Diclofenac For Back Pain

Diclofenac For Back Pain

Diclofenac is classified as a nonsteroidal anti-inflammatory drug (NSAID) with the generic name Diclofenac sodium. It is used to treat conditions like mild to severe pain, fever, inflammation of tissues (red, swollen, and tender tissues), rheumatoid arthritis, back pain, and gout.

As Diclofenac can be used for any type of joint, muscle, and bone problems, it can be used to treat back pain (Todd, P.A. and Sorkin, E.M., 1988).

A Study on the Efficacy of Diclofenac in the Treatment of Back Pain

A study was conducted in the Department of Health Policy and Management/iMTA, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands, to determine the effect of Diclofenac over back pain. The patients were given Diclofenac (immediate-release) 2 doses daily of 75 mg, placebo paracetamol four daily doses. It was observed that Diclofenac is relatively effective and fast-acting in cases of back pain (Efficacy of paracetamol, diclofenac and advice for acute low back pain)
Conversation of patient and doctor on diclofenac for back pain

Mechanism Of Diclofenac

Diclofenac is responsible for the inhibition of cyclooxygenase-1 and -2, the enzymes that are responsible for the production of prostaglandin (PG) G2, the precursor to other prostaglandins. These are related to the activity in pain and inflammation, inhibition of which by Diclofenac relieves the pain.

This inhibition of COX (COX-1 and COX-2) activity decreases the synthesis of prostaglandins involved in the mediation of inflammation, pain, and swelling while it could cause gastrointestinal ulceration, respectively (Todd, P.A. and Sorkin, E.M., 1988).

Half life and how long does it take Work?

The half-life of Diclofenac on a general basis is of 2 hours. However, depending upon the condition and medical history, it could be extended to 25-33 hours. Consumed orally, Diclofenac takes about 20 to 30 minutes to initiate its action, and in about one to two hours, the full effect is observed.

In the case of Diclofenac gel, it takes approximately 1 to 2 days to start working. To reach peak concentration, it could take up to 7 days, depending upon how severe the condition is (Todd, P.A. and Sorkin, E.M., 1988).

Forms And Strengths

Diclofenac is available in the forms of packets, regular tablets, delayed and extended-release tablets, and capsules.

Diclofenac sodium is available in the strengths of 25, 50, and 75mg delayed-release tablets, 100 mg extended-release tablets, and 18 and 35 mg capsules.

Diclofenac potassium is available in the strengths of 50mg single dose packet, 50 mg generic tablets, and 25mg capsules (Todd, P.A. and Sorkin, E.M., 1988).

Dosage

For Rheumatoid Arthritis

Standardized adult dosage:

  • Diclofenac sodium- 50 mg divided into an eight-hour cycle or 75 mg divided into a 12-hour cycle.
  • Diclofenac potassium- 50 mg divided into 8-12 hour cycle.
  • Extended-release tablets- 100 mg once a day, can be increased to 100mg divided into a 12-hour cycle.

For Osteoarthritis

Standardized adult dosage:

  • Diclofenac sodium- 50 mg divided into an eight-hour cycle or 75 mg divided into a 12-hour cycle.
  • Diclofenac potassium- 50 mg divided into 8-12 hour cycle.
  • Extended-release tablets- 100 mg once a day, can be increased to 100mg divided into a 12-hour cycle.
  • Capsule (Zorvolex)-35 mg three times a day

For Ankylosing Spondylitis

Standardized adult dosage:

  • Diclofenac sodium- 25 mg to be taken four to five times a day
  • Diclofenac potassium- 50 mg divided into a twelve-hour cycle.

For Dysmenorrhea

Standardized Adult Dosage: 100 mg once a day, increasing by 50mg divided into an eight-hour cycle depending upon the condition.

For Acute Pain

Standardized adult dosage:

  • Regular tablets- 100 mg, increasing by 50 mg when required divided into an eight-hour cycle.
  • Extended-release tablets- 25 mg four times a day of Zipsor or 18-35 mg three times a day for Zorovolex.

NOTE: Diclofenac is advised in the acute pain cases for mild to moderate pain in adults

How To Consume Diclofenac?

Swallow Diclofenac capsules and tablets with water, juice, or milk. In case of consumption with water, consume Diclofenac after a snack or meal. Consumption of juice or milk is less likely to upset your stomach or irritate it. Do not chew, crush, or break the capsules. Consume the whole (Todd, P.A. and Sorkin, E.M., 1988).

What To Do If You Missed A Dose?

Diclofenac is used only when needed unless prescribed otherwise. Skip the dose that is missed if you are close to the next dosage. Do NOT consume a double dose to even it out.

