ketoprofen is indicated for the same pathology with some changes: for arthritis, exacerbation of spinal osteochondrosis - protrusions and hernias, for migraines and headaches, various forms of neuralgia and radiculitis, for gout, as well as for postoperative pain syndrome, including after microdiscectomy.

Intramuscular administration involves one ampoule (100 mg) once or twice a day, the maximum daily dose is 2 ampoules. The drug also has a pronounced range of contraindications. In addition to the above contraindications to Movalis, Ketonal cannot be used for hemophilia or decompensated heart failure. It should not be used in children under 15 years of age. Ketonal, produced by the Sandoz company from Austria, costs 225 rubles. per pack of 10 ampoules.

Diclofenac (Voltaren, Diclobene, Diclovit, Dorosan, Ortofen)

Finally, the third drug widely used for protrusions and hernias is diclofenac, and perhaps the purest and most highly effective is the original Voltaren, produced by the Swiss company Novartis. Its cost is, on average, 260 rubles. per pack of 3 ampoules of 5 ml. But there are also more affordable analogues. Thus, diclofenac, produced by the Serbian company Hemofarm, will cost only 40 rubles for the same package. This indicates the high popularity of this drug.

Voltaren is an effective pain reliever: the effect occurs within 20-30 minutes. This drug is also widely used for various inflammatory and degenerative lesions of the musculoskeletal system, for back pain, lumbago, cervicalgia, sciatica, including protrusions and hernias. It is also indicated for severe migraine attacks.

Intramuscularly, it should be injected deeply, the dosage should be once a day, and in case of particularly severe pain, injections can be given twice a day, with an interval of several hours. It is recommended to use the lowest possible dose and the shortest possible course of treatment.

Prices for drug blockades

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