*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

There is a long-established strategy and tactics for the treatment of acute pain in the lower back, back, and in general, pain syndrome in neurology and therapy, if the pain comes from the structures of the musculoskeletal system, that is, pain from muscles, joints, ligaments and nerves. The nerves themselves do not have pain receptors and do not “ache”, but, being inflamed and swollen, they give rise to radicular symptoms, as well as neuralgia.

The use of injections for low back pain, which are always intramuscular and never intravenous, is the “heavy artillery” with which treatment begins. Injections for back pain are prescribed in the shortest possible courses, in order to suppress either pain impulses or the inflammation process.

Usually, the average duration of the use of injections and injections for the relief of back pain does not exceed 3-5 days. The injections are then changed to tablets, which have a weaker effect because they are first absorbed into the portal system, pass through the liver, and do not enter the bloodstream directly. Tablets are prescribed when the acute pain syndrome is relieved, and along with the transition from injections to tablets, the patient is prescribed physiotherapy, dry heat, numerous ointments, creams, and gels begin to be used. Some injections are available only with a prescription (Ketorolac), but even over-the-counter drugs should not be started on your own without consulting a doctor.

Main drug groups

Turning to the list of the main drugs that are used in ampouled form for intramuscular injections for back pain, do not expect completely new names in the article every time. The best means for that and the best to stay at the top of the rankings for at least a few years. Progress in pharmacology, of course, is underway, but in many respects it is directed to other aspects of the development of science. Now a lot of research is being carried out in the field of molecular genetic technology and the production of drugs that can modify genes and save a person from hereditary diseases. Therefore, the number of studies devoted to the search and production of “routine” painkillers has somewhat decreased.

The main groups of drugs that are available in injections are:

1. non-steroidal anti-inflammatory drugs, NSAIDs, distant “descendants” of white willow bark and acetylsalicylic acid;

2. steroid hormones of the adrenal cortex, or corticosteroids, which are the most powerful anti-inflammatory drugs;

3. local anesthetics (often as a means to make the injection not painful, but are used as symptomatic injections for back pain for blockades;

4. muscle relaxants of central action;

5. neurotropic B vitamins, which are considered by some researchers to be capable of exhibiting weak analgesic activity.

We will deal with these medicines. For each medicinal product, as usual, an international non-proprietary name, or INN, will be given. Then – the name of the original drug. An original drug is a drug that was first put on the market, it is equal to the manufacturers of all its commercial copies, or generics. The original drug is always a reference, the purest chemical substance is used for it, and the largest number of studies have been conducted for the original drug, confirming its safety, efficacy, as well as catamnesis data, that is, long-term results of treatment.

The following is a list of some generics, or commercial copies, sold in Russia, and the average cost of the original drug for pharmacies of all forms of ownership in the Russian Federation for the spring of 2020. Sometimes the price of the cheapest domestic generic will also be indicated, but this is not an advertisement for a “domestic manufacturer”. It is much more important to obtain a high-quality drug of European, or at least Indian quality, than a cheap medicine in which the active substance is represented by the cheapest substance with a large number of impurities and low pharmaceutical activity.

The list of medicines given below does not aim to create advertising for these particular medicines, their manufacturers, and also does not aim to create anti-advertising for any drugs without including them in the list. All of the following remedies exist in official national clinical guidelines for the treatment of acute and chronic back pain.

15 best injections for lower back pain

NSAIDs: fighting inflammation and pain

The main place for injections and injections for low back pain belongs to a large and well-developed group of non-steroidal anti-inflammatory drugs, the mainstay of the treatment of inflammation and pain in modern medicine. They are called non-steroidal because the chemical formula of drugs, the active substance, has nothing to do with the structure of steroid hormones, the most powerful anti-inflammatory drugs known to man.

It is important to separate steroid and non-steroidal drugs, because the more powerful the drug, the more complications and side effects can be from its use. And steroid hormones among such side effects most often have a sharp decrease in immunity, the occurrence of steroid gastric and duodenal ulcers, or steroid gastropathy. There is a risk of developing osteoporosis, steroid diabetes, and other complications. Of course, the development of these conditions depends on the dose of hormones and the duration of their use, and on the state of the patient’s body.

