Neurological Manifestations of Thoracic Outlet Syndrome Medication

  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD   more...
 
Updated: Feb 12, 2010
 

Medication Summary

Drug therapy for TOS can be divided into the following categories:

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

These agents inhibit inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis. NSAIDs may provide pain relief in the patient with TOS.

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Naproxen sodium (Anaprox, Naprelan, Naprosyn)

 

For relief of mild to moderately severe pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in decrease of prostaglandin synthesis.

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Ibuprofen (Motrin, Advil)

 

NSAIDs used commonly for patients with mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

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Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin)

 

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

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Oxycodone (OxyContin)

 

Long-acting form of opioid currently used commonly for severe pain. Start with small dose and increase gradually.

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Morphine sulfate (MS Contin, Duramorph, Astramorph)

 

Effective analgesic with good safety profile and ease of reversibility with naloxone. Various IV doses used; commonly titrated until desired effect obtained.

Oral morphine sulfate includes Avinza, Kadian, and MS Contin. These medications are available in multiple different strengths (15-120 mg).

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Fentanyl transdermal patch (Duragesic)

 

Potent narcotic analgesic with much shorter half-life than morphine sulfate. Excellent choice for pain management and sedation with short duration (30-60 min); easy to titrate. Easily and quickly reversed by naloxone. When using transdermal dosage form, most patients' pain controlled with 72-h dosing intervals; however, some patients may require dosing intervals of 48 h.

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Antidepressants

Class Summary

This complex group of drugs has central and peripheral anticholinergic effects, as well as sedative effects. They have central effects on pain transmission. They increase synaptic concentration of serotonin and/or norepinephrine in CNS by inhibiting their reuptake by the presynaptic neuronal membrane.

Other options include milnacipran (Savella), duloxetine hydrochloride (Cymbalta), venlafaxine (Effexor), and bupropion (Wellbutrin).

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Nortriptyline (Pamelor)

 

Has demonstrated effectiveness in treatment of chronic and neuropathic pain.

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Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain.

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Selective serotonin reuptake inhibitors

Class Summary

These agents may be considered as alternative to TCAs.

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Fluoxetine (Prozac)

 

Antidepressant with potent specific 5-HT uptake inhibition with fewer anticholinergic and cardiovascular adverse effects than TCAs.

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Sertraline (Zoloft)

 

Antidepressant with potent specific 5-HT uptake inhibition with fewer anticholinergic and cardiovascular adverse effects than TCAs.

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Paroxetine (Paxil)

 

Antidepressant with potent specific 5-HT uptake inhibition with fewer anticholinergic and cardiovascular adverse effects than TCAs.

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Benzodiazepines

Class Summary

By binding to specific receptor sites, these agents appear to potentiate the effects of GABA and facilitate inhibitory GABA neurotransmission and other inhibitory transmitters. They may act in the spinal cord to induce muscle relaxation.

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Clonazepam (Klonopin)

 

Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters.

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Anticonvulsants

Class Summary

Use of certain antiepileptic drugs, such as the GABA analogue gabapentin (Neurontin), has proven helpful in some patients with neuropathic pain. Other anticonvulsants (eg, clonazepam, topiramate, lamotrigine, zonisamide, tiagabine) also have been tried in chronic pain.

Pregabalin (Lyrica) can be effective, tolerable, and easy to titrate compared to gabapentin.

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Gabapentin (Neurontin)

 

Has anticonvulsant properties and antineuralgic effects; however, exact mechanism of action unknown. Structurally related to GABA but does not interact with GABA receptors.

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Contributor Information and Disclosures
Author

Manish K Singh, MD  Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD  Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University

Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge E Mendizabal, MD  Consulting Staff, Corpus Christi Neurology

Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

James H Halsey, MD  Professor, Department of Neurology, University of Alabama Medical Center

James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

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