How do drugs work?
The main goal of pharmacology is to create easy-to-take medications with maximum effectiveness and minimal side effects. The ideal option is a medicine that acts locally and does not affect the rest of the body. To achieve this, different forms of drug release are needed in different cases.
To determine the correct functioning of a drug in pharmacology, there are two concepts: bioavailability and half-life.
Bioavailability is the amount of a substance that reaches its intended purpose. This process is hampered by the body's protective barriers. The selection of the dose for treatment and the method of administration depend on bioavailability.
The half-life is the time after which the level of the drug is reduced to half its original level and ceases to have an active effect on the body. It is this period that determines how many times a day you need to take the medicine.
Kinds
What injections are given for osteochondrosis of the cervical spine and other areas of the spine is chosen for each patient by the attending doctor. The following groups of drugs are used:
- analgesics;
- NSAIDs;
- hormonal;
- muscle relaxants;
- chondroprotectors;
- vitamins;
- improving blood circulation;
- homeopathic.
Injections for osteochondrosis of the thoracic region are prescribed less often than for neighboring parts of the spine, since it is less susceptible to degenerative changes.
Non-steroidal anti-inflammatory injections
NSAIDs for spinal osteochondrosis are considered one of the most effective in the fight against inflammation, quickly and permanently eliminating pain and swelling. Due to the fact that they stop the action of prostaglandins, the inflammatory process stops. In addition, the sensitivity of the nerve plexuses and endings is blocked. Long-term use can cause abdominal and headache pain, dyspeptic disorders, dizziness, skin rash and other undesirable symptoms, including gastric bleeding.
Ortofen
The active ingredient is diclofenac sodium. One injection lasts for 12 hours. Usually a one-week course is required.
Ketorolac
The active substance is ketoprofen. Considered a strong analgesic. It is given for 1 week, 2 times a day.
Meloxicam
The drug is a selective COX-2 inhibitor, as a result of which it has fewer side effects. The course of therapy lasts on average 7-10 days, 2 injections per day.
Movalis
This is a German drug based on meloxicam. The product is injected deep into the muscle, providing an effect for 24 hours. The course lasts no more than a week.
Diclofenac
This non-steroidal anti-inflammatory drug is considered the “gold” standard. It is most often used for injections for lumbar osteochondrosis and other diseases of the musculoskeletal system.
Blockades
Nerve blocks are performed only for emergency indications. One or several drugs are administered, differing in the mechanism of action on the site of inflammation.
Novocaine
Included in the list of vital medications. It is a local anesthetic with a wide range of therapeutic effects. Quickly relieves pain.
Dexamethasone
A synthetic glucocorticosteroid with anti-inflammatory, antiallergic and immunosuppressive effects.
Prednisolone
A hormonal remedy to help in emergency situations with spinal osteochondrosis.
Muscle relaxants
Muscle relaxing injections for osteochondrosis are included in the treatment regimen to relieve muscle spasm, restoring normal blood circulation and the flow of nerve impulses.
Mydocalm
The active substance is tolperisone. Has a central effect on skeletal muscles.
Chondroprotectors
Course injections of chondroprotectors for spinal osteochondrosis help restore cartilage tissue, stopping the processes of its destruction.
Elbona
A Russian drug based on glucosamine sulfate.
Alflutop
The active component is represented by a biological concentrate obtained from small marine fish.
Mucosat
The active ingredient is chondratin sulfate.
Rumalon
Peptide complex from cartilage tissue and bone marrow of calves.
Vitamins
Vitamin injections are prescribed after relief of an “acute condition” and to prevent exacerbations of osteochondrosis.
Milgamma
A German drug consisting of B vitamins and lidocaine. It has a complex effect on the spine and the body as a whole. Metabolic processes, tissue trophism, and nervous system function improve.
Combilipen
Russian analogue of Milgamma. Has a good therapeutic effect. Injections for osteochondrosis are given for 5-10 days.
Why are the shapes different?
Initially, there were only two ways to deliver medicine to the body: swallowed or applied; other options were not available to doctors of the past.
But with the development of medicine, it has become clear that these options do not always work. When swallowed, the drug has a long journey to travel. Before getting to the right place, the tablet passes through the aggressive environment of the stomach. And after absorption, the substances enter the liver through the bloodstream, where toxins are neutralized and the medicine can become inactive before reaching the target organ.
Also, some drugs can negatively affect the functioning of the gastrointestinal tract. Cause nausea, vomiting or simply not work if the stomach or intestines are not in order and absorption is impaired.
“A classic example is when we changed a patient’s drug,” says GMS Clinic therapist Andrey Besedin, “during exacerbations of gastric ulcer, duodenal ulcer, or after surgery on the gastrointestinal tract. In this case, it is better to choose intramuscular or intravenous administration."
There are situations when it is necessary to administer medications intravenously. Most often this is due to urgency, but there are drugs that are destroyed in the gastrointestinal tract. For example, some antibiotics are available only in the form of injections, and in this case injections cannot be avoided.
“Any intramuscular, subcutaneous, intravenous injection is a small operation,” explains Andrey Besedin, “during which we violate the integrity of the body, skin, muscles, depending on what we do. Therefore, if possible, it is better to use tablets and capsules.”