Non-steroidal anti-inflammatory drugs are much less likely to cause such complications, but nevertheless, among them, first of all, one can name an exacerbation of gastritis, gastric ulcer and duodenal ulcer, or the occurrence of aspirin asthma with aspirin intolerance in nasal polyposis. Therefore, in the case of a compromised gastric mucosa, it is desirable to use proton pump blockers in conjunction with NSAIDs during treatment, for cover.

All NSAIDs have antipyretic, anti-inflammatory and analgesic effects. We will only be interested in the last two categories, so paracetamol, ibuprofen and the like will not be included in the list. Ketorolac has the strongest analgesic effect, and it can even be compared in strength to Tramadol, Fentanyl and narcotic analgesics.

Diclofenac has the most powerful anti-inflammatory effect, and if the pain in the back and lower back is caused by inflammation associated with compression of the nerve roots, then this drug will be most preferable. It should also be said that all drugs from the NSAID group can be both selective and non-selective. Selective drugs that inhibit only type 2 cyclooxygenase, or COX-2, such as Movalis, Xefocam, or Ketonal, are safer in terms of the risk of developing erosive gastritis and stomach ulcers than non-selective ones, such as diclofenac. Non-selective NSAIDs affect both COX-2 and COX-1.

Diclofenac (Voltaren, Ortofen Naklofen, Diklak, Dicloran, Feloran)

Rating: 4.9

Diclofenac is an old, tried and tested remedy. In case of an overdose, it can be very harmful, causing an exacerbation of stomach ulcers, heartburn, and with prolonged uncontrolled use, even drug-induced hepatitis with a very serious outcome. By long-term use is meant the appointment to oneself as a self-medication of daily injections for several weeks, or even months. Any diclofenac, and even the best and highest quality of them – Voltaren must be used in a short course.

Each ampoule of Voltaren contains 75 mg of diclofenac, produced by Novartis. A package of 5 ampoules of 2 ml costs about 2020 rubles in March 300. However, there are also cheap analogues of European quality. The same Hemofarm package will cost 45 rubles. Domestic analogues, such as Ortofen, produced by Tatkhimfarmpreparata, will cost about the same.

The strength of diclofenac is a pronounced anti-inflammatory effect. It is used for any pain associated with the pathology of the musculoskeletal system, and not only for back pain. These are rheumatic diseases, Bechterew’s disease, or ankylosing spondylitis, inflammation of the muscles, intervertebral hernia with the phenomenon of compression of the nerve roots. It very well reduces inflammatory edema, pain after injury, improves the range of motion in the back, and reduces pain in the joints. Therefore, lumbago, neuralgia, radiculitis can be successfully stopped by injections of diclofenac. However, it should be remembered that this drug is prescribed for symptomatic therapy, it will not find and cure the cause of back pain, and will not affect the progression of the disease in any way.

Voltaren should be used deeply intramuscularly, once a day, and with a severe pain syndrome, the maximum dose is two ampoules per day, and it can be used in this mode for no more than 2 days. Then you need to switch to tablets, or diclofenac suppositories for rectal administration.

Advantages and disadvantages

The disadvantages of diclofenac is that it can cause a large number of different side effects. These are abdominal pain, heartburn and nausea with vomiting, diarrhea, headache and dizziness, drowsiness. Against the background of taking large doses of diclofenac, especially in injections, dizziness occurs, quite often – a skin rash. It is necessary to remember about contraindications. These are aspirin intolerance, exacerbation of gastritis and stomach ulcers, age up to 18 years, and the third trimester of pregnancy. In general, the activity and rapid effect of the introduction of diclofenac must be paid for by the readiness for its not very good tolerance. In the official instructions, there are a very large number of relative contraindications when the doctor must be careful, for example, in the case of diabetes mellitus, coronary heart disease, underweight in old age, while taking prednisone, and so on.

