Cervical Radiculopathy Medication
- Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD more...
NSAIDs are commonly prescribed for their effects on pain and inflammation. In cervical radiculopathy, much of the pain is secondary to inflammation of the nerve root, usually due to a mechanical irritation of the nerve. In general, 10-14 days of regular dosing of an NSAID is all that is needed to control the pain and inflammation in cervical radiculopathy.
Oral steroids have been used to reduce the associated inflammation from compression. No controlled study exists to support the use of oral steroids in the treatment of cervical radiculopathy; however, these agents have been found to be clinically useful. Doses as high as 60 mg daily for 7 days and continuing for 5 days have been used without evidence of adrenal suppression. Longer-term use is not recommended. Tricyclic antidepressants can be a useful adjunct in controlling radicular pain. Opioid medications are generally not necessary for pain relief, but these drugs can be used when other medications fail to provide adequate relief or if other agents are contraindicated. When opioid medications are prescribed, adequate doses and appropriate dosing schedules should be used.
Nonsteroidal anti-inflammatory drugs
Various NSAIDs are available either over the counter or by prescription. Proper doses should be used in the acute phase around the clock for approximately 7-10 days.
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. These agents have central effects on pain transmission and block the active reuptake of norepinephrine and serotonin.
By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, may increase the synaptic concentration in the CNS. Useful as an analgesic for certain chronic and neuropathic pain.
Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase synaptic concentration in the CNS.
Pharmacodynamic effects, such as the desensitization of adenylate cyclase and downregulation of beta-adrenergic receptors and serotonin receptors, also appear to play a role in its mechanisms of action.
Bogduk N, Twomey LT. Clinical Anatomy of the Lumbar Spine. 2nd ed. Edinburgh, UK: Churchill Livingstone Inc; 1991.
Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994 Mar. 75(3):342-52. [Medline].
Malanga GA. The diagnosis and treatment of cervical radiculopathy. Med Sci Sports Exerc. 1997 Jul. 29(7 suppl):S236-45. [Medline].
Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr. 117(pt 2):325-35. [Medline].
van Gijn J, Reiners K, Toyka KV, Braakman R. Management of cervical radiculopathy. Eur Neurol. 1995. 35(6):309-20. [Medline].
White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1990. 102.
Parminder SP. Management of cervical pain. Delisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1988. 753.
Murphey F, Simmons JC, Brunson B. Chapter 2. Ruptured cervical discs, 1939 to 1972. Clin Neurosurg. 1973. 20:9-17. [Medline].
Shelerud RA, Paynter KS. Rarer causes of radiculopathy: spinal tumors, infections, and other unusual causes. Phys Med Rehabil Clin N Am. 2002 Aug. 13(3):645-96. [Medline].
Soubrier M, Dubost JJ, Tournadre A, et al. Cervical radiculopathy as a manifestation of giant cell arteritis. Joint Bone Spine. 2002 May. 69(3):316-8. [Medline].
Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine. 2002 Jan 15. 27(2):156-9. [Medline].
Fryholm R. Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis. Acta Chiru. Scand. 1951. 160(suppl):1-149.
Letchuman R, Gay RE, Shelerud RA, VanOstrand LA. Are tender points associated with cervical radiculopathy?. Arch Phys Med Rehabil. 2005 Jul. 86(7):1333-7. [Medline].
Nordin M, Carragee EJ, Hogg-Johnson S, et al for the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15. 33(4 suppl):S101-22. [Medline].
Furusawa N, Baba H, Miyoshi N, et al. Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production. Spine. 2001 May 15. 26(10):1110-6. [Medline].
Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine. 1997 May 15. 22(10):1065-73. [Medline].
Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989 Mar. 14(3):253-7. [Medline].
Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J. 2006 Jun. 15(6):794-801. [Medline].
Sasso RC, Macadaeg K, Nordmann D, Smith M. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging. J Spinal Disord Tech. 2005 Dec. 18(6):471-8. [Medline].
Anderberg L, Annertz M, Brandt L, Säveland H. Selective diagnostic cervical nerve root block--correlation with clinical symptoms and MRI-pathology. Acta Neurochir (Wien). 2004 Jun. 146(6):559-65; discussion 565. [Medline].
Huston CW, Slipman CW. Diagnostic selective nerve root blocks: indications and usefulness. Phys Med Rehabil Clin N Am. 2002 Aug. 13(3):545-65. [Medline].
Chesnut RM, Abitbol JJ, Garfin SR. Surgical management of cervical radiculopathy. Indication, techniques, and results. Orthop Clin North Am. 1992 Jul. 23(3):461-74. [Medline].