There are medications that have serious effects on the entire body when taken in the form of tablets or injections. For such cases, local forms were invented. Thus, hormones in creams and nasal spray are useful for skin manifestations and allergic rhinitis, but the same hormones in large doses can cause serious consequences with long-term use of tablets or intravenous injections.
For children, medications are available in the form of chewable tablets, drops, or reduced-size tablets, so as not to turn every dose of medication into a battle or cause the association between treatment and pain. Unfortunately, this is not always possible, especially in children's hospitals.
“There are no unambiguous dogmas in medicine,” says Andrey Besedin, “in each situation we choose the type of drug administration individually, depending on what goals we want to achieve with a particular patient.”
Forms of injections for osteochondrosis
What injections are prescribed for osteochondrosis of the lumbar region and other areas of the spine depends on the specific situation. Orthopedists, traumatologists and neurologists practice an integrated approach to treatment. The doctor prescribes a treatment regimen consisting of several drugs.
Intramuscular injections for osteochondrosis
What injections are given for osteochondrosis? Most often, the answer is clear - into the muscle. This method is considered the simplest and most accessible for the patient. The medicine, entering the muscle tissue, gradually penetrates through small vessels into the general bloodstream, providing a long-term therapeutic effect. Intramuscular injections for spinal osteochondrosis are prescribed in the acute period and in the remission stage.
Intravenous injections for osteochondrosis
Injections into a vein are indicated for severe unbearable pain, when it is necessary to achieve a positive effect as soon as possible. After the injection, the active substance immediately enters the bloodstream without loss. If you need to administer a large volume of medication, it is preferable to install a dropper. Intravenous injections for osteochondrosis of the cervical spine are often prescribed for severe compression of the vertebral arteries, when the blood supply to the brain is disrupted.
Nerve blockades
Spinal nerve blocks must be performed by a physician skilled in this technique. In “inept hands” the procedure can result in serious consequences (paralysis, sepsis, death). The drug is injected into trigger points (paravertebral) or directly into the epidural space to instantly reach nerve endings, relieve pain, vasospasm and swelling.
What does the choice depend on?
The doctor determines the form of administration, relying not only on those drugs that are available. He pays attention to the patient’s age, gender, financial capabilities, and even his mood and attitude towards treatment. Children require special attention.
“Choosing the form of a drug is partly a creative process,” says Ekaterina Bokova, a therapist at the 120 to 80 clinic. “There are no ready-made solutions here. But most often we focus on age. If this is a very young baby, then we choose liquid or rectal forms to prevent spitting and choking. This way, the child will receive his dose of the active substance with a greater guarantee. Sometimes you even have to make a choice in favor of an injectable drug. In any case, a child should not be prescribed “adult” pills and divided into parts.”
The wishes of the patient or relatives also matter when choosing the form of the medicine. For older people, it is important to take fewer pills per day, otherwise you can get confused, especially if there are a lot of medications. In such cases, tablet holders or planners help.
“Unfortunately, older people usually insist on prescribing the most affordable drug,” says Ekaterina Bokova, “here, if possible, we will meet them halfway.”
How to choose the right form
Even medications with the same dosage form may differ from each other. For example, capsules and tablets.
“Capsules are more expensive due to the difference in technology,” explains Andrey Besedin. — They hide the unpleasant smell and taste of medications, unlike tablets. The capsules enter the body: the stomach, intestines and, when dissolved, release powder, which is absorbed much more quickly. But there is a factor that many of my patients do not like. The tablets can often be split in half or into quarters and sometimes half the dose is sufficient in an emergency. In the case of a capsule, this will not work, so the choice is made in favor of tablets.”
There are patients who are confident that injections and droppers are much healthier than tablets and specifically insist on this form of treatment. It is believed that in this case the medicine goes directly into the blood and will definitely work. Although this method of administration is more difficult, more painful and most often there is no difference in the result if the same medicine is in the form of tablets or ampoules.
“For example, patients ask for intramuscular or intravenous painkillers for headaches,” says Andrey Besedin. — This type of administration has no advantages compared to oral forms: powders, capsules, tablets, if the patient can take medications by mouth. As a rule, injections are effective if a person has a large loss of fluid or for some reason cannot drink on his own.”
Intravenous and intramuscular delivery methods are more useful in emergency cases of stomach or intestinal disease or in situations where a drug is broken down in the digestive tract, such as heparin or insulin.
Subtleties of performing joint injections
For intra-articular injections, a syringe with a long needle is used. The specialist must hit it exactly into the joint space. To avoid mistakes, such manipulations are often performed under ultrasound guidance. If necessary, before administering the drug, fluid is pumped out of the joint, since complications may occur if it is present.
Contrary to popular belief, joint injections are a painless procedure. According to most patients, they cause the same sensations as regular intramuscular ones.
To ensure that the medicine is evenly distributed inside the joint, simple movements must be performed after the injection. Sometimes the doctor will apply a tight bandage. There is no other complex rehabilitation and recovery period after intra-articular injection. The doctor will only recommend not to put any strain on the affected joint for a while, not to lift heavy objects, and to give up alcohol for a few days.
3
Intra-articular injections feel comparable to intramuscular injections