Ketorolac tromethamine (Ketanov Ketalgin long, Ketanov, Ketolex, Medrolgin, Emodol)

Rating: 4.8

If you need to quickly relieve extremely severe back pain, then it is more difficult to find a remedy more effective than Ketanov, or Ketorol. All these drugs are sold in ampoules of 1 ml, 10 pieces per pack, and are inexpensive, within 120 rubles per pack. Ketanov is produced by the Indian company Ranbaxy, and Ketorol is also an Indian company – Dr. Reddis. Modern Indian medicines are of quite high quality, since good quality substances are created in India due to the intensive development of the chemical and pharmaceutical industries.

In terms of their analgesic power, these drugs come close to narcotic analgesics, and although they stop the pain syndrome very well, for example, which prevents you from falling asleep with acute back pain, they do not affect the outcome of the disease, its course and its cause. These are symptomatic therapies.

Ketorolac is a non-selective cyclooxygenase inhibitor and therefore has approximately the same safety spectrum as diclofenac. It is best used when the patient experiences acute, radicular pain, like an electric shock, which prevents going to the toilet, changing the position of the body in space and is associated with swelling of the nerve roots pressed by the intervertebral hernia. It is necessary to apply the solution for injection in the same way, deep intramuscularly, which is the case with diclofenac. It is impossible to administer Ketanov intramuscularly more often than 4 times a day, while the duration of treatment for acute back pain with injections should not exceed 5 days.

Advantages and disadvantages

In the Russian Federation, unfortunately, recently it is impossible to buy ketorolac without a prescription, this is an obvious minus. After all, sometimes pain occurs suddenly, for example, a toothache, and Ketanov as an ambulance pain reliever, in principle, should be in every first aid kit. Ketorolac should not be used in patients with hypersensitivity to NSAIDs, with exacerbations of gastric erosive and ulcerative processes, in case of blood clotting disorders. These are hemorrhagic stroke, hemorrhagic diathesis, and other coagulation disorders, impaired hematopoiesis. It should not be used by pregnant, lactating women and children under 16 years of age. This drug is not intended for the treatment of long-term and chronic pain, and its analgesic potential is great enough to be used as a premedication before surgery, but it is not used because it can increase the risk of bleeding.

Hence the conclusion follows: if you suffer from reduced blood clotting, if you have nosebleeds, bruises, bleeding from the gums, then it is better not to use Ketanov and its analogues at all, or use it in a minimally short course.

Meloxicam (Movalis Melox, Zeloxim, Inflamin, Revmoxicam)

Rating: 4.8

Movalis is the first meloxicam obtained, and it is currently produced by Boehringer Ingelheim. The package of 3 ampoules is specially designed for its use in a short course during the first three days, after the onset of severe back pain. Ampoules are available in 7,5 and 15 mg. Packing large dosage ampoules will cost you 700 rubles, and this is really the most expensive of meloxicams. Its price, twice that of Voltaren, is not accidental. This drug selectively inhibits type 2 cyclooxygenase, much stronger than the first. That is why it is safer in relation to the gastric mucosa than diclofenac.

If we compare it with Ketorol, then with a similar, slightly inferior analgesic ability, it does not affect the risk of bleeding. The drug is prescribed for back pain, arthritis and arthrosis, and for inflammatory and degenerative lesions of the musculoskeletal system. These are conditions such as dorsopathy, lumbago, backache or lumbago, sciatica and periarthritis of the shoulder, and even a condition called “low back pain.” The drug must be administered once a day, for 3 days strictly deep intramuscularly. The maximum daily dose is just 15 mg, that is, one ampoule. A dosage is produced, where in one ampoule there are half as much meloxicam, 7,5 mg. It is with this dose that it is recommended to start treatment.

Advantages and disadvantages

The advantage of the original production of meloxicam can be considered its higher safety and lower risk of side effects, with an efficiency approximately approaching that of diclofenac. However, there are still side effects, and the most common among them are headache, abdominal pain, nausea, pain and slight swelling at the injection site. The word “often” refers to the occurrence of an adverse symptom from one to 10% of all cases.

It must be remembered that the drug is strictly contraindicated in a number of diseases and conditions. These are pregnancy and breastfeeding, age under 18, aspirin asthma. This is an exacerbation of a stomach ulcer and inflammation of the intestine in an active form, the presence of severe liver and kidney failure, anticoagulant therapy and reduced blood clotting. There are also a number of diseases when the drug should be used with caution. There is a whole group of drug interactions, for example, with contraceptives, diuretics and hypoglycemic drugs, so the doctor must take into account comorbidities.