Johnson EW, ed. Practical Electromyography. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1979. 229-45.
American College of Radiology. ACR Appropriateness Criteria: chronic neck pain. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=8297. Accessed: March 24, 2009.
Cantu RC. Cervical spine injuries in the athlete. Semin Neurol. 2000. 20(2):173-8. [Medline].
Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Sep. 72(8):1178-84. [Medline]. [Full Text].
Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009 Oct 7. 339:b3883. [Medline]. [Full Text].
Cohen SP, Gupta A, Strassels SA, Christo PJ, Erdek MA, Griffith SR, et al. Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections: A Multicenter, Randomized Controlled Trial. Arch Intern Med. 2011 Dec 12. [Medline].
Friedly J, Deyo RA. Imaging and Uncertainty in the Use of Lumbar Epidural Steroid Injections: Comment on "Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections". Arch Intern Med. 2011 Dec 12. [Medline].
American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=10531. Accessed: March 25, 2009.
Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol. 2009 Mar. 30(3):507-11. [Medline].
Engel A, King W, MacVicar J. The effectiveness and risks of fluoroscopically guided cervical transforaminal injections of steroids: a systematic review with comprehensive analysis of the published data. Pain Med. 2014 Mar. 15(3):386-402. [Medline].
Council of Acupuncture and Oriental Medicine Associations. Acupuncture and electroacupuncture: evidence-based treatment guidelines. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=9343. Accessed: March 24, 2009.
Van Zundert J, Patijn J, Kessels A, Lamé I, van Suijlekom H, van Kleef M. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain. 2007 Jan. 127(1-2):173-82. [Medline].
Griffiths C, Dziedzic K, Waterfield J, Sim J. Effectiveness of specific neck stabilization exercises or a general neck exercise program for chronic neck disorders: a randomized controlled trial. J Rheumatol. 2009 Feb. 36(2):390-7. [Medline].
Skeppholm M, Lindgren L, Henriques T, Vavruch L, Löfgren H, Olerud C. The Discover artificial disc replacement versus fusion in cervical radiculopathy--a randomized controlled outcome trial with 2-year follow-up. Spine J. 2015 Jun 1. 15 (6):1284-94. [Medline].
Ahlgren BD, Garfin SR. Cervical radiculopathy. Orthop Clin North Am. 1996 Apr. 27(2):253-63. [Medline].
Carragee EJ, Hurwitz EL, Cheng I, et al, and the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15. 33(4 suppl):S153-69. [Medline].
Chiba S, Koge N, Oda M, et al. Synovial chondromatosis presenting with cervical radiculopathy: a case report. Spine. 2003 Oct 1. 28(19):E396-400. [Medline].
Dreyfus P. The cervical spine: non-surgical care. Presented at: The Tom Landry Sports Medicine and Research Center. April 8, 1993; Dallas, Tex.
Leblhuber F, Reisecker F, Boehm-Jurkovic H, Witzmann A, Deisenhammer E. Diagnostic value of different electrophysiologic tests in cervical disk prolapse. Neurology. 1988 Dec. 38(12):1879-81. [Medline].
Lipetz JS, Malanga GA. Oral medications in the treatment of acute low back pain. Occup Med. 1998 Jan-Mar. 13(1):151-66. [Medline].
Lo YL, Chan LL, Leoh T, et al. Diagnostic utility of F waves in cervical radiculopathy: electrophysiological and magnetic resonance imaging correlation. Clin Neurol Neurosurg. 2008 Jan. 110(1):58-61. [Medline].
Malanga GA, Campagnolo DI. Clarification of the pronator reflex. Am J Phys Med Rehabil. 1994 Sep-Oct. 73(5):338-40. [Medline].
Marks MR, Bell GR, Boumphrey FR. Cervical spine injuries and their neurologic implications. Clin Sports Med. 1990 Apr. 9(2):263-78. [Medline].
Miwa M, Doita M, Takayama H, et al. An expanding cervical synovial cyst causing acute cervical radiculopathy. J Spinal Disord Tech. 2004 Aug. 17(4):331-3. [Medline].
Thomas M, Bell GB. Radiologic evaluation and imaging of the spine. Nicholas JA, Hershman EB, eds. The Lower Extremity and Spine in Sports Medicine. 2nd ed. 1995. 1096-7.
Wilbourn AJ, Aminoff MJ. AAEE minimonograph #32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve. 1988 Nov. 11(11):1099-114. [Medline].