The best painkillers for back and lower back pain

Analgesics and NSAIDs are effective in the treatment of acute back pain. According to the most common point of view, the prescription of centrally acting muscle relaxants increases the effectiveness of treatment, but is accompanied by a high risk of developing adverse events, primarily associated with the sedative effect of the drugs.

However, in a placebo-controlled study, Benjamin W., Andrew A., (2015) failed to demonstrate the effect of the addition of a centrally acting muscle relaxant (cyclobenzaprine) or a combination of paracetamol with an opioid analgesic (oxycodone) during treatment with naproxen.

There are a wider range of medications available for the treatment of chronic back pain, but clinical trial evidence for their benefit is less convincing.

Types of lower back pain

Understanding the nature of the pain is very important, because this will help the doctor immediately make an assumption about the diagnosis and prescribe a more accurate diagnosis.

Pain happens:

• acute (occurs due to recent damage, lasts up to 1.5 months);
• aching;
• blunt;
• strong and long lasting;
• subacute (lasts 6-12 weeks);
• variable (transitory);
• chronic (lasts more than 12 weeks).

Low back pain is also divided into primary and secondary.

Primary

associated with chronic changes in the tissues of the spine and muscles. Sometimes the spinal roots are involved in the process.

Secondary

pain indicates another disease. This could be arthrosis, arthritis, or some pathology of the internal organs.

Nicoflex

Nicoflex ointment for the lower back stimulates blood circulation, has a warming effect, and copes well with pain symptoms. The active ingredients of Nikoflex are capsaicin, ethyl nicotinate and ethylene glycol salicylate. Ointment for back pain warms up and irritates the painful area of ​​the body - the inflammatory process is reduced due to increased blood circulation. "Nikoflex" restores mobility to the joints and lower back, is quickly absorbed without a greasy residue. The back ointment has a neutral odor, and the burning sensation after application lasts literally two minutes.

Nicoflex

Reanal, Hungary

- bruises;
- sprains; - arthrosis; - myalgia; - neuralgia; - chronic neuritis; — polyarthritis (chronic and subacute); - sciatica; — tendovaginitis (in the phase of incomplete remission); - to warm up muscles before and after sports. from 251

1268

• Like
• Write a review

Which doctor should I consult for pain in the lumbar region?

Usually, you first need to contact a therapist, who will already give a referral to a specialist - a neurologist, traumatologist, rheumatologist, or osteopath.

If you are sure that you know exactly the origin of the pain, you can contact a specific doctor directly. For example, if you recently had a bad fall, then you need to see a traumatologist.

Our clinic has a manual therapy department in St. Petersburg, where you can make an appointment with the right doctor for consultation or treatment.

How is diagnosis and examination done by a doctor?

First of all, the doctor must exclude conditions that are life-threatening. For this purpose, clinical and biochemical blood tests are performed. They make it possible to detect inflammatory processes and excess calcium, which is typical for cancer that has metastasized to the bones. Tests also detect multiple myeloma and many other pathologies.

A man over 50 years old may have a prostate-specific antigen test to rule out prostate cancer.

X-rays are required to determine the height of the intervertebral discs and identify osteophytes, if any. The latter are bone tissue growths that appear due to improperly distributed load on the vertebrae and changes in their shape.

MRI and CT are needed to determine whether there is a bulging intervertebral disc, calcifications, or spinal stenosis. Similar changes can be seen on ultrasound, which is increasingly being prescribed instead of CT, as it does not provide radiation exposure.

The patient must consult a neurologist and, if necessary, a chiropractor.

When the examination is completed, the doctor can accurately diagnose and determine treatment tactics. The success of therapy increases tenfold with early treatment.

Our clinic address: St. Petersburg, st. Bolshaya Raznochinnaya, 27 metro station Chkalovskaya

How to cure lower back pain: basic treatment methods

Treatment for the lower back depends on the cause of the pain. What helps in one case may not be effective in another. Let's look at the main types of therapy and ways to relieve pain at home.

Conservative treatment

Conservative therapy is rarely prescribed independently. Usually it complements medication.

Conservative methods primarily include physiotherapy. This can be manual therapy, classical or therapeutic massage, acupuncture. To relieve muscle spasms and restore blood flow, cupping massage with bloodletting at certain trigger points is often prescribed.

