Degenerative Lumbar Disc Disease in the Mature Athlete Medication

  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jan 7, 2010
 

Medication Summary

Various medications have been used in the treatment of LBP from DDD, to include acetaminophen, NSAIDs, muscle relaxants, opioid analgesics, oral corticosteroids, and antidepressants. No standard doses have been established for oral prednisone in the treatment of lumbar radicular pain. Before prescribing these medications, the physician should be aware of the contraindications, common adverse effects, and mode of action of each agent.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Offer additional anti-inflammatory effects compared with acetaminophen. The dose to produce anti-inflammatory effects differs substantially from that for analgesic effects. Most NSAIDs achieve only analgesic effects because the dose prescribed is too small and too infrequent to produce an anti-inflammatory effect. Risks are associated with NSAIDs, especially in the elderly population and in those with a history of peptic ulcer disease, hypertension, or renal insufficiency. Newer generation NSAIDs selectively interact with the COX-2 receptors and have a lower gastrointestinal risk. Prolonged use of these medications generally is not recommended for most patients with low back problems.

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Ibuprofen (Motrin, Ibuprin)

 

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

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Celecoxib (Celebrex)

 

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and by inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

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Analgesics

Class Summary

The use of opioids in the treatment of LBP should be limited to pain that is unresponsive to alternative medication. Opioids can be prescribed for acute disc herniation or other back injury to facilitate participation in an active rehabilitation program. They should be used on a defined dosing schedule and not on an as-needed basis. In addition, adequate baseline dose should be established to achieve analgesia. The use of nonopioid analgesics, such as tramadol, also is an option.

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Oxycodone (OxyContin)

 

Drug combination indicated for the relief of moderate to severe pain.

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Tramadol (Ultram)

 

Inhibits ascending pain pathways, altering perception of and response to pain. Inhibits reuptake of norepinephrine and serotonin.

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Muscle relaxants

Class Summary

Medications categorized as muscle relaxants may be helpful in some patients with LBP and seem to have additional beneficial effects when used in conjunction with NSAIDs. Muscle relaxants can be used as short-term adjunctive medications, and they should be taken at bedtime to take advantage of their sedating effects.

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Cyclobenzaprine (Flexeril)

 

Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins influencing both alpha and gamma motor neurons. Structurally related to tricyclic antidepressants and thus carries some of their same liabilities.

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Oral steroids

Class Summary

Potent anti-inflammatory medications represent theoretically useful agents in the treatment of patients with radiculopathy due to local inflammation resulting from disc injury or herniation. No standard doses have been established for oral prednisone in the treatment of lumbar radicular pain.

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Prednisone (Deltasone, Sterapred, Orasone)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Antidepressants

Class Summary

Tricyclic antidepressants (TCAs) have been well studied and supported as useful analgesics in patients with pain of neurogenic origin. TCAs also can be helpful as adjuncts for pain and sleep if used at bedtime. Initial doses should be low, and subsequent doses can be slowly increased to minimize adverse effects.

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Amitriptyline (Elavil)

 

By inhibiting reuptake of serotonin and/or norepinephrine in presynaptic neuronal membrane, may increase the synaptic concentration of serotonin in the CNS.

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Contributor Information and Disclosures
Author

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Coauthor(s)

Michal E Eisenberg, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, UMDNJ, New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph P Garry, MD, FACSM, FAAFP  Adjunct Associate Professor, Sports Medicine Faculty, Department of Family Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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

Sherwin SW Ho, 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.

References

  1. Suratwala SJ, Pinto MR, Gilbert TJ, Winter RB, Wroblewski JM. Functional and radiological outcomes of 360 degrees fusion of three or more motion levels in the lumbar spine for degenerative disc disease. Spine (Phila Pa 1976). May 1 2009;34(10):E351-8. [Medline].

  2. Arnold PM, Robbins S, Paullus W, Faust S, Holt R, McGuire R. Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up. Am J Orthop (Belle Mead NJ). Jul 2009;38(7):E115-22. [Medline].

  3. Hosea TM, Gatt CJ Jr. Back pain in golf. Clin Sports Med. Jan 1996;15(1):37-53. [Medline].

  4. Saal JS, Saal JA. Management of chronic discogenic low back pain with a thermal intradiscal catheter. A preliminary report. Spine. Feb 1 2000;25(3):382-8. [Medline].

  5. Videman T, Sarna S, Battié MC, Koskinen S, Gill K, Paananen H, et al. The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine. Mar 15 1995;20(6):699-709. [Medline].

  6. Carragee EJ, Tanner CM, Khurana S, Hayward C, Welsh J, Date E, et al. The rates of false-positive lumbar discography in select patients without low back symptoms. Spine. Jun 1 2000;25(11):1373-80; discussion 1381. [Medline].

  7. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine. Apr 15 2004;29(8):833-6; discussion 837. [Medline].

  8. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. Sep-Oct 2004;4(5):495-505. [Medline].

  9. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. Apr 2004;86-A(4):670-9. [Medline].

  10. Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine. Oct 15 2005;30(20):2312-20. [Medline].

  11. Fritzell P, Hägg O, Wessberg P, Nordwall A,. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine. Dec 1 2001;26(23):2521-32; discussion 2532-4. [Medline].

