Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Cervical Strain Medication

  • Author: Warren Magnus, DO; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 15, 2015
 

Medication Summary

The pharmacology of cervical strain involves pain control and palliation. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol) are mainstays of therapy. Muscle relaxants may prove valuable when treating severe strain injuries to reduce pain and muscle contracture.

One randomized control trial found no benefit in adding cyclobenzaprine to standard ibuprofen therapy.[7]

Next

Analgesics

Class Summary

For minor strain injuries, oral outpatient analgesics provide adequate pain control. OTC medications also may suffice.

Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

 

Rapidly absorbed from GI tract and distributed widely to all body tissues. Serum half-life is 1-3 h but may be altered in impaired liver function. Posthepatic metabolites excreted in urine.

Previous
Next

Nonsteroidal anti-inflammatory agents

Class Summary

NSAIDs control mild to moderate pain and decrease inflammatory reactions. This entire family of medications may ease pain in strain injuries. Tailor dosage on an individual basis.

Ibuprofen (Ibuprin, Advil, Motrin)

 

Rapidly absorbed orally and distributed widely through body tissues. Serum half-life is 1.8-2 h. Rapidly metabolized and excreted in urine. Complete clearance of single dose occurs in approximately 24 h.

Ketorolac (Toradol)

 

Provides effective control of moderate to severe pain, with higher potency than other NSAIDs, which results in more marked GI upset, platelet inhibition, and renal effects.

Previous
Next

Muscle relaxants

Class Summary

These agents provide adjunctive therapy to allow rest, control pain, and aid physical therapy for musculoskeletal injury.

Orphenadrine citrate (Norflex)

 

Action not well understood, but its analgesic properties make it clinically effective for muscular injury.

Cyclobenzaprine hydrochloride (Flexeril)

 

Centrally acting skeletal muscle relaxant structurally related to TCAs with similar liabilities. Can be useful adjunct to other therapies for acute musculoskeletal pain.

Previous
 
 
Contributor Information and Disclosures
Author

Warren Magnus, DO Center Medical Director, Concentra

Warren Magnus, DO is a member of the following medical societies: American Osteopathic Association

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.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Natalie T Shum, MD, to the development and writing of this article.

References
  1. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. 1995 Apr 15. 20(8 Suppl):1S-73S. [Medline].

  2. Conforti M, Fachinetti GP. High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1° and 2° grade of the Quebec Task Force classification) involving muscles and ligaments. Muscles Ligaments Tendons J. 2013 Apr. 3(2):106-11. [Medline]. [Full Text].

  3. Blackmore CC, Mann FA, Wilson AJ. Helical CT in the primary trauma evaluation of the cervical spine: an evidence-based approach. Skeletal Radiol. 2000 Nov. 29(11):632-9. [Medline].

  4. Grogan EL, Morris JA Jr, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. 2005 Feb. 200(2):160-5. [Medline].

  5. Resnick S, Inaba K, Karamanos E, Pham M, Byerly S, Talving P, et al. Clinical relevance of magnetic resonance imaging in cervical spine clearance: a prospective study. JAMA Surg. 2014 Sep. 149 (9):934-9. [Medline].

  6. Grunau BE, Dibski D, Hall J. The daunting task of "clearing" the cervical spine. CJEM. 2012 May. 14 (3):187-92. [Medline].

  7. Khwaja SM, Minnerop M, Singer AJ. Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. CJEM. 2010 Jan. 12(1):39-44. [Medline].

  8. Frohna WJ. Emergency department evaluation and treatment of the neck and cervical spine injuries. Emerg Med Clin North Am. 1999 Nov. 17(4):739-91, v. [Medline].

  9. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS One. 2015. 10 (7):e0133415. [Medline].

  10. Borchgrevink GE, Kaasa A, McDonagh D, Stiles TC, Haraldseth O, Lereim I. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine. 1998 Jan 1. 23(1):25-31. [Medline].

  11. Kongsted A, Qerama E, Kasch H, et al. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Spine. 2007 Mar 15. 32(6):618-26. [Medline].

  12. Pape E, Hagen KB, Brox JI, Natvig B, Schirmer H. Early multidisciplinary evaluation and advice was ineffective for whiplash-associated disorders. Eur J Pain. 2009 Jan 30. [Medline].

  13. Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, et al. Massage for mechanical neck disorders. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD004871. [Medline].

  14. Durall CJ. Therapeutic exercise for athletes with nonspecific neck pain: a current concepts review. Sports Health. 2012 Jul. 4(4):293-301. [Medline]. [Full Text].

  15. Brose SW, Jennings DC, Kwok J, Stuart CL, O'Connell SM, Pauli HA, et al. Sham manual medicine protocol for cervical strain-counterstrain research. PM R. 2013 May. 5(5):400-7. [Medline].