What Happens If You Overdose?

Seek emergency attention in case you overdose or call the poison helpline. Overdosing symptoms may include nausea, vomiting, stomach pain, drowsiness, black or bloody stools, shallow breathing, coughing up blood, fainting, or stroke.

Who Should Not Take Diclofenac?

If any of the below conditions sound relatable and familiar, it is not advised for you to consume Diclofenac. However, consulting the doctor before the decision would prove of help.

  • Allergy to aspirin
  • Allergy to any NSAIDs
  • Allergy to Diclofenac
  • Faced any side effects to NSAID such as wheezing, asthma, skin allergy
  • Suffered stomach ulcers
  • Have or had hypertension
  • Heart failures
  • Liver disease 
  • Kidney disease
  • Crohn’s disease
  • Ulcerative colitis
  • Lupus
  • Blood clotting disorder

If you are either pregnant or are breastfeeding, it is advised NOT to consume Diclofenac. Consult your doctor if you face any confusion.

Side Effects Of Diclofenac

Common side effects of Diclofenac include:

  • Gas
  • Indigestion
  • Nausea
  • Vomiting
  • Stomach pain
  • Diarrhea
  • Constipation
  • Headache
  • Dizziness
  • Drowsiness
  • Abnormality in lab tests
  • Itching
  • Sweating
  • Stuffy nose
  • Increase in blood pressure
  • Swelling or pain in arms or legs

Consult your doctor or seek immediate attention in case you notice any of the following side effects to Diclofenac:

  • Skin rash, even if mild
  • Flu or flu-like symptoms
  • Heart problems such as shortness of breath, swelling, or rapid weight gain
  • Little or no urinating
  • Stinging or difficult urination
  • Stomach pain
  • Dark urine
  • Excessive fatigue
  • Jaundice
  • Bloody or tarry stools
  • Coughing up blood
  • Coffee ground look-alike vomit
  • Slurred speech
  • Burning eyes

Conclusion

Diclofenac is an NSAID (nonsteroidal anti-inflammatory drug) that is used for conditions like mild to severe pain, fever, inflammation of tissues (red, swollen, and tender tissues), rheumatoid arthritis, back pain, gout, and period cramps. It is useful and effective for both acute and chronic back pain problems. However, the visible effect may vary depending upon the condition.

Diclofenac vs Ibuprofen

Diclofenac vs Ibuprofen

Diclofenac belongs to the non-steroidal anti-inflammatory medicine (NSAID) class of medications (NSAID). Diclofenac is a pain reliever used to treat mild to moderate pain and the signs and symptoms of osteoarthritis and rheumatoid arthritis.

Ibuprofen is also a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is a pain reliever used to treat various ailments, including headaches, tooth pain, menstrual cramps, muscle pains, and arthritis.

Is it Better to Take Diclofenac or Ibuprofen?

Diclofenac is a more strong NSAID than Ibuprofen and requires a prescription from your healthcare professional. Diclofenac was found to be more effective than Ibuprofen for arthritic pain alleviation in a meta-analysis published in the Journal of Arthritis Research and Therapy. The researchers looked at data from 176 trials that included 146,524 participants.

Diclofenac was also found to have a decreased risk of stomach-related side effects than Ibuprofen. When compared to other NSAIDs like celecoxib and naproxen, diclofenac was found to be more effective. (Granatto, C.F., Grosseli, G.M., Sakamoto, I.K., Fadini, P.S. and Varesche, M.B.A., 2020)

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Similarities Between Diclofenac and Ibuprofen

NSAIDs like diclofenac and Ibuprofen are routinely used to treat osteoarthritis and rheumatoid arthritis inflammation and pain. Both medications are nonselective NSAIDs, which means they block the prostaglandin-producing COX-2 and COX-1 enzymes. 

Diclofenac-vs-Ibuprofen

Forms and Dosage

Diclofenac Sodium

1.Tablet, delayed release – 25mg (generic), 50mg (generic), 75mg (generic)

2.Tablet, extended-release – 100mg (generic)

Diclofenac potassium

1.Packet-50 mg (1 packet) in 30-60 mL of water, mixed well and drunk immediately

2.Tablet-50 mg

3.Capsule-25 mg

Solution for IV injection – 37.5mg/mL (Dyloject)

Adults and children 12 years of age and older should take 25 milligrams (mg) four times a day for acute pain. Your doctor must determine the use and dosage for children under the age of 12.

