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Physical Medicine and Rehabilitation for Myofascial Pain Medication

  • Author: Jennifer E Finley, MD, FAAPMR; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Mar 17, 2015
 

Medication Summary

Muscle relaxant medications[36] and nonsteroidal anti-inflammatory drugs (NSAIDs) can at times be a useful adjunct to active, exercise-based treatment for myofascial pain, but they are helpful only rarely on their own. Medications such as low-dose amitriptyline may help to improve the patient's sleep cycle. Botulinum toxin type A injected into trigger points can reduce muscular contractions through the inhibition of acetylcholine release at the neuromuscular junction and appears to have an antinociceptive effect.[18, 19, 20, 21] Current research suggests that peripheral sensitization is blocked, which indirectly reduces central sensitization.[24] Transdermal lidocaine patches can be helpful.[37]

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Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs 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, such as the inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Ibuprin, Advil)

 

DOC for patients with mild to moderate pain. Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprosyn, Anaprox, Naprelan)

 

For relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by reducing the activity of cyclooxygenase, which results in decreased prostaglandin synthesis.

Ketoprofen (Orudis, Actron, Oruvail)

 

For relief of mild to moderate pain and inflammation.

Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.

Doses over 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient for a response.

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Tricyclic antidepressants

Class Summary

Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. These agents have central effects on pain transmission. They block the active re-uptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain.

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Contributor Information and Disclosures
Author

Jennifer E Finley, MD, FAAPMR Consulting Physiatrist and Sports Medicine Physician

Jennifer E Finley, MD, FAAPMR is a member of the following medical societies: American Academy of Medical Acupuncture, American College of Sports Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

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

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

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

Disclosure: Nothing to disclose.

Acknowledgements

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

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