Diagnosis and Management of Cervical Spondylosis Medication

Updated: Nov 09, 2018
  • Author: Sandeep S Rana, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to reduce pain and inflammation.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Used most commonly for the relief of mild to moderate pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include naproxen and diclofenac.

Ibuprofen (Motrin, Advil, Haltran, Nuprin)

Inhibits inflammatory reactions and pain by decreasing activity of COX, which results in prostaglandin synthesis.

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

Relieves mild to moderate pain; inhibits inflammatory reactions and pain, probably by decreasing activity of COX, which results in decreased prostaglandin synthesis.

Diclofenac (Voltaren)

Has analgesic, antipyretic, and anti-inflammatory activity; inhibits inflammatory reactions and pain, probably by decreasing activity of COX, which results in prostaglandin synthesis.

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Corticosteroids

Class Summary

Used for potent anti-inflammatory activity and relieve inflammation associated with cervical radiculopathy.

Prednisone (Sterapred)

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

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

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

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Tricyclic antidepressants

Class Summary

A complex group of drugs that has central and peripheral anticholinergic effects and sedative effects. They block the active reuptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

Increases synaptic concentration of serotonin and/or norepinephrine in CNS by inhibiting their reuptake at presynaptic neuronal membrane; useful as an analgesic for certain chronic and neuropathic pain.

Nortriptyline (Aventyl hydrochloride, Pamelor)

Effective in treatment of chronic pain; by inhibiting reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, it increases their synaptic concentration; additional pharmacodynamic effects (eg, desensitization of adenyl cyclase, down-regulation of beta-adrenergic receptors and serotonin receptors) appear to be involved.

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Cyclooxygenase 2 inhibitors

Class Summary

Although increased cost can be a negative factor, incidence of costly and potentially fatal GI bleeding is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeding will further define populations that most benefit from COX-2 inhibitors.

Celecoxib (Celebrex)

Inhibits primarily COX-2, which is considered an inducible isoenzyme 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 lowest dose for each patient.

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Muscle relaxants

Class Summary

Reduce associated cervical muscle spasm.

Carisoprodol (Soma)

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

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 TCAs and thus carries some of same liabilities.

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Opiates

Class Summary

For use in short-term management of acute pain.

Hydrocodone and acetaminophen (Vicodin, Lortab, Norcet, Margesic, Lorcet-HD)

Drug combination indicated for moderately severe to severe pain.

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

Drug combination indicated for relief of moderately severe to severe pain.

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