Thoracic Discogenic Pain Syndrome Medication

  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Dec 14, 2011
 

Medication Summary

Various medications can be used in the treatment of thoracic disc herniations, including acetaminophen, NSAIDs, muscle relaxants, opioid analgesics, oral corticosteroids, and antidepressants. 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 (NSAIDs)

Class Summary

Acetaminophen is used for its anti-inflammatory effects. The dose needed to produce anti-inflammatory effects substantially differs from that for analgesic effects. Most NSAIDs achieve only analgesic effects because the dosage prescribed is too small and too infrequent to produce an anti-inflammatory effect.

The risks associated with NSAIDs are particularly pertinent in elderly persons and patients with a history of peptic ulcer diseases, hypertension, or renal insufficiency. Newer-generation NSAIDs selectively interact with the cyclooxygenase-2 (COX-2) receptors and have a lower gastrointestinal risk. Prolonged use of these medications generally is not recommended for most 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, one induced with 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 for each patient.

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Analgesics

Class Summary

Use of opioids should be limited to pain that is unresponsive to alternative medication. Opioids can be prescribed for acute disc herniation to facilitate participation in an active rehabilitation program. These agents should be used on a defined dosing schedule and not on an as-needed basis. An adequate baseline dose should be established to achieve analgesia. Use of nonopioid analgesics, such as tramadol, is also an option.

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Oxycodone (OxyContin)

 

Analgesic with multiple actions similar to those of morphine; may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

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Tramadol (Ultram)

 

Inhibits ascending pain pathways, altering perception of and response to pain. Also 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 low back pain; these agents 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 the motor activity of tonic somatic origins that influence both alpha and gamma motor neurons. Structurally related to TCAs and, thus, has some of the same liabilities.

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Metaxalone (Skelaxin)

 

Prescribed for use as a muscle relaxant. The mechanism of action not firmly established, but it may act as a CNS depressant and direct pain reliever. No direct action on contractile mechanism of striated muscle. Can be used as an adjunct pain reliever for the short term in situations of severe myofascial strain.

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Corticosteroids

Class Summary

Corticosteroids are potent anti-inflammatory medications, and they represent a theoretically useful agent in the treatment of patients with radiculopathy due to local inflammation that results from disc injury or herniation.

Related eMedicine topics:

Corticosteroid-Induced Myopathy

Corticosteroid Injections of Joints and Soft Tissues

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Prednisone (Deltasone, Orasone, Meticorten)

 

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

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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, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

Coauthor(s)

James P McLean, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey

Disclosure: Nothing to disclose.

Irfan Alladin, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey

Irfan Alladin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Qing Tai, MD, PhD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Qing Tai, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Paraplegia Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Stephen G Andrus, MD  Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey

Stephen G Andrus, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Rachael Smith, DO  Consulting Staff, Mid-Atlantic Pain Institute, PC

Rachael Smith, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, 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, and Phi Beta Kappa

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

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

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

References

  1. Epstein NE, Epstein JA, Rosenthal AD. Thoracic disc disease. In: Dee R, ed. Principles of Orthopedic Practice. Vol 2. New York , NY: McGraw-Hill, Inc; 1989:991-7.

  2. Mirkovic S, Cybulski GR. Thoracic disc herniations. In: Garfin SR, Vaccaro AR, eds. Orthopaedic Knowledge Update V. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1996.

  3. Awwad EE, Martin DS, Smith KR Jr, Baker BK. Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery. Feb 1991;28(2):180-6. [Medline].

  4. Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. Nov 1995;77(11):1631-8. [Medline]. [Full Text].

  5. Schellhas KP, Pollei SR, Dorwart RH. Thoracic discography. A safe and reliable technique. Spine. Sep 15 1994;19(18):2103-9. [Medline].

  6. Nannapaneni R, Marks SM. Posterolateral thoracic disc disease: clinical presentation and surgical experience with a modified approach. Br J Neurosurg. Oct 2004;18(5):467-70. [Medline].

  7. Brown CW, Deffer PA Jr, Akmakjian J, Donaldson DH, Brugman JL. The natural history of thoracic disc herniation. Spine. Jun 1992;17(6 suppl):S97-102. [Medline].

  8. Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM. Musculoskeletal MRI. Philadelphia, Pa: WB Saunders Company; 2001:279-332.

  9. Wood KB, Schellhas KP, Garvey TA, Aeppli D. Thoracic discography in healthy individuals. A controlled prospective study of magnetic resonance imaging and discography in asymptomatic and symptomatic individuals. Spine. Aug 1 1999;24(15):1548-55. [Medline].

  10. Haufe SM, Mork AR, Pyne M, Baker RA. Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases. Int J Med Sci. Jun 1 2010;7(3):155-9. [Medline]. [Full Text].

  11. Kapural L, Sakic K, Boutwell K. Intradiscal biacuplasty (IDB) for the treatment of thoracic discogenic pain. Clin J Pain. May 2010;26(4):354-7. [Medline].

  12. Coppes MH, Bakker NA, Metzemaekers JD, Groen RJ. Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation. Eur Spine J. Sep 24 2011;[Medline].

  13. Kasliwal MK, Deutsch H. Minimally invasive retropleural approach for central thoracic disc herniation. Minim Invasive Neurosurg. Aug 2011;54(4):167-71. [Medline].

  14. Boswell MV, Trescot AM, Datta S, et al, for the American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. Jan 2007;10(1):7-111. [Medline]. [Full Text].