  16. Klein R, Bareis A, Schneider A, Linde K. Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial. Complement Ther Med. 2013 Feb. 21(1):1-7. [Medline].

  17. Myrtveit SM, Skogen JC, Petrie KJ, Wilhelmsen I, Wenzel HG, Sivertsen B. Factors Related to Non-recovery from Whiplash. The Nord-Trøndelag Health Study (HUNT). Int J Behav Med. 2013 Sep 19. [Medline].

  18. Nieto R, Miró J, Huguet A. Pain-Related Fear of Movement and Catastrophizing in Whiplash-Associated Disorders. Rehabil Psychol. 2013 Sep 16. [Medline].

  19. Beazell JR, Magrum EM. Rehabilitation of head and neck injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):523-57. [Medline].

  20. Bourbeau R, Desjardins D, Maag U, Laberge-Nadeau C. Neck injuries among belted and unbelted occupants of the front seat of cars. J Trauma. 1993 Nov. 35(5):794-9. [Medline].

  21. Bylund PO, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine. 1998 May 1. 23(9):1023-8. [Medline].

  22. Calliet R. Neck and Arm Pain. 2nd ed. FA Davis Co; 1981.

  23. Daffner RH. Controversies in cervical spine imaging in trauma patients. Emerg Radiol. 2004 Aug. 11(1):2-8. [Medline].

  24. Davis CG. Injury threshold: whiplash-associated disorders. J Manipulative Physiol Ther. 2000 Jul-Aug. 23(6):420-7. [Medline].

  25. Dickinson G, Stiell IG, Schull M, et al. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med. 2004 Apr. 43(4):507-14. [Medline].

  26. Dreyer SJ, Boden SD. Laboratory evaluation in neck pain. Phys Med Rehabil Clin N Am. 2003 Aug. 14(3):589-604. [Medline].

  27. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ. Jun 2002. 44(5):237-240. [Full Text].

  28. Griffiths HJ, Olson PN, Everson LI, Winemiller M. Hyperextension strain or "whiplash" injuries to the cervical spine. Skeletal Radiol. 1995 May. 24(4):263-6. [Medline].

  29. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992 Dec. 21(12):1454-60. [Medline].

  30. Kappler RE. Cervical Spine. Ward RC, et al, eds. Foundations for Osteopathic Medicine. Lippincott, Williams & Wilkins; 1997. 541-546.

  31. Ladig D, DeBell LS, Hubert MK. Mosby's Complete Drug Reference 1997. Physicians GenRx. Mosby-Year Book, Inc; 1997.

  32. Martinez JA, Timberlake GA, Jones JC, et al. Factors affecting the cervical prevertebral space in the trauma patient. Am J Emerg Med. 1988 May. 6(3):268-72. [Medline].

  33. McMorland G, Suter E. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther. 2000 Jun. 23(5):307-11. [Medline].

  34. McSwain NE, Martinez JA, Timberlake GA. Cervical Spine Trauma: Evaluation and Acute Management. 1989.

  35. Patel RV, DeLong W Jr, Vresilovic EJ. Evaluation and treatment of spinal injuries in the patient with polytrauma. Clin Orthop Relat Res. 2004 May. 43-54. [Medline].

  36. Richards PJ. Cervical spine clearance: a review. Injury. 2005 Feb. 36(2):248-69; discussion 270. [Medline].

  37. Shaffer MA, Doris PE. Limitation of the cross table lateral view in detecting cervical spine injuries: a retrospective analysis. Ann Emerg Med. 1981 Oct. 10(10):508-13. [Medline].

  38. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25. 349(26):2510-8. [Medline].

  39. Sturzenegger M, DiStefano G, Radanov BP, Schnidrig A. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology. 1994 Apr. 44(4):688-93. [Medline].

  40. Van Goethem JW, Maes M, Ozsarlak O, van den Hauwe L, Parizel PM. Imaging in spinal trauma. Eur Radiol. 2005 Mar. 15(3):582-90. [Medline].

  41. Wang JC, Hatch JD, Sandhu HS, Delamarter RB. Cervical flexion and extension radiographs in acutely injured patients. Clin Orthop Relat Res. 1999 Aug. 111-6. [Medline].

  42. Zmurko MG, Tannoury TY, Tannoury CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):513-21. [Medline].

Previous
Next
 
External craniocervical ligaments.
Internal craniocervical ligaments.
Lateral view of the muscles of the neck.
Anterior view of the muscles of the neck.
Radiograph of the cervical spine shows a normal lordotic curve.
Radiograph of the cervical spine shows straightening of the lordotic curve.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.