Back pain, acute low back pain : some drugs décontracturants muscle are déremboursés in 2018

AndreyPopov/epictura

Published the 30.12.2017 at 11: 38 am

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lot of doslombalgiedécontracturant

Coltramyl®, Miorel®, Myoplege®, generic… from the January 2, 2018, these drugs décontracturants-based thiocolchicoside (tablets or capsules) will not be reimbursed, according to 2 arrested published in the official gazette of November 29, 2017.
These orders are the result of a notice dated July 20, 2016 of the transparency Commission of the High Authority of health (HAS), according to which The medical service rendered by Coltramyl® (and others) is insufficient to justify support from the national solidarity in ” the adjunctive treatment of muscle spasms and painful in cases of pathology of the vertebral column, acute in adults and adolescents over 16 years of age “.

A scientific dossier thin

In fact, these drugs have a marketing authorisation on the market (AMM) ” adjunctive treatment of muscle spasms and painful in the low back pain acute “. This marketing authorisation has been obtained a long time ago, with a scientific record rather slender, and their effectiveness on the pain and the muscle contracture is, at best, modest.
By contrast, there is a risk of abnormal number of chromosome in the nucleus of cells (” aneuploidy “), an abnormality is recognized as a potential factor of risk of cancer, and teratogenicity, spontaneous abortion and decreased male fertility associated with its use.
Given the existence of alternatives (benzodiazepines) for which this risk has not been demonstrated, the clinical relevance of the thiocolchicoside is now insufficient to justify its reimbursement.

Treatment by movement

If you are suffering regularly from backache, these molecules are probably not unknown and you may wonder why these drugs which are intended to protect the muscles of the back are removed at a time when a campaign of the National health Insurance Fund advocated by the movement and the muscle activity as the primary element in the treatment of acute low back pain. The 2 decisions are disconnected as they are from 2 different jurisdictions that follow their own logic. Moreover, the CNAM does not justify décontracturants muscle in this context.
Back pain is brutal and sitting at the bottom of the back, lumbago, acute, or chronic lumbago, when they are associated with a muscle contracture, heal in a few days if it relieves actively the pain. Bed rest is not especially recommended, because it promotes the “deconditioning muscle” and the risk of progression to a chronic form of the disease.

Acute low back pain common

The pain started suddenly, after a false movement or effort of heaving. She is calmed by rest and increased during effort, coughing, and defecation. It only lasts a few days to a few weeks and is generally accompanied by a muscle contracture and hamper movements.
In some cases, the muscle contracture and the pain are so strong that movement becomes almost impossible. Very often, there is significant stiffness of the back which can be manifested by a deformity of the spine (deformity ” bayonet “). It is in these cases where the relaxation of the muscles may have an interest.

Not to be mistaken for back pain

In the vast majority of cases, the cause of acute low back pain is related to dysfunction of the spine, mainly due to a deterioration of the discs between the vertebrae of the spine (tear of the disc), joints facet joints between the vertebrae (osteoarthritis), and ligaments or muscles. Often, not all the lesions are entangled. These lower back pain usually heal in a few days because there are minor problems that do not involve disability.
It is important not to confuse it with a low back pain that wakes us up in the second part of the night, with a stiff extended wake up in the morning and fades in the day and effort. In the latter case, it is a low back pain inflammatory which should make mention of other causes, and in particular the spondylarthrites.

Reduce the pain before moving on

In case of acute low back pain common, it is important to reduce the pain as soon as possible, at once to relieve the sufferer, but also to preserve the musculature of the back.
Pain medications are called analgesics. It is allowed to take paracetamol, a combination of paracetamol with a morphine derivative or a nonsteroidal anti-inflammatory drugs (or NSAIDS) such as ibuprofen, ketoprofen, or aspirin. It is not necessary to mix the anti-inflammatory and aspirin. The décontracturants play a complementary role to be minimal and only in cases of severe muscle contracture.
It is essential to maintain physical activity, even minimal. Inactivity does not allow for proper healing of muscles, tendons and ligaments are also affected in lower back pain. The reversal of an adapted physical activity is the best guarantee for a fast healing.

Practical advice

A few tips can help relief of low back pain :
– Applying heat (hot shower or pocket heating) on the whole of the painful area to relax the muscles
– Getting a back massage
– Continue usual activities, adapting them in order to keep a right position to the back.
– Be careful not to force and to avoid sudden movements.
– Check that the bed is not too low and the mattress is of good quality.

It is also interesting to use the relaxation of the muscles especially incase of stress associated with it. Here are a few positions of relaxation :
– Extended, the back is well-tackled to the ground, legs bent resting on the seat of a chair, hands crossed behind the head.
– Lying on your back, bring both knees to the chest, one after the other. Keep both knees together and pull them toward the chest.
– Kneeling, sitting on heels, back wound, forehead against the ground, and framed by the elbows, forearms resting on the ground.
These positions, which allow you to rest the back can be performed a few moments every day.