Adductor Strain Medication
- Author: Marlon P Rimando, MD; Chief Editor: Consuelo T Lorenzo, MD more...
The goals of pharmacotherapy in adductor strain are to reduce morbidity and prevent complications. Agents of treatment include Celecoxib (Celebrex), nonsteroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, and local anesthetics. Cyclooxygenase type-2 inhibitors(COX-2 inhibitors) are the drug of choice for this condition; in cases of severe pain, opioid analgesic agents may be prescribed. Muscle relaxants often are used to reduce muscle spasm after initial injury.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are also a drug of choice for adductor strain for this condition. In cases of severe pain, opioid analgesic agents may be prescribed. Muscle relaxants often are used to reduce muscle spasm after initial injury.
Ibuprofen is a member of the propionic acid group of NSAIDs. It possesses anti-inflammatory, analgesic, and antipyretic mechanisms of action and may be related to prostaglandin synthetase inhibition.
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.
Celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient. It is extensively metabolized in liver primarily via cytochrome P450 2C9. Celecoxib is approved by the FDA to treat osteoarthritis and rheumatoid arthritis.
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 NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.
Skeletal Muscle Relaxants
Skeletal muscle relaxants are indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute painful musculoskeletal conditions.
Cyclobenzaprine is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions.
Baclofen is metabolized in the liver and excreted primarily in urine. This agent is not a controlled substance under the Drug Enforcement Administration (DEA).
Tizanidine is a centrally acting muscle relaxant metabolized in the liver and excreted in urine and feces. It is used in patients with predominantly upper motor neuron involvement. It is not a DEA-controlled substance.
Carisoprodol is a short-acting medication that may have depressant effects at the spinal cord level.
Skeletal muscle relaxants have modest short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and are used intermittently for diffuse and certain regional chronic pain syndromes. Long-term improvement over placebo has not been established.
Local Anesthetics, Amides
Local anesthetics are used for local pain relief.
Lidocaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. It is used for relief of pain associated with postherpetic neuralgia and has been used for pain relief of many other types of pain generators as well.
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