Sometimes doctors prescribe herbal treatment that improves blood circulation in the spine where spasms occur.

Kinesitherapy is becoming more and more popular. This is a special gymnastics that needs to be done on decompression machines. Such devices allow you to relieve overstrained muscles and form correct motor stereotypes in a person.

Medications

In most cases, back pain is not health threatening and can be overcome by taking certain medications and using ointments.

First of all, patients are shown non-steroidal anti-inflammatory tablets - Ibuprofen, Ketoprofen, Piroxicam, Nimesulide, Diclofenac. These are good pain relievers that also relieve inflammation.

You can also give injections for pain. One of the effective drugs for pain relief is Baralgin. This is a proven and good remedy to quickly relieve pain caused by spasms. The drug is available in ampoules, is a non-narcotic pain reliever and can relieve even very severe pain.

Where is Baralgin injected?

In a hospital setting, the drug can be administered intravenously. This is how it works faster and more efficiently.

At home you can inject it intramuscularly - into the buttock. Visually divide the buttock into four segments by drawing two lines - horizontally and vertically in the middle. The injection should be given in the upper right part (for the right buttock). With one confident movement, you need to insert the needle to its entire length and then inject the drug by pressing the syringe. The medicine should be administered moderately quickly. Before the injection, be sure to disinfect the skin, and afterward, apply a cotton swab soaked in antiseptic for about 5 minutes.

Important!

We do not recommend self-medication. Before using any medications, be sure to consult your doctor!

Let's return to drug treatment methods. In some cases, hormonal medications are prescribed to reduce swelling and pain. They act faster than non-steroidal anti-inflammatory drugs. They are administered under medical supervision or strictly according to the prescribed regimen. At home, you can give intramuscular injections or take the prescribed drug in tablets. In the hospital, IVs are usually placed.

Hormonal drugs are also used for therapeutic blockades, that is, they are injected directly into the source of pain. The main drugs in this group are Prednisolone and Dexamethasone.

Many commercials position ointments and gels as the most effective means of combating pain. However, in fact, this method of introducing the active substance into the body is considered the most ineffective, because most of the drug does not even pass through the skin.

Low risk

No risk factors

NSAIDs differ in the severity of their ulcerogenic effects.

Indomethacin has the highest risk of gastrointestinal complications (relative risk {RR} 2.25), followed by naproxen (RR 1.83), diclofenac (RR 1.73), piroxicam (RR 1.66), ibuprofen (RR 1.43), and meloxicam (OR 1.24).

A dose-dependent effect of the drugs was noted (Richy F, Bruyere O, Ethgen O, 2004):

Low-dose ibuprofen (RR 1.6, 95% confidence interval 0.8-3.2)

High-dose ibuprofen (RR 4.2, 95% confidence interval 1.8–9.8)

Low-dose naproxen (RR 3.7, 95% confidence interval 1.7-7.7)

Naproxen at high doses (RR 6.0, 95% confidence interval 3.0-12.2)

Low-dose indomethacin (RR 3.0, 95% confidence interval 2.2-4.2)

High-dose indomethacin (RR 7.0, 95% confidence interval 4.4-11.2)

Not included in this review, ketorolac also has a pronounced gastrotoxic effect. In one study (García Rodríguez LA, Cattaruzzi C, 1998), it was shown that the risk of developing adverse events from the gastrointestinal tract with the drug is 5.5 times higher than that of other NSAIDs. Therefore, the duration of taking the drug is limited to 5 days.

In Russia and abroad, the drug is available with a prescription.

Despite the possibility of early gastrotoxicity, in most cases it does not appear within several weeks of taking the drugs. The possibility of modifying risk factors depends on the conditions of medical care for the patient.