Ibuprofen 

Tabelts – 100mg, 200mg, 400mg, 600mg, 800mg

Capsules – 200mg

Chewable tablets – 100mg

Oral suspension – 100 mg per 5 mL , 50 mg per 1.25 mL

High-strength Ibuprofen is only prescribed to people suffering from severe pain or inflammation caused by a specific ailment.

Ibuprofen is usually taken in 200mg pills three times a day, with a six-hour gap between each dose. An adult can take 800–1,200 mg of Ibuprofen per day to manage minor discomfort. A juvenile patient can take 2–10 mg/kg every 6–8 hours to relieve pain and fever. Adults should not use ibuprofen tablets for more than ten days unless recommended by a physician or ibuprofen-containing gels for more than two weeks.

Conditions Treated

Diclofenac

Diclofenac is a medication used to treat mild to moderate pain and the signs and symptoms of osteoarthritis and rheumatoid arthritis. Ankylosing spondylitis is another condition for which Voltaren is used. This medication is also used to treat menstrual cramps under the brand name Cataflam. Migraine headaches are treated with diclofenac powder.

Ibuprofen

Ibuprofen is used to treat a type of joint disorder due to excess uric acid in the blood called gout, minor musculoskeletal injury, fever, headache, pain, pain with menstruation

rheumatoid arthritis, joint inflammatory disease in children and young adults joint damage causing pain and loss of function, non-radiographic axial spondyloarthritis ankylosing spondylitis, a rheumatic disease causing pain and stiffness in the backbone.

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Is Diclofenac the Same as Ibuprofen?

Diclofenac is a prescription NSAID, whereas Ibuprofen is available without a prescription or over-the-counter. Diclofenac is only prescribed for adults, whereas Ibuprofen is safe for children. So, diclofenac and Ibuprofen are not the same. (Pradal, J., 2020)

Scientific Study for Diclofenac Vs Ibuprofen

A study was conducted to compare the effectiveness of various oral analgesics in relieving pain and distress in adults following tooth extraction and deep cavity preparations under local anesthesia.

One hundred and twenty patients were randomly assigned to one of three groups. The paracetamol (1 gram) group had 40 patients, the Ibuprofen (400 mg) group had 40 patients, and the diclofenac potassium (50 mg) group had 40 patients. Patients rated their post-extraction and deep cavity preparation pain on standard 100 mm visual analog scales immediately after surgery, 2, 4, and 6 hours later (VAS). Furthermore, each patient was assessed for signs of distress using a 5-point face scale both preoperatively and immediately postoperatively.

 

Diclofenac vs Ibuprofen

At 4 hours postoperatively, the diclofenac potassium group had significantly lower mean pain VAS scores than the paracetamol and ibuprofen groups. Diclofenac potassium was found to be more effective than paracetamol or Ibuprofen in reducing postoperative pain after tooth extraction and deep cavity preparation (Comparison of paracetamol, ibuprofen, and diclofenac potassium for pain relief)

Diclofenac vs Meloxicam

Diclofenac vs Meloxicam

Diclofenac and Meloxicam are non-steroidal anti-inflammatory medications that treat pain and inflammation. 

Diclofenac and its Working

Diclofenac is a medication sold under the brand name Voltaren, which is a non-steroidal anti-inflammatory medication primarily used to treat pain and inflammatory illnesses, including gout. Its working mechanism functions by lowering the levels of hormones in the body that induce inflammation and discomfort (Gan, Tong J).

Meloxicam and its Working 

Meloxicam, sold as Mobic, is a non-steroidal anti-inflammatory medicine used to treat pain and irritation caused by inflammation and enlargement, and hardness in the joints. This medication works by preventing the synthetic Cyclooxygenase protein from doing its job, resulting in pain and inflammation are caused by prostaglandins (Seedher, N. and Bhatia, S., 2005)

How to take Diclofenac?

Diclofenac is a medication that can be ingested with the help of water or even milk as it might nullify the discomfort in the stomach. This mediation can be taken with or with food or any snack. Ingest the whole medicine do not crush or break the drug (Todd, P.A. and Sorkin, E.M., 1988). 

How to take Meloxicam?

Meloxicam can be taken with or without food and is recommended to take at a fixed time every day. But do not forget the directions and the prescription provided by the medical expert (Davies, Neal M., and Neil M. Skjodt).

Forms and Strength of Diclofenac

Diclofenac
  • Form: Diclofenac is available in pills, capsules, suppositories, slow-release tablets, and capsules. These medications are considered prescription-only medications. 
  • Strength: Diclofenac potassium packet

50 milligrams per single-dose packet (generic, Cambia)

When combined with water, it delivers a 50-mg dosage.