  12. Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine. Sep 1 2003;28(17):1913-21.

  13. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikerås O. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine. Jan 1 2004;29(1):3-8. [Medline].

  14. Barendse GA, van Den Berg SG, Kessels AH, Weber WE, van Kleef M. Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain: lack of effect from a 90-second 70 C lesion. Spine. Feb 1 2001;26(3):287-92. [Medline].

  15. [Best Evidence] Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC. A randomized, double-blind, controlled trial: intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine. Nov 1 2005;30(21):2369-77; discussion 2378. [Medline].

  16. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. Jan-Feb 2004;4(1):27-35. [Medline].

  17. Park SY, Moon SH, Park MS, Kim HS, Choi YJ, Lee HM. Intradiscal electrothermal treatment for chronic lower back pain patients with internal disc disruption. Yonsei Med J. Aug 31 2005;46(4):539-45. [Medline].

  18. Boden SD, Swanson AL. An assessment of the early management of spine problems and appropriateness of diagnostic imaging utilization. Phys Med Rehabil Clin N Am. May 1998;9(2):411-7, viii. [Medline].

  19. Bogduk N, Modic MT. Lumbar discography. Spine. Feb 1 1996;21(3):402-4. [Medline].

  20. Buschbacher R. The aging athlete's spine. J Back Musculoskel Rehabil. 1995;5:55-74.

  21. Dawson E, Bernbeck J. The surgical treatment of low back pain. Phys Med Rehabil Clin N Am. May 1998;9(2):489-95, x. [Medline].

  22. Dreisinger TE, Nelson B. Management of back pain in athletes. Sports Med. Apr 1996;21(4):313-20. [Medline].

  23. Gamradt SC, Wang JC. Lumbar disc arthroplasty. Spine J. Jan-Feb 2005;5(1):95-103. [Medline].

  24. German JW, Foley KT. Disc arthroplasty in the management of the painful lumbar motion segment. Spine. Aug 15 2005;30(16 Suppl):S60-7. [Medline].

  25. Goins ML, Wimberley DW, Yuan PS, Fitzhenry LN, Vaccaro AR. Nucleus pulposus replacement: an emerging technology. Spine J. Nov-Dec 2005;5(6 Suppl):317S-324S. [Medline].

  26. Greenan TJ. Diagnostic imaging of sports-related spinal disorders. Clin Sports Med. Jul 1993;12(3):487-505. [Medline].

  27. Hackley DR, Wiesel SW. The lumbar spine in the aging athlete. Clin Sports Med. Jul 1993;12(3):465-8. [Medline].

  28. Hession WG, Stanczak JD, Davis KW, Choi JJ. Epidural steroid injections. Semin Roentgenol. Jan 2004;39(1):7-23. [Medline].

  29. Hickey DS, Hukins DW. Relation between the structure of the annulus fibrosus and the function and failure of the intervertebral disc. Spine. Mar-Apr 1980;5(2):106-16. [Medline].

  30. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. Jul 14 1994;331(2):69-73. [Medline].

  31. Kahler DM. Low back pain in athletes. J Sport Rehabil. 1993;2:63-78.

  32. Kaul MP, Herring SA. Rehabilitation of lumbar spine injuries in sports. Phys Med Rehabil Clin N Am. 1994;5(1):133-56.

  33. Malanga GA, Nadler SF. Nonoperative treatment of low back pain. Mayo Clin Proc. Nov 1999;74(11):1135-48. [Medline].

  34. Mayer HM. Total lumbar disc replacement. J Bone Joint Surg Br. Aug 2005;87(8):1029-37.

  35. Modic MT. Degenerative disc disease and back pain. Magn Reson Imaging Clin N Am. Aug 1999;7(3):481-91, viii. [Medline].

  36. Nachemson A, Zdeblick TA, O'Brien JP. Lumbar disc disease with discogenic pain. What surgical treatment is most effective?. Spine. Aug 1 1996;21(15):1835-8. [Medline].

  37. Nadler SF, Malanga GA, DePrince M, Stitik TP, Feinberg JH. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes. Clin J Sport Med. Apr 2000;10(2):89-97. [Medline].

  38. Nadler SF, Wu KD, Galski T, Feinberg JH. Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain. Spine. Apr 1 1998;23(7):828-33. [Medline].

  39. Rothman RH. The clinical syndrome of lumbar disc disease. Orthop Clin North Am. Jul 1971;2(2):463-75. [Medline].

  40. Sinaki M, Mokri B. Low Back Pain and Disorders of the Lumbar Spine. In: Braddom RL. Physical Medicine & Rehabilitation. 2nd. Philadelphia, Pa: WB Saunders; 1996:813-50.

  41. Tall RL, DeVault W. Spinal injury in sport: epidemiologic considerations. Clin Sports Med. Jul 1993;12(3):441-8. [Medline].

 
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Degenerative lumbar disc disease in the mature athlete. Degenerative changes of the lumbar spine, includingdecreased signal intensity and disc bulging at the L-3/4, L-4/5 and L-5/S-1 discs.
Degenerative lumbar disc disease in the mature athlete. The process of disc degeneration following internal discdisruption and herniation.
Degenerative lumbar disc disease in the mature athlete. The various forces placed upon the discs of the lumbarspine that can result in degenerative changes.
 
 
 
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