Cervical Sprain and Strain Medication

  • Author: Oregon K Hunter Jr, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jun 8, 2011
 

Medication Summary

Early and appropriate treatment with analgesics for pain relief, with anti-inflammatory agents for inflammation, with muscle relaxants for spasms, and with aids for sleep disturbance, are the mainstay pharmaceutical therapies for cervical sprain/strain injuries.

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Nonopioid analgesics

Class Summary

Pain control is essential to high-quality patient care. Nonnarcotic analgesics ensure patient comfort and promote pulmonary toilet. These medications have sedating properties, which are beneficial for patients who have traumatic injuries.

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Acetaminophen (Tylenol, Panadol, Aspirin-Free Anacin)

 

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

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Opioid analgesics

Class Summary

These agents are indicated for the medical treatment of moderate to severe pain.

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Hydrocodone/acetaminophen (Lortab)

 

For relief of moderate to severe pain. Dose available with 2.5, 5, 7.5, 10 mg of hydrocodone. Total daily dose of acetaminophen should be considered; not to exceed 4 g/d. Individualize dose from qd to q4h, depending on degree of pain, effect of pain on patient's lifestyle, and need to keep blood levels of analgesic at therapeutic dose consistently or only intermittently.

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Cyclooxygenase-2 (COX-2) inhibitors

Class Summary

Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Ongoing analysis of cost avoidance of GI bleeds will further define the populations for whom COX-2 inhibitors are most beneficial.

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Celecoxib (Celebrex)

 

COX-1 is important for platelet aggregation, regulation of blood flow in the kidney and stomach, and regulation of gastric acid secretion. Inhibition of COX-1 may contribute to NSAID GI toxicity. COX-2 is considered an inducible isoenzyme, being induced during pain and inflammatory stimuli. Celecoxib inhibits primarily COX-2. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose for each patient.

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Nonsteroidal anti-inflammatory agents

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well; these include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation and various cell-membrane functions.

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Nabumetone (Relafen)

 

Nonacidic NSAID rapidly metabolized after absorption to a major active metabolite that inhibits cyclooxygenase enzyme, which in turn inhibits inflammation.

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Muscle relaxants

Class Summary

These medications are indicated for the relaxation of increased muscle tone, spasm, and rigidity associated with cervical strain syndromes.

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Tizanidine (Zanaflex)

 

Indicated for treating muscle spasm in patients with cervical strain. Centrally acting muscle relaxant metabolized in the liver and excreted in urine and feces.

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Carisoprodol (Soma)

 

Short-acting medication that may have depressant effects at the spinal cord level.

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Cyclobenzaprine (Flexeril)

 

Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins, influencing alpha and gamma motor neurons. Structurally related to tricyclic antidepressants and thus has some of their disadvantages.

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Methocarbamol (Robaxin)

 

Reduces nerve impulse transmission from spinal cord to skeletal muscle.

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Tricyclic antidepressants

Class Summary

Disturbed sleep is often a significant symptom with cervical strain. If analgesics and muscle relaxants do not provide enough relief, medications such as low-dose antidepressants can be used. These agents have central and peripheral anticholinergic effects, as well as sedative effects.

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Amitriptyline (Elavil)

 

Analgesic for certain types of chronic and neuropathic pain.

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Corticosteroids

Class Summary

These agents are used for severe inflammation (eg, radiculopathy) caused by the release of inflammatory chemicals from disk injury. These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli.

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Methylprednisolone (Solu-Medrol, Depo-Medrol)

 

Indicated for treatment of severe pain and/or radiculopathy if inflammation is suspected.

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Contributor Information and Disclosures
Author

Oregon K Hunter Jr, MD  Physiatrist, Southeastern Rehabilitation Medicine, SIMED

Oregon K Hunter Jr, MD is a member of the following medical societies: American Academy of Pain Management, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Legal Medicine, American College of Occupational and Environmental Medicine, American Congress of Rehabilitation Medicine, American Medical Association, Florida Medical Association, Florida Society of Physical Medicine and Rehabilitation, International Association for the Study of Pain, International Society of Physical and Rehabilitation Medicine, National Association of Disability Evaluating Professionals, and North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Michael D Freeman, PhD, MPH, DC  Clinical Associate Professor of Epidemiology, Department of Public Health and Preventive Medicine, Oregon Health Sciences University; Adjunct Associate Professor of Forensic Medicine and Epidemiology, Institute of Forensic Medicine, Faculty of Health Sciences at Aarhus University, Denmark

Michael D Freeman, PhD, MPH, DC is a member of the following medical societies: American Academy of Forensic Sciences, American Academy of Pain Management, American College of Epidemiology, Association for the Advancement of Automotive Medicine, North American Spine Society, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Martin K Childers, DO, PhD  Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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Radiograph of the cervical spine shows a normal lordotic curve.
Radiograph of the cervical spine shows straightening of the lordotic curve.
MRI of the cervical spine shows disk protrusion.
 
 
 
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