Pain is a common companion of osteochondrosis, arthritis, and other musculoskeletal diseases. It can be caused by a herniated disc, a tumor, or spasm of the muscles surrounding the spinal column, the destruction of the articular disc. Whatever the cause, the result is the same: the patient cannot straighten up, turn around, do the usual work, and sometimes just get out of bed. In this situation, local and systemic medications come to the rescue – injections, pills, ointments and gels. They relieve pain, eliminate muscle spasm and relieve the condition.
In this article, let’s look at two well-known drugs prescribed for back pain – Midocalm and Diclofenac. We chose them for a reason: they are used in cases of muscle, joint and spine problems. Usually both drugs are prescribed together. They belong to different groups and have different effects on the body: Diclofenac relieves pain, Midocalm eliminates muscle spasm. Together these remedies relieve symptoms of the disease and improve the condition. What else you need to know about the drugs – read more.
Such different means: compare the composition of drugs
The first thing that sticks out when comparing drugs is that they belong to different pharmaceutical groups. Diclofenac is a classic representative of non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are traditionally prescribed for pain of different origin – for example, in exacerbation of osteochondrosis, arthritis of the knee or hip joint, after trauma or surgery. Previously, only NSAIDs were used in the clinical practice of orthopedists and neurologists. Doctors today have come to the conclusion: it doesn’t work that way. Anti-inflammatory drugs alone will not solve the problem of pain. It is necessary not only to remove inflammation, but also to relieve muscle spasm surrounding the affected organ.
Midocalm is the kind of drug that relaxes muscle tissue. It refers to myorelaxants of central action. Without myorelaxants, NSAIDs don’t work to their full potential. Just imagine: the patient was relieved of pain, but the muscles around the spine or joint remain tight. The result is a vicious circle: muscle spasm causes pain, and pain increases muscle spasm. Therefore, to the aid of anti-inflammatory drugs come myorelaxants – to break the pathological chain and remove the patient from the attack.
Detailed characteristics of the drugs are presented in the table:
The active ingredient
Form of production
Tablets, ointment, cream, gel, rectal suppositories, solution for injections
Tablets, solution for injections
Diclofenac is produced in different countries. There are many generic drugs, going under different trade names (Diclovit, Voltaren, etc.). On the Russian market we offer drugs from India and Serbia. Midocalm comes from Hungary.
Against pain and spasm: how do they work??
The effect of the drugs on the body varies. We have studied the drug guides and reviewed scientific articles to describe the effects of the selected remedies. Read more about each drug below.
Diclofenac – a derivative of phenylacetic acid. It is a typical NSAID and is one of the oldest drugs. It has these effects:
Anti-inflammatory action – relieves swelling and hyperemia of tissues, suppresses the activity of the inflammatory process in the affected area.
Analgesic effect – relieves pain caused by inflammation.
Antipyretic effect – lowers high body temperature. This is a concomitant effect of the drug and it is expressed quite weakly.
Diclofenac inhibits the production of the enzyme cyclooxygenase (COX). This enzyme ensures the production of those substances in the body that are responsible for the development of inflammation – prostaglandins and bradykinins. While these substances are there, inflammation progresses, swelling and tissue pain increases. Diclofenac interrupts the chain of biochemical transformations, prevents the COX enzyme to activate the synthesis of new inflammatory mediators and trigger pain.
In rheumatic and inflammatory diseases of the joints and spine Diclofenac removes local tissue swelling, reduces pain on movement and at rest, eliminates morning stiffness and increases range of motion. The drug is also used in the postoperative period – it relieves pain, swelling, inflammation.
After intramuscular injection, diclofenac sodium quickly enters the bloodstream and reaches a maximum in 20-30 minutes. Orally administered, the action is slower. It passes through the digestive tract, enters the liver and peaks in the blood 2-4 hours later. When administered rectally, the absorption rate is faster – 40-60 minutes.
Diclofenac penetrates the synovial fluid that fills the joints, and acts directly in the affected organ. But it reaches the inside of the joint slowly – only after 4-6 hours. It is excreted with urine through the kidneys and with bile through the intestines.
The mechanism of action is not fully understood. Manufacturers suggest that tolperizone stabilizes nerve cell membranes and prevents impulse flow through sensitive fibers and motor neurons. It has a local anesthetic effect – it relieves pain in the lesion area. It may also inhibit the release of pain mediators by inhibiting the flow of calcium into cell channels.
