eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Cervical Strain: Treatment & Medication
Updated: Apr 7, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Prehospital Care
All persons involved in MVAs who sustain neck injuries should, at a minimum, receive cervical collars prior to transport. Many emergency medical service (EMS) protocols require these patients to be placed on a backboard in full spinal precautions. Because MVAs often involve enough force to seriously injure the cervical spine, such precautions are essential to prevent further injury.
Emergency Department Care
- Apply ice to acute strain injuries.
- Administer analgesia and pain control.
- Administer muscle relaxants.
- Soft collars are commonly used but have not been proven effective. A single-blind study with 6-month follow-up conducted by Borchgrevink et al found that patients who received "usual care," with early mobilization and pain control, fared better than similarly treated patients placed in soft collars.2 This was reinforced by Kongsted et al in 2007.3
Consultations
At various times over the last 2 decades, there have been various calls for early multidisciplinary management including aggressive early physical therapy and other modalities. Current consensus, however, shows that consultations are rarely required for strain injuries; however, follow-up with a physician familiar with rehabilitation therapies is essential for longer-term management, particularly for patients who have experienced an occupational injury.
Medication
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.
Analgesics
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.
Adult
375-650 mg PO q4-6h prn or 1000 mg PO q6-8h prn
Pediatric
15 mg/kg/dose PO q4-6h prn
Rifampin can reduce analgesic effects; possible increase in hepatotoxicity with use of barbiturates, carbamazepine, hydantoins, or isoniazid
Documented hypersensitivity; known G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible in chronic alcoholics following various dose levels of acetaminophen; severe or recurrent pain or high or continued fever possible indication of serious illness
Nonsteroidal anti-inflammatory agents
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.
Adult
400-600 mg PO q4-6h prn or 800 mg PO q8h prn
Pediatric
Not recommended for pain control; used as antipyretic
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT in patients on anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; may increase phenytoin levels
Documented hypersensitivity; hypersensitivity to aspirin, iodides, or other NSAIDs; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal or hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy (monitor PT closely); monitor for signs of bleeding
Ketorolac tromethamine (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.
Adult
10 mg PO q4-6h prn; not to exceed 40 mg/d
30 mg IV q6h prn
30-60 mg IM q6h prn; repeat doses should be at the 30 mg IM level
Pediatric
Not established
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT in patients on anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; may increase phenytoin levels
Documented hypersensitivity; not to be administered into CNS; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis possible; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; may increase risk of bleeding (monitor patient for signs of bleeding); low WBC counts (rare) usually return to normal during ongoing therapy; discontinue therapy if leukopenia, granulocytopenia, or thrombocytopenia persists
Muscle relaxants
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.
Adult
100 mg PO bid prn
60 mg IM q12h prn
Pediatric
Not established
None reported
Documented hypersensitivity; GI obstruction; glaucoma; myasthenia gravis; cardiospasm
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in cardiac arrhythmias, anxiety, hemodynamic instability, tremors, confusion, and congestive heart failure
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.
Adult
10 mg PO tid prn
Pediatric
Not established
Coadministration with MAOIs or TCAs may increase toxicity; may have additive effect when used concurrently with anticholinergics; may enhance effects of alcohol, CNS depressants, and barbiturates
Documented hypersensitivity; MAOIs within last 14 d; hyperthyroidism
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in angle-closure glaucoma or urinary hesitancy; may impair consciousness and ability to operate machinery
More on Cervical Strain |
| Overview: Cervical Strain |
| Differential Diagnoses & Workup: Cervical Strain |
 Treatment & Medication: Cervical Strain |
| Follow-up: Cervical Strain |
| Multimedia: Cervical Strain |
| References |
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References
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Further Reading
Keywords
cervical strain, neck strain, neck pain, whiplash, whiplash neck sprain, hyperextension strain to the cervical spine, cervical spine injuries, cervical spine strain injuries, edema of cervical tissue, radicular pain in cervical spine injuries, rapid cervical strain injuries, low-velocity cervical strain injuries