Ketoprofen (Ketonal, Flamax, Flexen, Arthrosilen)

Rating: 4.7

Ketoprofen of European quality, or Ketonal, is a drug of about the same line as Movalis, and is the same selective cyclooxygenase type 2 inhibitor, good quality, which is used for the symptomatic treatment of inflammation and pain, including low back pain. Ketonal in injections is used for various arthritis, including rheumatoid and psoriatic arthritis, for gout, and for various neurological diseases. It helps to relieve pain with myalgia and sciatica, with tendonitis and neuralgia of peripheral nerves, and even with migraines and menstrual irregularities.

Like other drugs, it only improves the quality of life, but does not change the course of the disease. Ketonal should be administered deep intramuscularly in one 100 mg ampoule, no more than 2 times a day, until the maximum daily dose of 200 mg is reached. The duration of treatment should not exceed 3-5 days. Ketonal is produced by Lek from Slovenia, and one pack of 10 ampoules of 2 ml will cost about 250 rubles. There are numerous domestic and foreign analogues.

Advantages and disadvantages

The advantage of Ketonal can be considered its fairly high activity and a decent safety profile, and its disadvantages are typical for non-steroidal anti-inflammatory drugs. Perhaps, its separate advantage can be considered the possibility of intravenous, infusion administration in a hospital, when one or two ampoules, diluted in 100 ml of sodium chloride (0,9%), can be injected slowly over an hour. Side effects and contraindications are standard for this group of drugs. These are aspirin intolerance, exacerbation of gastric ulcers, severe bleeding disorders, liver and kidney failure. Also, this is the age of up to 15 years, the state of pregnancy and breastfeeding.

Dexketoprofen (Dexalgin, Alfort Dexa, Decafen, Sertofen)

Rating: 4.7

Dexalgin is a relatively new drug that has been used for only 12 years. In the Russian Federation, Dexalgin, an Italian production of the Menarini group, is approved for use. A package of 2 ml No. 5 ampoules will cost approximately 260 rubles.

This drug belongs to propionic acid derivatives, and, in addition to back pain, radicular symptoms, muscle strain and soft tissue injuries of the back, it is even used to relieve toothache and malignant neoplasms. It helps with osteochondrosis, arthrosis, rheumatoid arthritis and spondylopathies. One ampoule contains 50 mg of the active substance, but it inhibits two enzymes at once, COX-1 and COX-2, so it cannot be considered strictly selective. The analgesic effect after the introduction of one ampoule lasts, on average, 6 hours, and comes quickly: after 30 minutes. For adult patients, one ampoule every 12 hours is recommended for back pain. Re-introduction is also possible, but not earlier than after 6 hours, and more than 3 ampoules should not be administered per day. It should be remembered that it is possible to stop acute pain in the lower back with Dexalgin only for 2 days, and then the risk of the possibility of developing side effects will exceed its effectiveness.

Advantages and disadvantages

Dexalgin is a well balanced drug with relatively few side effects, all of which are well known. These are heartburn, abdominal pain and nausea, the possibility of increasing the activity of liver enzymes. But all these side effects are much less common than other drugs from this group. Contraindications are standard: bronchial asthma, hemorrhagic diathesis, exacerbation of gastric ulcer or the presence of gastrointestinal bleeding, along with hypersensitivity to the drug.

Lornoxicam (Xefokam)

Rating: 4.7

In conclusion of the review of drugs from the NSAID group, we will consider another representative from the group of oxycams, namely Xefocam. This drug has high efficiency, good European quality, but by no means a small price. Produced by Nycomed, it will cost you 700 rubles.lei. This is the price of a pack of 5 vials containing 8 mg of lornoxicam powder. Ksefokam must be used by dissolving the contents of the vial with plain water for injection in an amount of 2 milliliters. The drug is administered intramuscularly for at least 5 seconds, and the drug is produced in two concentrations: 8 or 16 mg, but it is necessary to start the treatment of acute pain syndrome with a lower dosage. No more than 16 milligrams can be administered per day, and if we are talking about postoperative pain, then the agent can even be administered intravenously, but only in a hospital setting.

