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Thoracic Disc Injuries Medication

  • Author: Kambiz Hannani, MD; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Apr 30, 2014

Medication Summary

Medications are used to minimize pain and inflammation. In the early phase of a disc herniation, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended. If NSAIDs are not effective, a tapering course of steroids, such as with methylprednisolone, can be used to try to minimize the inflammatory process. In cases of severe pain, narcotics can be used in the acute phases; if pain has become a chronic problem, narcotics then become the primary modality for pain control. Muscle relaxants can be utilized to potentiate the effectiveness of NSAIDs, narcotics, or steroids.


Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs are used to decrease the inflammatory process that is involved in disc herniation and nerve root irritation; furthermore, NSAIDs can help to decrease the pain that is associated with disc herniation.

Ibuprofen (Motrin, Ibuprin)


Drug of choice (DOC) for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprosyn, Anaprox, Naprelan)


For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Diclofenac (Voltaren)


Inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors.

Celecoxib (Celebrex)


Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme; it is induced during pain and 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 the lowest dose of celecoxib for each patient.



Class Summary

Corticosteroids are potent anti-inflammatory agents that are used to relieve inflammation of the nerve roots and surrounding tissue.

Prednisone (Deltasone, Meticorten, Orasone)


May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity.

Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)


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


Muscle relaxants

Class Summary

Muscle relaxants reduce muscle spasms in the paraspinal muscles.

Carisoprodol (Soma)


Short-acting medication that may have depressant effects at the spinal cord level.

Cyclobenzaprine (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 their same risks.


Narcotic analgesics

Class Summary

Narcotic analgesics are used for short-term pain control.

Hydrocodone and acetaminophen (Vicodin, Lortab, Norcet)


Drug combination indicated for short-term (< 10 d) relief of moderate to severe acute pain.

Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)


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

Contributor Information and Disclosures

Kambiz Hannani, MD Medical Director, Spine Specialty Institute

Kambiz Hannani, MD is a member of the following medical societies: Phi Beta Kappa

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.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

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, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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