Tablet

50 milligrams (generic)

Forms and Strength of Meloxicam

Meloxicam
  • Form: This medicine can be measured via capsules, pills, or injections. 
  • Strength: Available in strengths 7.5 mg and 15mg. 

Dosage of Diclofenac

Oral administration

In the case of acute pain, try the following:

  • Initial dosage: Adults and children aged 12 and above should take 25 milligrams (mg) four times a day.
  • Pediatric dosage: The doctor must establish the dosage for children under the age of 12.

Dosage of Meloxicam

The dosage of Meloxicam varies in the case of adults and pediatrics; however, For safety reasons, the measurement of medicine for children should be discussed with a professional. The dose for adults is as follows:

  • Initial dosage: This medicine’s starting dose is 15mg, which can be increased to 25mg with a doctor’s approval.
  • Pediatrics: the clinical professional should take precautions about intake and health.
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Side effects of Diclofenac

The side effects of this medication can be adverse as well as common. However, in any case, consult the medical practitioner.

Adverse effects

If you notice any of these effects, contact the doctor as fast as possible. 

  • Bleeding gums 
  • Acid or sour stomach
  • Blood in the pee or feces
  • Bloody or black stools, tarry stools
  • Chest discomfort and chills
  • Coughing up clay-colored feces
  • Constipation with hazy urine
  • Urine that is dark in color
  • Dizziness and fatigue 

Common Side Effects 

These side effects might fade in a few days. If not, then consult the medical expert. 

  • Burning, crawling, itching
  • Numbness, prickling, or tingling feelings 
  • Blistering, peeling, loosening of the skin 
  • Blurred vision
  • Consternation shift in consciousness
  • Discouragement
  • Sense of dizziness, faintness, or lightheadedness upon rapidly rising from a sleeping or seated posture

Side effects of Meloxicam

The side effects can be both common and harmful. In any case, however, seek medical advice.

Adverse side effects include:

These symptoms are uncommon, but they can have serious consequences. The following are the symptoms:

  • Angina pectoris
  • A stroke, a seizure, or epilepsy
  • Damage to the liver
  • Swelling or inflammation.

If you come across any of these issues, see a doctor as soon as possible. Contact the health line if the problems become unbearable.

Common side effects include:

  • Tiredness or exhaustion
  • Pain in the abdomen
  • Nausea and vomiting are common side effects.
  • rashes 

These are some of the side effects that may or may not occur.

Who cannot take Diclofenac? 

Do not consume Diclofenac if you are undergoing the following conditions:

  • Do not take this medication if allergic to NSAIDs. 
  • Do not consume this medication if suffering from any diseases related to the heart, kidney, or alcohol issues which can create an adverse situation.
  • Do not consume this drug or consult the medical practitioner if suffering from asthma.

Who cannot take Meloxicam?

Do not consume Meloxicam if undergoing any of these conditions, namely: 

  • Any heart-related issue
  • Kidney or liver conditions 
  • Asthma or difficulty in breathing 
  • Fever or any flu 
  • Skin blisters 
  • Inflammation in any part of the body
  • Hives

This prescription is considered a high-risk drug since it increases the risk of heart attacks, strokes, and other cardiovascular events, and it can be fatal if used by someone who already has a heart condition.

Medical Conditions of Diclofenac

  • Overdose: symptoms of overdosing on Diclofenac can be vomiting, nausea, breathlessness, urine problems, stomach ache, and furthermore. So, it is not advised to take Diclofenac more than prescribed as it can be lethal. In any condition, contact the medical practitioner. 
  • Alcohol: do not consume Diclofenac with alcohol or tobacco as it can lead to adverse effects such as bleeding stomach. Consult the medical expert for further details.
  • Pregnancy: It is not advised to consume Diclofenac if pregnant as it can harm the unborn child. However, do consult the doctor in any situation.

Medical Conditions of Meloxicam

  • Overdose: overdosing on Meloxicam can lead to gastrointestinal bleeding and severe issues, namely breathlessness, vomiting, fatigue, and internal bleeding. Thus, it is not advisable to take more than what is prescribed. 
  • Alcohol: it is strictly not instructed to take Meloxicam with any alcohol. This can lead to severe issues such as intestinal bleeding and increase the risk of stomach ulcers. 
  • Pregnancy: it is not advised to take Meloxicam when pregnant as it can be harmful and can cause infertility. 
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Study: Diclofenac vs Meloxicam

Research: this study was conducted by CHU Trousseau, Service de Rhumatologie, Tours, France. Aim: To compare and evaluate the efficiency of Meloxicam and Diclofenac in patients dealing with osteoarthritis of the lumbar spine. Method: This was a 14 days examination of both the medication where In the subjects were given 7.5 mg of Meloxicam and 100mg diclofenac in the whole process. Result: There was no such significant difference in both the drugs. However, the results detected that Meloxicam was comparatively more tolerable as compared to Diclofenac (Valat JP, Accardo S, Reginster JY, Wouters M, Hettich M, Lieu PL).