While scientists argue about how the drug works, practitioners prescribe it to relieve muscle spasm in arthritis, osteochondrosis and other musculoskeletal pathologies. By relieving spasm, tolperizone also eliminates pain – and enhances the effects of NSAIDs.
When injected intramuscularly, the drug quickly peaks in the blood. The effect is noticeable after 20-30 minutes. When taken internally the drug must undergo transformation in the liver, so it will work slower – after 30-60 minutes. Metabolites are excreted with the kidneys.
Evaluating the effectiveness of medications: can they be trusted??
Medications used for pain syndrome must meet certain criteria:
Quickly and effectively relieve pain;
not cause local allergic and toxic reactions;
Have a large therapeutic window – there should be a significant difference between the therapeutic and toxic dosage;
Do not accumulate in tissues.
Both Midocalm and Diclofenac meet these criteria. But another aspect is important to consider: the evidence base for drug effectiveness. Find out what experts say about it.
Diclofenac sodium is a long known drug. The PubMed database and the Cochrane Library have many scientific articles devoted to it. We can trust these sources – the most reliable data on the effectiveness and safety of medications are collected here. There is a lot of information, but it is contradictory. Most scientists say that diclofenac sodium works, but only as a symptomatic treatment. It can relieve pain and inflammation, but not cure the disease.
Excerpts from scientific articles:
One Cochrane review compared diclofenac and placebo. The drug has been shown to be effective in treating musculo-articular pain when used topically. Side effects were found in 20% of the subjects. Researchers included only double-blind, placebo-controlled studies in the review.
Another Cochrane review examined the use of diclofenac in the postoperative period. The authors analyzed eight studies and found that the drug relieves pain after surgery and is more effective than a placebo. However, the quality of the evidence has been assessed as poor, so new studies on this problem are needed.
Another review in the Cochrane Library focuses on the use of NSAIDs for acute and chronic pain in adults. Diclofenac patches and gels have been shown to effectively relieve pain in arthritis and osteoarthritis.
Other sources also state that diclofenac relieves pain and relieves inflammation in rheumatoid diseases.
A review article on diclofenac stated: the drug is as effective as other NSAIDs for osteoarthritis and rheumatoid disease.
In the Russian-language literature, you can find quite a few articles on NSAIDs and diclofenac in particular. One of them presents the drug as effective but unsafe. Researchers emphasize that diclofenac relieves pain and increases range of motion, but often causes adverse reactions. The authors of the article do not recommend the use of this drug in elderly patients. Another source claimed diclofenac as a tried-and-true remedy. The combination of good tolerability and high efficacy makes diclofenac the drug of choice for many conditions.
The Cochrane Library has eight clinical reviews on tolperizone, and the PubMed database has over two hundred articles. Here’s what the researchers say:
PARUS clinical trial results showed: Midocalm effectively relieves pain and relaxes muscles, improves blood flow in tissues and improves the condition of patients with myofascial pain syndrome. Data confirmed clinically and by ultrasound investigation. It is stated that the drug does not have a sedative effect and does not lower blood pressure.
Studied the effect of Midocalm in the early rehabilitation of patients after stroke. The study involved 1,700 participants (mean age 63.4 years). According to the results of the study, it is clear that the drug improves muscle tone, relieves pain and improves quality of life. Good tolerance of the drug has been noted.
In a systematic review dedicated to Midocalm, a good effect of the drug in the treatment of back pain is noted. The authors emphasize that the drug can be used in combination therapy with NSAIDs (e.g., diclofenac).
In Russian-language literature, Midocalm is positioned as an effective treatment for myofascial pain syndrome.
Indications for therapy and scheme of use
Mydocalm and Diclofenac are prescribed in similar situations – where pain and muscle spasm need to be relieved. The difference lies in the nuances of application. Let’s consider each remedy in more detail.
The main task of the drug is to relieve pain. It is prescribed in such situations:
Inflammatory and degenerative diseases of the musculoskeletal system: osteoarthritis, chronic arthritis of different origin, tendovaginitis, bursitis;
Spinal pain syndrome: ischalgia, lumbago, radiculitis, myalgia, neuralgia, etc.;
pain after joint and spine surgery;
gynecological inflammatory diseases (endometritis, salpingo-oophoritis);
Inflammatory diseases of ENT organs: pharyngitis, otitis, tonsillitis.
