Physical Medicine and Rehabilitation for Stress Fractures Medication

Updated: Sep 10, 2019
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Consuelo T Lorenzo, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce patient discomfort, minimize associated morbidity, and to prevent complications. Medications used in the management of stress fractures include the nonsteroidal anti-inflammatory drugs (NSAIDs) celecoxib, ibuprofen, and naproxen and the analgesic acetaminophen.

A study by Yoo et al suggested that in elderly patients with sacral insufficiency fractures and preexisting comorbidities, treatment with teriparatide may shorten healing time and lead to faster functional improvement and better pain reduction. [42]

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Nonsteroidal anti-inflammatory drugs

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Mechanism of action is not known, but they may inhibit COX activity and prostaglandin synthesis. Other mechanisms may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

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-related GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose for each patient.

Ibuprofen (Motrin, Excedrin IB, Advil, Ibuprin)

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

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

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

NSAIDs decrease intraglomerular pressure and decrease proteinuria.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

May be a reasonable alternative for symptom management in individuals who cannot tolerate NSAIDs or if the practitioner is concerned that NSAIDs may interfere with bone healing.

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