• Patients with a history of complicated or uncomplicated gastrointestinal ulcer disease are advised to undergo testing for H. pylori before prescribing NSAIDs or aspirin. If the result is positive, appropriate treatment is carried out (even in cases where it is assumed that the previous development of ulcers was associated with taking NSAIDs).
• It is necessary to use minimal doses of drugs, the course of treatment should be as short as possible.
• In patients with an average and high risk of complications from the gastrointestinal tract, the use of selective COX-2 inhibitors or NSAIDs in combination with antisecretory drugs: proton pump inhibitors (omeprazole 20 mg/day, esomeprazole 20 mg/day up to 6 weeks), H2 blockers is indicated -histamine receptors (ranitidine 150 mg/day once at night, famotidine 40 mg x 2 times a day). Both groups of drugs reduce the severity of dyspepsia in patients. Efficacy at recommended doses is similar.
• In patients with a high risk of complications from the gastrointestinal tract, selective COX-2 inhibitors may be prescribed in combination with antisecretory drugs
• Concomitant use of aspirin with COX-2 inhibitors completely eliminates the gastrointestinal safety benefits of the latter.
• Unexplained anemia, iron deficiency, severe dyspepsia, signs of gastrointestinal bleeding indicate a possible complication of taking NSAIDs. It is necessary to consider the possibility of performing esophagogastroduodenoscopy.

How to quickly get rid of pain without drugs and at home

You won’t be able to get rid of pain in a minute, but in 5-10 it’s quite possible. To do this, you need to do an exercise aimed at relieving muscle spasm and relaxing the lumbar region.

We offer two options:

Exercise one

• Starting position: kneeling.
• The right leg should be bent at a right angle, it should stand in front. With your left foot, place your knee on the floor.
• In this position you need to find balance and fixate.
• When you succeed, reach back with your left hand and grab your left foot.
• After this, pull your left leg by the heel to the pelvis. The thigh muscles should be well stretched. You can enhance the effect by squeezing your left buttock.
• Stay in this position for half a minute, then slowly and carefully lower your left leg, returning to the starting position.
• After this, do the exercise for your right leg.

Exercise two (you will need a massage roller)

• Lie on your back with a massage roller under your sacrum. Important: do not place the roller under your spine under any circumstances.
• Gently pull your right knee toward your chest. The left heel should touch the floor. At this moment, you will feel the anterior thigh muscle stretch.
• To increase muscle tension, place your left hand behind your head and turn your bent knee slightly to the right.
• Hold this position for half a minute.
• Repeat the exercise for the other leg.

Other home remedies for lower back pain

If the pain is caused by swelling, a dry cold compress can help. Take ice or something frozen from the freezer, put it in a bag and wrap it in a cloth. Apply to the lower back for 20 minutes for two days. You can repeat every two hours.

If the pain does not go away from the cold, then after two days you can try warm compresses. They increase blood circulation in the lower back and relieve pain by interrupting pain signals from nerve endings to the brain. It is best to use an electric heating pad for this. If you don't have it, a regular one will do. You can also simply take a warm bath.

Contraindications and side effects of ointments for the lower back

Non-steroidal anti-inflammatory drugs in tablet form have many side effects: they are toxic, have a bad effect on the kidneys, liver, stomach, and hemostatic function. That is why tablets and injections for back pain are prescribed only in extreme cases and for a short course. But ointments for back pain can be used for a relatively long time, but, of course, not constantly either. A small part of the drug still enters the blood through the skin, which can negatively affect overall well-being during long-term treatment.

Among the contraindications for use

back ointments:

• individual intolerance to the active substance of the drug or its auxiliary components;
• open wounds on the skin, inflammation or suppuration in the places where you plan to apply the back cream;
• allergy to NSAIDs, acetylsalicylic acid;
• age up to 14 years;
• pregnancy (third trimester).

In these cases, ointment for back pain is prescribed with caution:

• first and second trimester of pregnancy;
• severe kidney or liver damage;
• history of gastritis or ulcer;
• nasal polyps, rhinitis, bronchial asthma;
• lactation. Possible side effects
  from lower back ointments:
• stomach pain, gastritis;
• skin redness, dermatosis, urticaria, itching;
• anaphylaxis, Quincke's edema (in very rare cases). Read also: Choosing chondroprotectors for joints What are chondroprotectors, what active substances they contain and what they treat.

What diseases may cause lower back pain?

Ankylosing spondylitis

This disease develops gradually. At first, mild pain appears in the lower back, then it intensifies and spreads to other parts of the spine. The pain may occur sporadically, but most often it is constant and decreases only as long as the pain medication is in effect.

Features of the nature of pain:

• worsens at rest, especially in the morning and in the second half of the night in a horizontal position;
• accompanied by stiffness of movements;
• goes away or decreases after charging;
• goes away quickly after taking a non-steroidal anti-inflammatory drug.