  15. Quint U, Bordon G, Preissl I, Sanner C, Rosenthal D. Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J. Dec 10 2011;[Medline].

  16. Albrand OW, Corkill G. Thoracic disc herniation. Treatment and prognosis. Spine. Jan-Feb 1979;4(1):41-6. [Medline].

  17. Arce CA, Dohrmann GJ. Herniated thoracic disks. Neurol Clin. May 1985;3(2):383-92. [Medline].

  18. Bohlman HH, Zdeblick TA. Anterior excision of herniated thoracic discs. J Bone Joint Surg Am. Aug 1988;70(7):1038-47. [Medline]. [Full Text].

  19. Broc GG, Crawford NR, Sonntag VK, Dickman CA. Biomechanical effects of transthoracic microdiscectomy. Spine. Mar 15 1997;22(6):605-12. [Medline].

  20. Carson J, Gumpert J, Jefferson A. Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry. Feb 1971;34(1):68-77. [Medline]. [Full Text].

  21. Derby R, Chen Y, Lee SH, Seo KS, Kim BJ. Non-surgical interventional treatment of cervical and thoracic radiculopathies. Pain Physician. Jul 2004;7(3):389-94. [Medline]. [Full Text].

  22. el-Kalliny M, Tew JM Jr, van Loveren H, Dunsker S. Surgical approaches to thoracic disc herniations. Acta Neurochir (Wien). 1991;111(1-2):22-32. [Medline].

  23. Haro H, Domoto T, Maekawa S, et al. Resorption of thoracic disc herniation. Report of 2 cases. J Neurosurg Spine. Mar 2008;8(3):300-4. [Medline].

  24. Hott JS, Feiz-Erfan I, Kenny K, Dickman CA. Surgical management of giant herniated thoracic discs: analysis of 20 cases. J Neurosurg Spine. Sep 2005;3(3):191-7. [Medline].

  25. Krauss WE, Edwards DA, Cohen-Gadol AA. Transthoracic discectomy without interbody fusion. Surg Neurol. May 2005;63(5):403-8; discussion 408-9. [Medline].

  26. Le Roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty consecutive patients. Neurosurgery. Jul 1993;33(1):58-66. [Medline].

  27. Lesoin F, Rousseaux M, Autricque A, et al. Thoracic disc herniations: evolution in the approach and indications. Acta Neurochir (Wien). 1986;80(1-2):30-4. [Medline].

  28. Maiman DJ, Larson SJ, Luck E, El-Ghatit A. Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery. Feb 1984;14(2):178-82. [Medline].

  29. Mulier S, Debois V. Thoracic disc herniations: transthoracic, lateral, or posterolateral approach? A review. Surg Neurol. Jun 1998;49(6):599-606; discussion 606-8. [Medline].

  30. Ohnishi K, Miyamoto K, Kanamori Y, Kodama H, Hosoe H, Shimizu K. Anterior decompression and fusion for multiple thoracic disc herniation. J Bone Joint Surg Br. Mar 2005;87(3):356-60. [Medline]. [Full Text].

  31. Patterson RH Jr, Arbit E. A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg. May 1978;48(5):768-72. [Medline].

  32. Perez-Cruet MJ, Kim BS, Sandhu F, Samartzis D, Fessler RG. Thoracic microendoscopic discectomy. J Neurosurg Spine. Jul 2004;1(1):58-63. [Medline].

  33. Perot PL Jr, Munro DD. Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg. Oct 1969;31(4):452-8. [Medline].

  34. Ransohoff J, Spencer F, Siew F, Gage L Jr. Transthoracic removal of thoracic disc. Report of three cases. J Neurosurg. Oct 1969;31(4):459-61. [Medline].

  35. Regan JJ, Ben-Yishay A, Mack MJ. Video-assisted thoracoscopic excision of herniated thoracic disc: description of technique and preliminary experience in the first 29 cases. J Spinal Disord. Jun 1998;11(3):183-91. [Medline].

  36. Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine. May 1 1994;19(9):1087-91. [Medline].

  37. Simpson JM, Silveri CP, Simeone FA, Balderston RA, An HS. Thoracic disc herniation. Re-evaluation of the posterior approach using a modified costotransversectomy. Spine. Oct 1 1993;18(13):1872-7. [Medline].

  38. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg. Apr 1998;88(4):623-33. [Medline].

  39. Stillerman CB, Weiss MH. Management of thoracic disc disease. Clin Neurosurg. 1992;38:325-52. [Medline].

  40. Ulivieri S, Oliveri G, Petrini C, Voltolini L, Gotti G. Transmanubrial osteomuscolar sparing approach for T1-T2 thoracic disc herniation. Minerva Chir. Oct 2008;63(5):421-3. [Medline].

  41. Wakefield AE, Steinmetz MP, Benzel EC. Biomechanics of thoracic discectomy. Neurosurg Focus. Sep 15 2001;11(3):E6. [Medline].

  42. Wenger DR, Frick SL. Scheuermann kyphosis. Spine. Dec 15 1999;24(24):2630-9. [Medline].

  43. Williams MP, Cherryman GR, Husband JE. Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Assist Tomogr. Mar-Apr 1989;13(2):211-4. [Medline].

  44. Wood KB, Blair JM, Aepple DM, et al. The natural history of asymptomatic thoracic disc herniations. Spine. Mar 1 1997;22(5):525-9; discussion 529-30. [Medline].

 
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Axial magnetic resonance image of a thoracic herniated disc.
Sagittal magnetic resonance image of a lower thoracic herniated disc.
 
 
 
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