Conclusion

Both Meloxicam and Diclofenac are medications that treat pain and inflammation-related issues. However, Meloxicam also treats rheumatoid arthritis. As detected in the study above, Meloxicam was considerably more tolerable as compared to Diclofenac. But the results also noticed both showed equally significant outcomes in treating the pain.

The Efficacy of Diclofenac in the Treatment of Migraine

The Efficacy of Diclofenac in the Treatment of Migraine

Diclofenac is effective for relief from migraine. It is a very common drug used in day-to-day routine by migraine patients. It is also available widely across the entire country and around the world.

Diclofenac is a phenylacetic acid derivative that has anti-inflammatory, antipyretic, and analgesic properties through inhibition of COX-1 and COX-2 activity and prostaglandin synthesis.  Diclofenac is a potent COX inhibitor, with activity 3–1000 times greater than other NSAIDs. These actions relieve migraine (Gan, T.J., 2010. Diclofenac: an update on its mechanism of action).

chat with doctor to treat migraine

Scientific study for Treatment of Acute Migraine Attack With Diclofenac

In a double-blind placebo-controlled experiment comprising 86 migraine patients, the efficacy of diclofenac sodium, a powerful prostaglandin inhibitor, was examined in patients with acute migraine attacks.

Forty-six patients with acute migraine attacks were given a 75 mg diclofenac sodium intramuscular injection, while another forty individuals were given a paracetamol intramuscular injection.

The diclofenac sodium group experienced partial or complete relief of pain and other symptoms of an acute migraine episode within 10 minutes of treatment, while the paracetamol group experienced relief within 32 minutes.

In 40 patients (88 percent), complete alleviation of the attack was achieved within 30 minutes after diclofenac sodium, compared to 7 patients (17.5 percent) in the paracetamol group. Side effects were uncommon and minor.

In conclusion, diclofenac sodium given intramuscularly is a highly effective treatment for acute migraine attacks (McNeely, W. and Goa, K.L., 1999. Diclofenac-potassium in migraine).

diclofenac vs paracetamol infographic

Dosage forms and Strengths

Diclofenac potassium

  • Packet-50 mg (1 packet) in 30-60 mL of water, mixed well, and drunk immediately
  • Tablet-50 mg
  • Capsule-25 mg

Diclofenac sodium

1.Tablet, delayed release

  • 25mg (generic)
  • 50mg (generic)
  • 75mg (generic)

2.Tablet, extended-release

  • 100mg (generic)

Diclofenac is not for prophylaxis but only for an acute attack of migraine. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

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Who can and cannot take diclofenac?

Most adults can take diclofenac. Diclofenac is not suitable for some people. To make sure it’s safe for you, tell your doctor or pharmacist if you:

  • Have ever had an allergic reaction to diclofenac or any other medicines.
  • Have an allergy to aspirin or other non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen.
  • Have ever had side effects from taking NSAIDs, such as wheezing or other signs of asthma, a runny nose, swelling of the skin (angioedema), or a rash.
  • Have ever had stomach ulcers, bleeding in the stomach or intestines, or a hole in your stomach.
  • Have high blood pressure (hypertension).
  • Have heart failure, severe liver disease, or kidney disease.
  • Are pregnant, planning to get pregnant, or breastfeeding.

What if I take too much?

Taking more than your prescribed dose of diclofenac tablets, capsules or suppositories can be dangerous. It can cause side effects such as:

  • Stomach Ache
  • Feeling or Being Sick (Vomiting)
  • Diarrhea
  • Black poo or Blood in your vomit – a sign of Bleeding in your Stomach
  • Headaches
  • Drowsiness
  • Ringing in your Ears (Tinnitus)

Contact your doctor if you consume more than required or visit a hospital near you for proper management.

Conclusion

Diclofenac Sodium is a generic medication that is used to treat mild to moderate pain as well as the signs and symptoms of osteoarthritis and rheumatoid arthritis. Ankylosing spondylitis can also be treated with diclofenac sodium. Menstrual cramps can be treated with several brand-name versions. Diclofenac Sodium is also known by the names Diclofex DC, Voltaren, Solaraze, Voltaren Gel, and Pennsaid.