Sometimes the pain is very weak or not at all, and the only symptom is a decrease in the mobility of the spine, which spreads from the bottom up. Some patients also have pain in their shoulders and their mobility is limited. It happens that the joints of the legs and arms swell and hurt.

Hernia and osteochondrosis

These diseases have similar symptoms and depend on each other, so we will look at them together.

With lumbar osteochondrosis, the pain is severe because the nerve roots are mechanically irritated. In addition, when the membranes and septa of the intervertebral disc rupture, substances enter the bloodstream that irritate pain receptors.

At the late stage of osteochondrosis, the intervertebral discs bulge and a hernia forms. The lower back is most often affected because the openings between the fourth and fifth lumbar vertebrae and between the fifth vertebra and the sacrum are the narrowest, but the nerve roots that pass through them are the most massive. The patient feels severe pain, similar to radiculitis. If the hernia is massive, it begins to put pressure on the spinal cord, which leads to decreased sensitivity in the legs and even paralysis.

Characteristic signs of a hernia:

• it is impossible to stand up without leaning on a chair or knee, because the load on the disc responds with a severe attack of pain;
• You can’t lie on your stomach just like that, but only with a pillow;
• It is impossible to bend down to pick something up from the floor, but to do this you need to carefully squat.

Kyphosis and scoliosis

In the early stages there is no pain. You may feel very tired in your back muscles, and in the evening you really want to go to bed as soon as possible. At the second stage, neurological disorders appear:

• hands go numb;
• shoulders and forearms weaken;
• My back starts to hurt a lot.

Spondyloarthrosis

At the same time, spondylosis develops. When it occurs, the cartilage of the intervertebral disc is destroyed, and bone protrusions grow around the altered disc. This can lead to a narrowing of the spinal canal and compression of the spinal cord, which causes the legs to go numb or even paralyzed, and the function of the pelvic organs is disrupted.

Main symptoms:

• lower back pain, which in rare cases radiates to the thigh closer to the hip joint;
• reduction of pain after rest or cessation of exercise;
• soreness and tension in the lower back muscles;
• limitation of spinal mobility.

The pain intensifies while standing and walking, there is a feeling of heaviness and stiffness in the lower back in the morning. Usually, stiffness and heaviness go away after morning exercises.

The pain is moderate and can become chronic. This is due to constant irritation of the nerve roots and nerves.

Protrusions

Protrusions occur where mobility, and therefore wear, is highest. Therefore, the lower back is most often affected.

The symptoms are mild for a long time, so people do not even suspect that this is not ordinary fatigue, but a serious diagnosis. However, then the manifestations intensify:

• discomfort in the lower back gradually turns into pain, which becomes stronger and occurs more often, it hurts a person to move, the pain radiates to the legs and eventually spreads to them;
• pain in the legs spreads to the buttocks, numbness, tingling, and cramps may occur;
• I'm worried about lumbago in the lower back;
• constant sharp or aching pain appears;
• in the final stages, without treatment, the leg muscles weaken and motor activity decreases;
• pain occurs in the right and/or left hypochondrium.

Arthritis

The symptoms of lumbar osteoarthritis are similar to those of osteochondrosis. With this disease, the nutrition of the intervertebral discs is disrupted and the joints become inflamed. In later stages, limited mobility and even paralysis are possible.

Arthritis is a chronic disease, so you need to follow all doctor’s instructions for life to maintain a normal quality of life.

Main symptoms:

• aching dull pain in the lower back;
• lumbago in the lower back due to hypothermia;
• impaired sensitivity in different parts of the body;
• the inability to move due to pain after a person has been in one position for a long time.

Osteomyelitis

With this disease, there is constant aching pain in the lower back, which intensifies with movement and does not go away with rest. The pain may be worse at night and can be relieved with a dry, warm compress.

Other symptoms are also present:

• signs of general intoxication of the body - sweating, chills, weight loss, slight increase in body temperature;
• local abscess, as a result of which the nerve roots are compressed and the functions of the organs innervated by them are disrupted;
• paresis and paralysis (in severe cases).

