Definition
We speak of disc herniation referring to a painful pathological condition affecting the spine, characterized by a loss of gelatinous material from the pulpy nucleus of the intervertebral disc. This loss, precisely defined herniation, is the result of the breakage of the fibers that surround and protect the nucleus pulposus, constituting the external fibrous ring of the disc wall.
Causes
In most cases, a herniated disc is the result of gradual wear and degeneration of the disc: as we age, the discs lose some water; this explains why the intervertebral discs appear less. flexible and more exposed to tearing, twisting and breaking.
- Risk factors: severe traumatic events, weight lifting, violent rotation of the torso, blow to the back
Symptoms
Disc herniation is often associated with pain, of varying magnitude and location based on where it occurs in the spine (eg at the level of the lumbar or cervical spine). In addition to pain in the limbs, disc herniation it often manifests itself with numbness or tingling in the part of the body affected by the herniated disc, as well as creating general weakness and muscle weakness.
- Contrary to popular belief, a herniated disc is not always painful: in some patients, in fact, it does not cause any symptoms.
The information on Disc Herniation - Drugs for Disc Herniation is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Disc Herniation - Drugs for the Treatment of Herniated Disc.
Medicines
From recent scientific surveys it has emerged that the so-called treatment conservative - essentially consisting in the administration of painkilling drugs and in avoiding taking painful positions - it is very useful for the control of pain in the context of herniated discs. In most cases, the aforementioned treatment should be continued for at least a couple of months, the period of time needed to reduce the protruding portion of the disc, thus relieving symptoms and improving the patient's clinical profile.
The drugs most used in therapy to mask the pain derived from herniated disc are NSAIDs, muscle relaxants, narcotics and, in some cases, cortisone injections.
It is recommended to follow a pharmacological path always in association with a specific physiotherapy therapy: the choice of specific exercises and the assumption of a correct posture can minimize the pain caused by the herniated disc. After having achieved a moderate improvement in pain and related disorders, it is advisable to undertake a rehabilitation process aimed at maximizing the general health of the back, which is also very useful and above all to prevent any possible future damage.
In the most extreme cases, in which physiotherapy and drug therapy fail to produce satisfactory results, surgery (discectomy) is recommended.
Now let's see in detail the most used drugs in therapy for the treatment of herniated disc.
The following are the classes of drugs most used in the therapy against herniated disc, and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and the dosage most suitable for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
NSAIDs and narcotics: indicated to relieve inflammation and to reduce sudden / acute pain deriving from herniated disc. In particular, non-steroidal anti-inflammatory drugs are used to minimize the symptoms associated with herniated discs caused by trauma (eg accident. road). Narcotic drugs are also used in therapy for this purpose, especially in case of severe pain in the back and legs. For this purpose, NSAIDs can be taken for quite long periods; narcotics are usually given when the patient is not benefiting from the administration of NSAIDs.
- Ibuprofen (eg. Brufen, Moment, Subitene): for medium-moderate pain, it is recommended to take by mouth a dose of active equal to 200-400 mg (tablets, effervescent sachets) every 4-6 hours after meals, at need. Do not take more than 2.4 grams per day.
- Naproxene (eg Aleve, Naprosyn, Prexan, Naprius): it is recommended to take the drug at a dosage of 550 mg, orally, once a day, followed by 550 mg of active ingredient every 12 hours; alternatively, take 275 mg of naproxen every 6-8 hours, as needed. Do not exceed 1,100 mg per day.
- Diclofenac (eg. Fastum, Dicloreum): for the control of mild pain associated with herniated discs, it is recommended to take 25 mg of active, 4 times a day. Follow the instructions given by the doctor.
- Acetylsalicylic acid (eg Aspirin, Vivin, Ac Acet, Carin): the drug, indicated for adults only, should be taken at a dosage of 325-650 mg orally or rectally, every 4 hours, as needed. Do not exceed 4 grams per day. In case of pain associated with herniated disc, it is possible to take 3 grams per day of the drug, possibly dividing the load into several doses. The administration of the drug to children under 12 years can cause serious side effects, such as Reye, liver dysfunction and brain changes.