Advantages and disadvantages

This drug can be considered a high-quality and effective drug, which, although it has the same list of contraindications for use as other non-steroidal anti-inflammatory drugs, but this drug is surprisingly balanced, well tolerated, and the incidence of side effects is never very frequent, that is less than 10% of all cases. Of the general contraindications, it should be noted a ban on prescribing to persons under 18 years of age, lactating and pregnant women, the possibility of increasing bleeding time and a ban on its use in conjunction with other NSAIDs, due to the risk of mutual potentiation of side effects.

Muscle relaxation: relaxation

Muscle tone is the necessary, reflexively maintained muscle tension, which helps to find the human muscular system in full readiness. The regulation of muscle tone is carried out using a simple reflex arc. And, like any extremes, both a decrease in tone (hypotension) and an increase in it (muscle hypertonicity) are harmful.

Thus, a decrease in muscle tone leads to looseness in the joints, the appearance of dislocations, leads to weakness and muscle hypotrophy. And hypertonicity, which often occurs with extensive ischemic strokes, often contributes to contractures and pain in paralyzed limbs.

In clinical practice, most often you have to deal with conditions in which the tone of the skeletal muscles increases.

An increase in muscle tone occurs by a very simple mechanism. Suppose, due to osteochondrosis, the intervertebral disc has shifted, a hernia has occurred. She began to rub the ligaments, deep muscles of the back, a focus of inflammation arose, with the involvement of the nerve roots. Edema immediately appeared in the focus of inflammation, and the local temperature increased. What will be the reaction of the surrounding deep back muscles?

Muscles can react to any irritation in only one single way: this is a contraction. But what if the inflammation does not go away? Then the muscle falls into a state of persistent contraction, which is called a spasm. In a state of spasm, the muscle does not receive nutrients, and very poorly removes its own waste products, that is, lactic acid. This state forms a vicious circle. Contraction induces muscle ischemia, and ischemia provokes contraction.

As a result of this, a secondary component of low back pain arises, which is manifested by aching pains, stiffness, and muscle compaction. Therefore, it is necessary to prescribe muscle relaxants. They affect the spinal cord neurons, reflexively reduce muscle tone, normalize blood circulation and capillary blood flow, and relieve aching, annoying back pain.

Tolperisone + lidocaine (Mydocalm, Kalmirex)

Rating: 4.9

A very important component that leads to chronic back pain is severe muscle spasm. Tightened muscles are able to maintain soreness for quite a long time, even after the primary cause (for example, sprain from injury) can be eliminated. This is how chronic pain is maintained in osteochondrosis of the lumbosacral spine in patients with physical inactivity, leading a sedentary lifestyle. To break the vicious vicious circle, Mydocalm is used.

It is a muscle relaxant, or a drug that relaxes the muscles, and its action is central. This means that it blocks tonic muscle reflexes by acting on the neurons of the brain and spinal cord, and not on the musculature itself. Mydocalm is used, in addition to the treatment of acute back pain, also for strokes with spasticity and severe pain. It is prescribed for various muscle spasms, paralysis, multiple sclerosis and other neurological pathologies.

Mydocalm is used in injections together, for example, with Movalis on the same days (naturally, without mixing the funds in one syringe). Such an injection form is called Mydocalm-Richter, each ampoule contains 100 mg of the drug, and in the acute period the drug should be used intramuscularly 2 times a day, in the morning and in the evening. One pack of 5 ampoules costs, on average, 560 rubles.

Advantages and disadvantages

Mydocalm is generally well tolerated, but it relieves back pain in the best way only as part of complex therapy, that is, being prescribed along with NSAIDs. On its own, it relaxes the muscles, but it does not have a true analgesic effect. The downside of Mydocalm will be a ban on its use in children, allergic reactions as a side effect. Muscle relaxation can be an obstacle to driving a car and working with moving machines and mechanisms, so it is advisable to refrain from such work during the treatment period. Otherwise, the use of Mydocalm in complex therapy accelerates the pace of pain treatment.

