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Biceps Tendinopathy Medication

  • Author: Peter Gonzalez, MD; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: Aug 05, 2015
 

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.[22]

Related Medscape topic:

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.

Ibuprofen (Ibuprin, Advil, Motrin)

 

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

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.

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.

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.

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.

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, Eastern Virginia Medical School

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, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

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, FRCSC 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, FRCSC is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, College of Physicians and Surgeons of Ontario, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada

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, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

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.

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

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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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