Definition
One speaks of a herniated disc, 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, defined precisely as herniation, is the result of the breaking of the fibers that surround and protect the nucleus pulposus, constituting the outer fibrous ring of the disk wall.
Causes
In most cases, the herniated disc is the result of a gradual wear and degeneration of the disc: with age, the discs lose part of the water; this explains why the intervertebral discs appear less flexible and more exposed to tears, twists and breaks.
- Risk factors: severe traumatic events, weight lifting, violent torso rotation, back injury
Symptoms
The herniated disc is often associated with pain, of variable size and location based on the point at which it occurs in the spine (eg at the level of the lumbar spine or cervical spine). In addition to pain in the limbs, the herniated disc often manifests itself with numbness or tingling in the part of the body affected by the herniated disc, in addition to creating general weakness and muscle weakness.
- Unlike what is commonly thought, herniated disc is not always painful: in some patients, in fact, it does not cause any symptoms.
Information on herniated discs - Drugs for the treatment of herniated discs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hernia to the disc - Herniated discs.
drugs
Recent scientific surveys have shown that the so-called conservative treatment - essentially consisting of the administration of painkillers and the avoidance of painful positions - is very useful for controlling pain in the context of a herniated disc. In most cases, the aforementioned treatment should be continued for at least a couple of months, the time frame needed to reduce the protruding portion of the disc, thereby alleviating the symptoms and improving the patient's clinical profile.
The most widely used drugs in therapy to mask the pain derived from the 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 achieving 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, very useful also and above all to prevent any possible future damage.
In the most extreme cases, where physiotherapy and pharmacological 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 disc herniation.
NSAIDs and narcotics : indicated for inflammation and to reduce the sudden / acute pain caused by the herniated disc. In particular, non-steroidal anti-inflammatory drugs are used to minimize the symptoms associated with herniated disc caused by trauma (eg road accident). Narcotic drugs are also used in therapy for this purpose, especially in the case of severe back and leg pain. For this purpose, NSAIDs can be taken for quite long periods; narcotics are usually administered when the patient does not benefit from the administration of NSAIDs.
- Ibuprofen (eg. Brufen, Moment, Subitene): for medium-moderate pain, it is recommended to take an active dose of 200-400 mg (tablets, effervescent sachets) by mouth every 4-6 hours after meals, at need. Do not take more than 2.4 grams per day.
- Naproxen (eg Aleve, Naprosyn, Prexan, Naprius): it is recommended to take the drug at an oral dose of 550 mg once a day, followed by 550 mg of active 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 disc herniation, it is recommended to take 25 mg of active, 4 times a day. Follow the directions given by your doctor.
- Acetylsalicylic acid (eg. Aspirin, Vivin, Ac Acet, Carin): the drug, indicated for adults only, should be taken at a dose of 325-650 mg orally or rectally, every 4 hours, as needed. Do not exceed 4 grams per day. In the case of pain associated with the herniated disc, it is possible to take 3 grams per day of medication, possibly fractionating the load in several doses. The administration of the drug to children under the age of 12 can cause serious side effects, such as Reye's syndrome, liver dysfunction and brain changes.
- Codeine (eg. Codein, Hederix Plan): narcotic drug, widely used for cough treatment. The same active, is also indicated in the context of the disc hernia. As an indication, take a dose of 30 mg, orally, intramuscularly or intravenously, every 6 hours, as needed. In some patients, it is necessary to increase the dose to 60 mg every 4 hours. Don't abuse. Follow the instructions prescribed by your doctor.
- Side effects derived from NSAID abuse: gastric pain, gastrointestinal bleeding, liver damage. It is recommended to take active substances at the same time that can reduce the NSAID-induced gastrolesivity.
- Side effects derived from long-term use of narcotics: sedation, confusion, constipation.
Muscle relaxants : indicated to lighten 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 drug 3-4 times a day orally; alternatively, administer the active ingredient intravenously or intramuscularly at a dose of 5-10 mg in 3-4 hours, as needed. Indicated to inhibit muscle spasms derived from a severe herniated disc.
- Ciclobenzaprina (eg Flexiban) the drug is indicated to reduce muscle spasms derived from the herniated disc. Start taking the drug at a dose of 5 mg orally, three times a day. Based on the patient's response, it is possible to increase the dosage up 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.
- Inordinate use of these drugs can induce sedation and dizziness
Cortisonic drugs: these drugs, belonging to the class of glucocorticoids, are powerful active, able to act through an important anti-inflammatory mechanism. In cases of particularly severe disc herniation, it is advisable to take these drugs orally or by local injection.
- Prednisone (eg. Deltacortene, Lodotra): take 5 to 60 mg of active in 1-4 divided doses during 24 hours. Consult your doctor. Do not prolong the therapy beyond what is due.
- Methylprednisolone (eg Advantan, Solu-medrol, Depo-medrol, Medrol, Urbason): to burn the area affected by the herniated disc, take 4-48 mg per day of medication. 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 the most marked 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 a herniated disc, it is advisable to take 60 mg of drug a day, possibly on an empty stomach. Consult your doctor.
- Gabapentin (eg. Gabapentin, Apentin, Gabexine, Neurontin): the drug is an anticonvulsant used sometimes in therapy in the context of the herniated disc. The dosage must be carefully established by the doctor. The drug is one of the most used active in the treatment of epilepsy.
- Pregablin (eg Lyrica): the drug is an analogue of the amino butyric acid, antiepileptic and anxiolytic used in therapy also for the herniated disc. For the dosage: consult a doctor.
- Tramadol (s. Tralenil, Tramadolo, Fortradol): the drug is an opioid derivative, the dose of which must be determined by the doctor based on the intensity of the pain in the context of the herniated disc (posology variable 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 a 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.