Tizanidine (Sirdalud)

Rating: 4.8

As an exception, we will place in this review the second muscle relaxant, which is not available in ampoules, but in tablets. What’s the difference? Anyway, after 3-5 days of using a muscle relaxant in the form of intramuscular injections, you will have to switch to tablets. It might be tizanidine. It is available in 2 versions: 2 mg and 4 mg tablets, 6 mg sustained release capsules. Tizanidine also acts on the alpha receptors of the spinal cord, suppressing excitation in muscle synapses, and as a result, muscle tone decreases. It is necessary to use Sirdalud in conditions of painful neck spasm, including if there is a concomitant myofascial syndrome with chronic back pain. It is desirable to prescribe it inside, at a dose of 6 mg 2 times a day. Sirdalud is produced by the well-known pharmaceutical company Novartis, and a package of 30 sustained-release capsules of 6 mg each will cost 500 rubles.

Advantages and disadvantages

Like any muscle relaxant, it can have side effects such as muscle weakness and drowsiness, and increased fatigue. It is not recommended to drive a car and work with mechanisms in a high-risk area while taking this drug. This, of course, is an obvious disadvantage. But, on the other hand, if the patient already has insomnia due to chronic back pain, then you can “kill two birds with one stone”: alleviate the patient’s condition, relieve secondary muscle pain, and improve his sleep. If we talk about comparing Mydocalm and Sirdalud, then Sirdalud causes drowsiness much more often, and Mydocalm is almost invisible in this case.

Steroids (hormonal drugs for back pain)

With a significant severity of the pain syndrome, medications are prescribed in the lower back, including various types of blockades. They are injected deep into the muscles of the back. Neurologists and traumatologists-orthopedists carry out blockades of the facet joints, the posterior branches of the spinal nerves.

Drugs used for blockades are local anesthetics, among which lidocaine, B vitamins are most often used. In some cases, the most powerful anti-inflammatory drugs known to medicine are used – these are synthetic analogues of corticosteroid hormones.

Betamethasone (Diprospan, Depos, Flosteron, Betaspan)

Rating: 4.9

Diprospan has gained great popularity, since its anti-inflammatory effect is very powerful, the effect comes very quickly and is long-lasting, that is, prolonged. Diprospan allows you to break the vicious circle between pain and muscle spasm for a long time. Diprospan is very active. It is 25 times more potent than hydrocortisone and 10 times more potent than prednisone when compared in equivalent doses by weight. The betamethasone dipropionate molecule, in addition to a quick effect, can also have a long-term effect. This is due to the insolubility of the molecule and the formation of a crystalline depot at the injection site. The absorption of the hormone is very small, and therefore it acts for a long time.

For lower back pain, paravertebral blockade is performed, with preliminary anesthesia at four points. Lidocaine is used as an anesthetic, and 2 milliliters of Diprospan is added to it. If we are talking about the lumbar region, then Diprospan is injected fan-shaped, including into the area of ​​​​inter – and supraspinous ligaments, and in this case, the indication is chronic muscle spasm, which is not able to be resolved by muscle relaxants and standard anti-inflammatory drugs.

Advantages and disadvantages

Betamethasone is a powerful hormone, it has many complications and side effects for use. So, it is contraindicated if a person is already using hormones, if he has a fungal infection. Diprospan stimulates protein breakdown, free amino acids are converted into glucose, and blood sugar rises. If Diprospan is used uncontrollably, steroid diabetes may occur. Due to lipolysis, there may be a redistribution of body fat, a change in figure.

Hormones cause edema, sodium retention in tissues, loss of potassium, disruption of the cardiovascular system, and increased blood pressure. You should always be aware of the risk of muscle weakness on the background of long-term treatment with corticosteroids, the development of osteoporosis and pathological bone fractures with the appearance of pain in the bones.

Hormones enhance the process of ulcer formation in the stomach, exacerbate erosive gastritis and other inflammatory diseases of the gastrointestinal tract. The introduction of Diprospan in women can cause menstrual irregularities, in patients with glaucoma, cataract symptoms and an increase in intraocular pressure, the development of a serious attack, may occur.