Pancreatitis

If only the head of the pancreas is affected, then the pain occurs in the right hypochondrium, if its body - “in the pit of the stomach”, if the tail - in the left hypochondrium.

If the entire gland is inflamed, the pain is girdling in nature and radiates to the back, under the left shoulder blade.

In some cases, the pain radiates to the left thigh, groin, tailbone, and perineum.

The nature of the pain can be different - acute, nagging, periodic. Usually it starts to hurt 2-3 hours after eating, but sometimes almost immediately - after 10-15 minutes. During physical activity, the capsule of the gland is stretched, which also causes pain.

Spinal stenosis

Occurs due to hernia, protrusion or sequestration. Compresses the lower spinal nerves that innervate the lower extremities. The pain spreads along the affected nerve root, from the lower back to the foot, bothers you when walking and at rest, intensifies when a person tries to straighten the spine, and subsides when bending forward.

Facet syndrome

This is a disease of the intervertebral joints, which are called “facet joints”. The pain can be localized only at the site of the lesion or radiate to the tailbone, groin, and back of the thigh. Unpleasant sensations intensify when rotating in the lower back and bending, after physical activity and in the evening.

Paravertebral blockade

This procedure is performed only by a specialist on an outpatient basis, due to the risk of damage to the nerve trunks (paravertebral block) and the spinal cord (paravertebral block). The purpose of the procedure is to eliminate back pain by introducing a solution of medications (local anesthetics, steroid hormones) into the epidural space of the spinal cord. This achieves an immediate analgesic effect, which helps even with unbearable pain in the back, lower back and lower extremities (symptomatic and pathogenetic therapy of back pain).

This procedure, if performed incorrectly, can lead to serious complications. Therefore, this treatment method is used only for severe and unbearable pain. In all other cases, it is better to limit yourself to safer methods.

For paravertebral blockades, it is permissible to use a more complex combination of drugs - NSAIDs, glucocorticosteroids, local anesthetics, chondroprotectors, vitamin B complex. The injection is performed through the muscles running along the spine until it touches the transverse process of the vertebra, 2 cm away from the center of the spine. The roots of the spinal cord pass in close proximity to the tip of the needle, where the drug is injected. The procedure can be performed under the control of an ultrasound machine.

Causes of lower back pain

Let's consider the main causes of lower back pain, taking into account their localization.

Pain above the lower back, but below the shoulder blades

The main reasons why it hurts in this area:

• diseases of the spine (primary pain);
• injury - from a fall, an incorrectly performed exercise, or a blow;
• muscle strain, spasm;
• cardiovascular diseases;
• tumors, including malignant ones;
• gastrointestinal diseases.

Pain below the waist

Pain in the lower back occurs due to diseases of the spine or internal organs. In the second case, the pain is called “referred”. Most often, pain occurs after a long walk, prolonged sitting, bruises and injuries, infectious diseases, or heavy lifting.

Often, pain below the lower back is associated with unhealthy and improper stress on the spine. Less commonly, these may be diseases of the gastrointestinal tract and genitourinary system - cholecystitis, cystitis, pyelonephritis, gastritis, constipation.

Signs of referred pain:

• rare or frequent and painful urination;
• bloating;
• lower abdominal pain;
• increased body temperature;
• nausea, vomiting;
• diarrhea or constipation.

In women, the causes of pain below the lower back can be: pregnancy and its complications, menopause, menstruation.

If there are no other symptoms other than pain, then they say that it is due to problems with the musculoskeletal system. If the pain is localized in the pelvic area, this may be a consequence of a previous disease of the hip joint.

Left lower back pain

The nature of the pain is aching, it does not go away with rest, it occurs when walking, physical activity, running, or after prolonged sitting.

If the pain does not go away after rest, then its causes may be:

• scoliosis;
• osteochondrosis;
• spinal infections;
• circulatory disorders.

If pain occurs when walking and goes away after rest, it could be radiculitis, diabetes mellitus, spinal displacement, or pinched nerve root.

Aching pain above the lower back on the left occurs with a sedentary lifestyle and may indicate the presence of osteochondrosis, recent hypothermia or incorrect posture.

Acute, girdle pain in the side, which radiates to the left shoulder blade, may be one of the symptoms of myocardial infarction. A stomach ulcer radiates to the same area, the pain is sudden, sharp, cutting.