It is important to remember:
Diclofenac, although it has an antipyretic effect, but is not used as a means of reducing body temperature. This is a side effect of the drug, not the main one.
Diclofenac only relieves symptoms and alleviates the condition of the patient, but does not eliminate the cause of the disease and has no effect on its progression. To slow down the development of the pathological process, other means should also be used. For example, in arthritis of the knee joint, Diclofenac and chondroprotectors are prescribed. The first will relieve pain and increase range of motion, the second will slow down the destruction of the joint.
Dosage of the drug is chosen by the doctor, taking into account the severity of the condition and age of the patient. In the acute stage, the drug is first prescribed intramuscularly. After 3-5 days, the patient is transferred to tablets, suppositories or means for local application (gel, cream, ointment). The course of treatment usually lasts no more than 10-14 days. Prolonged use of NSAIDs is dangerous in the development of severe side effects.
Myorelaxant is prescribed when it is necessary to relieve increased muscle tone on the background of various pathologies:
Neurological diseases: multiple sclerosis, stroke, etc.;
Pathology of the musculoskeletal system: osteochondrosis, arthrosis of large joints;
Rehabilitation after trauma and joint surgery;
Obliterating vascular diseases – as part of complex therapy;
Cerebral palsy in children.
Mydocalm is first prescribed intramuscularly for a course of 3-5 days. The patient is then switched to the oral form of the drug. The duration of therapy is determined by the doctor.
Both remedies are prescription, and for good reason. They have many side effects and contraindications, so they should only be prescribed by a doctor. Do not take the drugs yourself – do not risk your health!
All drugs from the NSAID group have a large number of side effects, and Diclofenac is no exception. Against the background of therapy, there may be such reactions:
Digestive tract: abdominal pain, nausea and vomiting, stool disorders, flatulence, reduced appetite. The drug causes worsening of digestive tract diseases: provokes gastritis, gastrointestinal bleeding from ulcers that opened during long-term use and/or overdosing. Can cause severe hepatitis with liver necrosis.
Nervous system: headache, drowsiness. Sometimes there is insomnia, disorientation in space, seizures.
Sensory organs: visual disturbances, dizziness, tinnitus.
Skin: allergic reactions.
Cardiovascular system: palpitations, chest pain, increased blood pressure. At high doses, increases the risk of thrombosis (more than 150 mg per day).
Blood system: NSAIDs inhibit the growth of blood cells and may lead to a decrease in all blood-forming elements. A drop in platelets leads to bleeding, white blood cells provoke infections, red blood cells lead to anemia.
Diclofenac is not prescribed for these conditions:
individual intolerance to the drug;
“aspirin triad”: bronchial asthma, allergic rhinitis, and urticaria in response to the administration of any NSAID;
Digestive tract diseases in the stage of exacerbation;
I and III trimester of pregnancy;
Children under 18 years of age – for intramuscular administration and prolonged forms.
With caution – with a history of gastric and intestinal ulcers, liver pathology, allergic diseases, diabetes, in the second trimester of pregnancy and in patients who smoke.
Doctors warn: diclofenac is dangerous in heart and vascular pathology. Clinical trials have shown that taking the drug increases the risk of complications by 50%.
Myorelaxant is well tolerated. Adverse reactions sometimes occur:
Decreased blood pressure;
Nausea and vomiting;
These symptoms usually occur with increased dosage and go away after correction.
Mydocalm is not prescribed for myasthenia gravis, pregnancy and lactation, children under three years of age.
Diclofenac and Midocalm are prescribed in orthopedics, neurology and other areas of medicine. They relieve symptoms of osteochondrosis, arthritis and other musculoskeletal diseases.
Both drugs have been clinically tested and proven effective.
Diclofenac is a drug from the NSAID group. It directly relieves pain and inflammation.
Midocalm is a myorelaxant. It cannot relieve pain on its own. This drug relaxes muscles and enhances the effects of Diclofenac.
The drugs are usually prescribed together. Isolated use is ineffective.
Diclofenac more often causes adverse reactions. Midocalm is better tolerated.
In fact, it is incorrect to compare Diclofenac and Midocalm. Each drug has a different point of effect on the body. It is impossible to say which remedy is better, because they provide the maximum effect when used together. Therefore, the drugs are usually prescribed together in the complex treatment of diseases of the musculoskeletal system and the nervous system.