Triamcinolone (Kenalog)

Rating: 4.8

Kenalog is also a representative of hormones from the group of corticosteroids, only it is already triamcinolone. Its activity is just as good, it relieves acute pain in the back and lower back, but only if it is dosed, like Diprospan, is administered by a specialist in a treatment room in the form of therapeutic blockades. The medicine is sold in the form of a package of ampoules of 1 ml No. 5, the drug is produced in Slovenia, and is relatively inexpensive, 700 rubles.lei.

It should be remembered that this remedy is also intended for the treatment of many diseases, such as dermatitis, gout, psoriasis, and allergic asthma. For use in the form of blockades, it must be administered together with novocaine from 10 to 40 mg at a time, slowly, and deeply intramuscularly. The effectiveness and time of pain relief from a single injection into the area of ​​paravertebral muscles can range from 2 weeks to 6 months.

Advantages and disadvantages

Dignity is the apparent duration of action, up to several months, in a “prick and forget” type. However, there are also dangers. There are side effects and contraindications, which include stomach ulcers, a sharp decrease in immunity and osteoporosis. After the introduction, it is necessary to observe the patient with a therapist or neurologist.

Methylprednisolone (Solu-Medrol)

Rating: 4.7

Another drug that can be used as deep intramuscular blockades for chronic back and lower back pain syndrome is Solu-Medrol, or methylprednisolone. However, it is used much less frequently than Kenalog or Diprospan. Its main application is pulse therapy, which is often used for various rheumatic diseases, as well as for multiple sclerosis. However, in various forms of osteoarthritis, inflammatory conditions such as spondyloarthritis or Bechterew’s disease, post-traumatic inflammatory lesions of the spine, it can be successfully used in the form of deep intramuscular blocks in combination with local anesthetics, for example, novocaine. It is administered as a deep intramuscular injection, treatment begins with a low dose, and if blockade is necessary, the doctor determines the final dose of the drug. Solu-Medrol is a high-quality hormonal drug produced by the well-known American company Pfizer, and one small bottle of lyophilisate in the amount of 0,5 ml will cost about 370 rubles.

Advantages and disadvantages

Solu-Medrol is not the best remedy for blockades, methylprednisolone and prednisolone in general still have their application most of all to various diseases in internal medicine, for example, multiple sclerosis. His task is to stop the exacerbation. It is better, if necessary, to make a therapeutic blockade in case of chronic or acute back pain to focus on those long-acting hormones that are often used to treat pathologies of the musculoskeletal system. First of all, it is Diprospan.

Novocain as a local anesthetic

Rating: 4.7

Finally, in this group, let’s stop our attention on cheap, widely used novocaine. Novocain belongs to local anesthetics, and can be prescribed for acute back pain, of course, and as a means for electrophoresis. But since we are discussing intramuscular injections, here we will talk about an agent for infiltration anesthesia. A long needle is taken, 5-10 ml of novocaine, or 0,25, or 0,5%, is drawn into it. And gradually the needle moves inward, feeding forward itself a solution for pain relief (infiltrate). Then the syringe with novocaine is removed. A syringe containing a hormonal substance, or vitamins, is attached to the needle, and additional medicine is delivered to the necessary place, into the paravertebral muscles or into the surrounding tissues. Novocain is cheap and available. One package of 10 ampoules of 5 ml of a 0,5% solution can be purchased for only 50 rubles.

Advantages and disadvantages

Paravertebral injections are rarely done with Novocain alone, since it is necessary to carry out the same rather laborious and painstaking process, but the result will not last very long. Indeed, in the case of the introduction of corticosteroid hormones, the effect can persist even up to 6 months, and in the case of one novocaine, it is good if it takes several days.

neurotropic vitamins

In conclusion of our review, we will analyze a short group of neurotropic vitamins, and agents that can be additionally administered intramuscularly for acute or chronic low back pain in order to anesthetize. Neurotropic vitamins are considered as moderate analgesics, since they normalize the metabolism of nerves, including those that are sensitive branches and carry the sensation of pain to the central nervous system. However, if they are used on their own, alone, they are unlikely to remove severe pain, so it is better to use them as a means of complex therapy for one to two weeks, along with drugs from the NSAID group, as well as with muscle relaxants.