Right lower back pain

• Cramping pain is characteristic of diseases of the genitourinary system.
• Increasing pain indicates an inflammatory process, including an abscess.
• Dagger pain is an emergency condition, that is, internal bleeding, ulcer, rupture of an organ, thromboembolism.
• Shooting is characteristic of diseases of the spine when the spinal roots are involved in the process.
• Constant dull and monotonous pain is characteristic of diseases of parenchymal organs, such as the liver.
• Nagging pain occurs with damage to the musculoskeletal system, including trauma.

Lower back pain when coughing

The most important causes of pain when coughing:

• Hernia – accompanied by loss of sensation in the limbs. Pain also appears when bending forward.
• Stenosis. At the same time, it is difficult to walk, there is weakness in the legs. The examination shows a decrease in the thickness of the discs.
• Facet arthropathy. The lower back hurts when coughing, but the pain goes away if you bend towards the traumatic injury. The muscles on the affected side become overstrained.
• Injury to the fibrous ring. The pain intensifies when bending over, moving, or sitting for long periods of time.
• Osteochondrosis. It reduces the function of the spine.
• Kidney diseases.
• Neuralgia – girdling pain.

How to prevent pain?

In order not only to remove, but to prevent the appearance of pain, you simply need to prevent the appearance of a hernia. Simple rules must be followed:

• move correctly and work on your posture, avoid flat feet;
• carry weights only evenly in a backpack on your back;
• when lifting weights, try to hold the load symmetrically, and in no case on one shoulder or in one hand;
• do not bend or turn while carrying a heavy load;
• monitor body weight, avoiding its excess;
• regularly try to hang on the horizontal bar or swim, unloading the spine, and do therapeutic exercises;
• after reaching a certain age, check the level of calcium in the blood, prevent osteoporosis;
• in winter, and especially in the presence of ice, you need to refrain from sudden movements, since falls and injuries are a risk factor for protrusion and hernia.

This way you can avoid severe back pain. If you already have a protrusion, or, moreover, a hernia, and they bother you regularly, then the best way is a modern minimally invasive surgical intervention.

Currently, they are being carried out with great success in Bulgaria, the Czech Republic, and including Russia. These are cold plasma and laser nucleoplasty, vaporization, endoscopic microdiscectomy. As a result, either the appearance of a hernia from the protrusion is prevented, or the cartilaginous protrusion itself is eliminated, and the nerve roots, muscles and ligaments no longer compress anything. Only surgery can lead to radical extraction and improve the quality of life.

Ways to prevent lower back pain

To prevent lower back pain, you must:

• Provide yourself with adequate exercise - do exercises in the morning, simple exercises to stretch the muscles and spine.
• Periodically take massage courses - classic, cupping on trigger points.
• Do warm-ups or undergo cryotherapy courses as prescribed by your doctor.
• Eat right to avoid gastrointestinal pathologies. It is necessary to maintain a balance of proteins, fats, carbohydrates, and consume enough plant fiber. Alcohol, fatty, fried, salty and spicy foods should be excluded from the diet. Do not overuse smoked and canned foods, fast food. Another important point is the drinking regime: you need to drink 1.5-2 liters of liquid per day (along with soups, tea, etc.).
• At the first signs of illness, you should consult a doctor. In the early stages, almost any disease can be cured quickly and easily, without any consequences. If you are predisposed to lower back problems, you should visit a neurologist for prevention at least once a year.

Our clinic address: St. Petersburg, st. Bolshaya Raznochinnaya, 27 metro station Chkalovskaya

Nurofen Express

Back ointment "Nurofen Express" helps well with osteochondrosis and arthritis. The product perfectly relieves pain, penetrating deep into tissues and fighting inflammation from the inside. Ointment for the lower back for acute pain is recommended to be used four times a day. The drug is suitable for the treatment of joint pain and sprains, the ointment is effective for swelling, neuralgia and injuries. Nurofen Express ointment contains ibuprofen, which relieves inflammation and reduces pain.

Nurofen express gel

Farmasierra Manufacturing SL, Spain

When applied externally, it has an anti-inflammatory and analgesic effect.
Reduces morning stiffness and helps increase range of motion in joints. from 133

5.0 1 review

184

• Like
• Write a review