Biceps Tendinopathy Medication

  • Author: Peter Gonzalez, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Nov 29, 2011
 

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage acute symptoms of pain and stiffness. No apparent advantage is noted with regard to the use of one agent over another. Liniments, including NSAID and capsaicin creams, may be considered. Acetaminophen may be used for analgesia.[18]

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Resource Center Pharmacologic Management of Pain

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Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs are most commonly used for the relief of mild to moderate pain. Although the effects in the treatment of pain tend to be patient specific, ibuprofen is usually the drug of choice (DOC) for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam. Celebrex, a cyclooxygenase-2 (COX-2) inhibitor, may also be used, although its efficacy is not greater. An improved adverse-effect profile is controversial.

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Ibuprofen (Ibuprin, Advil, Motrin)

 

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

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Naproxen (Anaprox, Naprelan, Naprosyn)

 

For relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.

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Ketoprofen (Oruvail, Orudis, Actron)

 

For relief of mild to moderate pain and inflammation. Small dosages of ketoprofen are indicated initially in patients with small body size, in elderly patients, and in patients with renal or liver disease. Doses >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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Celecoxib (Celebrex)

 

Primarily inhibits COX-2. COX-2, which is considered an inducible isoenzyme, is induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, the incidence of GI toxicity, such as endoscopic peptic ulcers, bleeding ulcers, perforations, and obstructions, may be decreased in comparison with nonselective NSAIDs. Seek the lowest dose for each patient.

Celecoxib neutralizes circulating myelin antibodies through anti-idiotypic antibodies; down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade; promotes remyelination; and may increase CSF IgG (10%).

Celecoxib has a sulfonamide chain and is primarily dependent on cytochrome P450 enzymes (hepatic enzymes) for metabolism.

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Analgesics

Class Summary

Pain control is essential for quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients with tendinitis.

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Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

 

DOC for pain in patients with documented hypersensitivity to aspirin, NSAIDs, those who have been diagnosed with upper GI disease, and patients on oral anticoagulants.

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Capsaicin topical (Dolorac, Capsin, Zostrix)

 

Derived from plants of the Solanaceae family. Capsaicin may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.

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Contributor Information and Disclosures
Author

Peter Gonzalez, MD  Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Peter Gonzalez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Carter H Sigmon, MD, MHA  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Carter H Sigmon, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

William J Sullivan, MD  Associate Professor, Pain Medicine Fellowship Site Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Nothing to disclose.

Keith Aj Sequeira  MD, FRCPC, Associate Professor, Director of Education, Department of Physical Medicine and Rehabilitation, Parkwood Hospistal, University of Western Ontario

Disclosure: Nothing to disclose.

Patrick J Potter, MD, FRCP(C)  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Kaplan, MD  James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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