Vitamins B1 + B12 + B6 (Neuromultivit)

Rating: 4.9

Neuromultivit contains vitamins B6, B1 and B12, and water for injections has been added to it. The next drug, which is called Milgamma, has already added lidocaine as a local anesthetic, therefore, despite the same vitamin composition, they have different tolerability. The next drug, Milgamma, is better tolerated: it’s just that the injections “do not hurt”. Neuromultivit is prescribed for polyneuropathies, intercostal neuralgia, lumbago, acute and chronic pain syndrome in the back and lower back, sciatica, lumboischialgia. It is produced by a domestic manufacturer, 5 ampoules with a volume of 2 ml costs 250 rubles.

Advantages and disadvantages

The drug helps well only in complex therapy, together with non-steroidal anti-inflammatory drugs and muscle relaxants. The downside is the presence of water in the form of a solvent, and injections are made quite painful from this. Of the contraindications, only hypersensitivity, pregnancy, childhood and breastfeeding can be noted.

B1 + B12 + B6 + lidocaine (Milgamma)

Rating: 4.8

The drug Milgamma is considered to be multicomponent, multivitamin in its composition, and contains neurotropic vitamins of group B, and the solvent is a local anesthetic – Lidocaine. Do not confuse Lidocaine, which is administered specifically for therapeutic blockades to relieve pain, and Lidocaine, which is administered intramuscularly as a solvent. In the latter case, it simply contributes to the fact that the injection will not be so painful. Each ampoule contains 2 milliliters and the content of vitamins B1, B6 and B12 are respectively 100mg, 100mg and 1mg. Milgamma produces analgesic, metabolic and neuroprotective effects.

Milgamma is used, in addition to acute pain in the back, lower back, with neuritis and neuralgia, with plexopathies and various polyneuropathies, and other neurological diseases. Dosage regimen – deep intramuscularly (in the upper outer quadrant of the buttocks) 2 ml daily for 5 to 10 days. The cost of one package of 10 ampoules of 2 ml, which is produced by the German company Verwag Pharma, averages 560 rubles per package.

Advantages and disadvantages

As in the previous case, the main disadvantage of Milgamma will be a rather weak analgesic effect, if the drug is used alone. And if the patient is prescribed Milgamma and Mydocalm plus Movalis, then the analgesic effect will be more pronounced. The return time for patients with back pain to active life will be shorter. In some cases, the drug can cause side effects, most often allergic reactions occur, but usually their frequency is not higher than 0,1%. The drug is contraindicated during pregnancy and during breastfeeding, in children and in patients with severe heart failure. A big plus is the ability to continue therapy with the drug in tablet form after a short course of injections.

Instead of a conclusion: “troychatka”, lytic mixture

We have listed enough drugs and preparations for intramuscular and even intravenous injections to relieve acute and chronic low back pain emanating from the structures of the musculoskeletal system. In conclusion, it would not be superfluous to recall how doctors and ambulance paramedics struggled with acute back pain, and continue to struggle in the absence of rather expensive medicines.

They make the so-called “troychatka”, or lytic mixture. The standard triad is a favorite drug that a doctor or paramedic, like an alchemist, prepares directly at the patient’s home. To do this, you need to take one ampoule of analgin, 50%, one ampoule of diphenhydramine, 1%, and one ampoule of papaverine hydrochloride. It is even better if instead of papaverine there is an ampoule of No-shpy. And then something is done that is strictly prohibited by all the rules in pharmaceuticals. The entire contents of three ampoules are drawn into one syringe and injected into the patient’s buttocks. As a result, Analgin has an analgesic effect, Papaverine, or No-shpa, as a myotropic antispasmodic, relieves spasms of smooth muscles, and Diphenhydramine, as a rough first-generation antihistamine, calms, has an anti-allergic effect, produces a mild hypnotic and sedative effect. At the same time, the cost of “troychatka” in the aggregate will not exceed 30 rubles, if you calculate the retail price of ampoules. Naturally, this information is only historical and educational in nature, and it is strictly forbidden to mix any drugs in one syringe, as well as attempts to self-medicate.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.