Lumbar Disk Problems in the Athlete Medication

  • Author: Luis E Palacio, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 7, 2012
 

Medication Summary

  • NSAIDs are used to for LBP.
  • Muscle relaxants (eg, cyclobenzaprine) show some benefit in controlling LBP, but the use of these agents should be limited to the acute phase (ie, the first 4-7 d). Side effects such as drowsiness limit the use of muscle relaxants, but they may be helpful for patients with night symptoms.
  • Tramadol is effective for pain control in chronic LBP and can be safely used in combination with NSAIDs.
  • Acetaminophen is effective for pain control in chronic LBP, although NSAIDs may be superior. Acetaminophen may also be used as an adjunct to the analgesic properties of NSAIDs (not to exceed 4 g/d).
  • Narcotic medications may be helpful in severe cases that involve functional limitations, but long-term use should be avoided.
  • Selective serotonin reuptake inhibitors (SSRIs) may have a role in managing chronic radicular symptoms.
  • Tricyclic  and tetracyclic antidepressants (TCAs) have shown moderate symptom reduction that is independent of the patient's depression status in chronic pain cases.
  • Oral steroids help reduce acute pain and swelling; however, no study has shown benefit over the potential harmful side effects of steroid use.
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Analgesics

Class Summary

Because pain is usually the most debilitating symptom of lumbar disc disease, pharmacologic therapy is directed at alleviating the patient's pain.

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Acetaminophen (Tylenol)

 

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, or who are taking oral anticoagulants.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

This class of medications provides analgesia to the low back and reduces inflammation surrounding a herniated nucleus pulposus.

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Ibuprofen (Motrin)

 

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

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Muscle relaxants

Class Summary

These agents are indicated for severe muscle spasms that are associated with LBP; little evidence exists to support universal use in lumbar disc disease.

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Cyclobenzaprine HCl (Flexeril)

 

Skeletal muscle relaxant that acts centrally and reduces the motor activity of tonic somatic origins that influence both alpha and gamma motor neurons.

Structurally related to tricyclic antidepressants and, thus, carries some of the same liabilities.

One of the least expensive and least addictive options in this class.

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Antidepressant, Tricyclic

Class Summary

These agents are used in the treatment of depression.

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Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain. Blocks reuptake of norepinephrine and serotonin, which increases concentrations in the CNS. Decreases pain by inhibiting spinal neurons that are involved in pain perception. Highly anticholinergic. Often discontinued because of somnolence and dry mouth.

Cardiac arrhythmia, especially in overdose, has been described; monitoring the QTc interval after reaching the target level is advised. Up to 1 mo may be needed to obtain clinical effects.

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Contributor Information and Disclosures
Author

Luis E Palacio, MD  Director of Primary Care Sports Medicine, Northern Nevada Medical Group

Luis E Palacio, MD, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey W R Dassel, MD  Associate Director, Sports Medicine and Faculty, Department of Family and Community Medicine, Christiana Care Health System

Jeffrey W R Dassel, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Medical Society for Sports Medicine, and Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Annie Collier, MD  Staff Physician, Department of Emergency Medicine, Our Lady of Mercy Medical Center

Annie Collier, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John Munyak, MD  Associate Program Director, Director of Sports Medicine Education, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew D Perron, MD  Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine

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

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

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Radiograph of the lumbar spine. This image demonstrates L5-S1 disk space narrowing (the most common location).
Magnetic resonance image of the lumbar spine. This image demonstrates a herniated nucleus pulposus at multiple levels.
 
 
 
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