- Codeine (eg.Codein, Hederix Plan): narcotic drug, widely used for the treatment of coughs. The same active is also indicated in the context of disc herniation. Indicatively, take a drug dose of 30 mg, orally, intramuscularly or intravenously, every 6 hours, as needed. In some patients, it is necessary to increase the dose at 60 mg every 4 hours Do not abuse Follow the directions prescribed by your doctor.
- Side effects deriving from the abuse of NSAIDs: gastric pain, gastrointestinal bleeding, hepatic damage. It is recommended to simultaneously take active substances capable of reducing NSAID induced gastric injury.
- Side effects derived from long-term use of narcotics: sedation, confusion, constipation.
Muscle relaxants: indicated to relieve the pain caused by the herniated disc, especially when the patient complains of muscle spasms in the back.
- Diazepam (Micropam, Ansiolin, Diazepam FN, Valium, Diazepam, Valpinax): indicatively, take 2-10 mg of the drug 3-4 times a day orally; alternatively, administer the active principle intravenously or intramuscularly at a dosage of 5-10 mg over 3-4 hours, as needed. Indicated to inhibit muscle spasms resulting from a severe herniated disc.
- Ciclobenzaprine (eg. Flexiban) the drug is indicated to reduce muscle spasms resulting from herniated disc. Start taking the drug at a dose of 5 mg orally, three times a day. Depending on the patient's response, it is possible increase the dosage to 7.5-10 mg, 3 times a day Alternatively, take the drug in the form of slow-release tablets, at a dose of 15 mg or 30 mg, orally, once a day.
- Excessive use of these drugs can induce sedation and dizziness
Cortisone: these drugs, belonging to the class of glucocorticoids, are potent active, able to act through an important anti-inflammatory mechanism. In cases of particularly severe herniated disc, it is advisable to take these drugs by mouth or via a local injection.
- Prednisone (eg. Deltacortene, Lodotra): take 5-60 mg of active orally in 1-4 divided doses over 24 hours. Consult your doctor. Do not continue therapy beyond what is necessary.
- Methylprednisolone (eg. Advantan, Solu-medrol, Depo-medrol, Medrol, Urbason): to relieve the area affected by the herniated disc, take 4-48 mg per day of the drug orally. Consult your doctor.
Other drugs used in therapy to relieve pain associated with herniated disc: the active ingredients listed below are used in therapy for herniated disc when the patient complains of frequent or persistent neuropathic pain. They are drugs widely used for the control of pain associated with hernia, much more than narcotics (considered to be the most pronounced side effects of the latter).
- Duloxetine (eg. Xeristar, Cymbalta, Yentreve): the drug is a serotonin reuptake inhibitor, also indicated for the treatment of disc herniation. To relieve pain in the context of disc herniation, it is recommended to take 60 mg of drug per day, preferably on an empty stomach. Consult your doctor.
- Gabapentin (eg. Gabapentin, Apentin, Gabexine, Neurontin): the drug is an anticonvulsant sometimes used in therapy in the context of disc herniation. The dosage should be carefully established by the doctor. The drug is one of the most used active ingredients for the treatment of "epilepsy.
- Pregablin (eg Lyrica): the drug is an analogue of amino butyric acid, antiepileptic and anxiolytic used in therapy also for herniated discs. For the posology: consult your doctor.
- Tramadol (s. Tralenil, Tramadol, Fortradol): the drug is an opioid derivative, the dose of which must be established by the doctor based on the intensity of the pain in the context of the herniated disc (variable dosage from 25 to 400 mg per day. Consult your doctor)
- Amitriptyline (eg. Laroxyl, Triptizol, Adepril): in addition to being an antidepressant drug, amitriptyline is used in therapy for the treatment of pain associated with herniated disc.
- Hydrocodone (eg Vicodin, not sold in Italy): the drug is a powerful anti-inflammatory, often used in combination with Paracetamol to enhance the therapeutic effect of pain reduction. The two active ingredients are formulated in tablets consisting of 500 mg of paracetamol and 5 mg of hydrocodone, to be taken every 6 hours, orally, as needed.The drug is also available as an elixir or oral solution: consult your doctor.
