Cervical Myofascial Pain Medication

Updated: Aug 18, 2016
  • Author: C Douglas Phillips, MD, FACR; Chief Editor: Dean H Hommer, MD  more...
  • Print
Medication

Medication Summary

The goal of medication for patients with cervical myofascial syndrome is to reduce pain. Avoid the use of opioid analgesics. If the clinical picture is one of more chronic pain accompanied by sleep dysfunction, consider the use of a tricyclic antidepressant (TCA). Anticonvulsants used as neuropathic analgesics may be helpful, because myofascial pain may at its core be a spinal-mediated disorder affected by neuropathic dysfunction. Muscle relaxants, although commonly administered to treat muscle pain, must be used cautiously because of their sedative effects and, in some cases, addictive potential.

Next:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs are the drugs of choice for the initial treatment of myofascial pain.

Ibuprofen (Motrin, Advil, Neoprofen, Ultraprin)

Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. It is used to provide relief of cervical myofascial pain.

Indomethacin (Indocin)

Indomethacin is thought to be the most effective NSAID for the treatment of ankylosing spondylitis, although no scientific evidence supports this claim. It is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Naproxen (Naprosyn, Naprelan, Aleve, Anaprox)

Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

Ketoprofen

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

Previous
Next:

Tricyclic Antidepressants

Class Summary

Tricyclic antidepressants are commonly used for chronic pain. They help to treat insomnia and reduce painful dysesthesia. These agents treat nociceptive and neuropathic pain syndromes.

Amitriptyline

Amitriptyline inhibits the reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, which increases their concentration in the central nervous system (CNS). Amitriptyline may increase or prolong neuronal activity, since the reuptake of these biogenic amines is important physiologically in terminating transmitting activity.

Previous
Next:

Skeletal Muscle Relaxants

Class Summary

Muscle relaxants are commonly used to treat muscle pain, but they must be used cautiously because of sedation and because of the addictive potential of some of the medications in this category of drugs (benzodiazepines).

Cyclobenzaprine (Flexeril, Fexmid, Amrix)

Cyclobenzaprine acts centrally and reduces motor activity of tonic somatic origins, influencing alpha and gamma motor neurons. It is structurally related to the tricyclic antidepressants.

Skeletal muscle relaxants have modest, short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and, used intermittently, for diffuse and certain regional chronic pain syndromes. Long-term improvement over placebo has not been established.

Cyclobenzaprine often produces a "hangover" effect, which can be minimized by taking the nighttime dose 2-3 hours before going to sleep.

Baclofen (Lioresal, Gablofen)

Baclofen is metabolized in the liver and excreted primarily in urine. This agent is not a controlled substance under the Drug Enforcement Administration (DEA).

Carisoprodol (Soma)

Carisoprodol is a short-acting medication that may have depressant effects at the spinal cord level.

Skeletal muscle relaxants have modest short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and, used intermittently, for diffuse and certain regional chronic pain syndromes. Long-term improvement over placebo has not been established.

Tizanidine (Zanaflex)

Tizanidine is a centrally acting muscle relaxant that is metabolized in the liver and excreted in the urine and feces. It is used in patients with predominantly upper motor neuron involvement. It is not a DEA-controlled substance.

Previous
Next:

Opioid Analgesics

Class Summary

Tramadol is a weak opioid and an inhibitor of serotonin and norepinephrine reuptake in the dorsal horn. Studies have shown efficacy when it has been used to treat fibromyalgia, although no formal studies have been performed for myofascial pain. Tramadol is known to help with chronic low back pain and osteoarthritic pain, both of which are commonly associated with myofascial pain.

Tramadol (Ultram, Ryzolt)

Tramadol is an analgesic that probably acts over monoaminergic and opioid mechanisms. Its monoaminergic effect is shared with tricyclic antidepressants. Tolerance and dependence appear to be uncommon.

Previous
Next:

Anticonvulsants, Other

Class Summary

Anticonvulsants used as neuropathic analgesics may be helpful, because myofascial pain may at its core be a spinal-mediated disorder affected by neuropathic dysfunction. Gabapentin has been shown to be effective in treating myofascial and neuropathic pain.

Gabapentin (Neurontin)

Gabapentin is a membrane stabilizer. It is a structural analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), but, paradoxically, it is thought not to exert an effect on GABA receptors. Gabapentin appears to exert action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gaited calcium channels. It is used to manage pain and provide sedation in neuropathic pain.

Titration to effect occurs over several days (300 mg on day 1, 300 mg twice on day 2, and 300 mg 3 times on day 3).

Previous