Medication Summary
Table. (Open Table in a new window)
For trochanteric bursitis (greater trochanteric pain syndrome [GTPS]), medications are used primarily to decrease pain and inflammation. The most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and focal corticosteroid injections; these are employed in conjunction with the rest of the rehabilitation plan. |
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Although an off-label use, another option is symptomatic treatment with a topical, sustained-release local anesthetic patch, such as the Lidoderm (lidocaine transdermal) patch, especially when there is an associated sleep disturbance due to the patient lying on the side affected by GTPS. |
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Class Summary
Oral NSAIDs can help to decrease pain and inflammation and may be given for several weeks. Various oral agents can be used. The choice of an NSAID is largely a matter of convenience (eg, how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.
Ibuprofen (Motrin, Advil, Addaprin, Ibu, Caldolor)
Ibuprofen inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclo-oxygenase (COX), thus inhibiting prostaglandin synthesis.
Ketoprofen
Ketoprofen is used for the relief of mild to moderate pain and inflammation. Administer small dosages initially to patients with small body size, elderly patients, and those with renal or liver disease.
When administering this medication, doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.
Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)
Naproxen relieves mild to moderately severe pain and inhibits inflammatory reactions. It probably does so by decreasing the activity of the enzyme cyclo-oxygenase, thus inhibiting prostaglandin synthesis.
Flurbiprofen
Flurbiprofen may inhibit the cyclo-oxygenase enzyme, thereby inhibiting prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.
Indomethacin (Indocin)
Indomethacin inhibits prostaglandin synthesis. It is rapidly absorbed, and metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation.
Corticosteroids
Class Summary
In contrast to the widespread systemic distribution of an orally administered anti-inflammatory drug, a local corticosteroid injection can achieve focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation. Various corticosteroid preparations are available from which to choose. Commonly, the corticosteroid is mixed with a local anesthetic before injection. Again, there are various local anesthetic agents from which to choose.
Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol, A-Methapred)
Corticosteroids such as methylprednisolone are used commonly for local injections of bursae or joints, to provide a local anti-inflammatory effect while minimizing some of the gastrointestinal and other risks of systemic medications.
Dexamethasone (Baycadron)
Dexamethasone has many pharmacologic benefits, but it also has significant adverse effects. It stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, and inhibits prostaglandin and proinflammatory cytokines (eg, tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6], IL-2, and interferon-gamma [IFN-gamma]). The inhibition of chemotactic factors and factors that increase capillary permeability inhibits recruitment of inflammatory cells into affected areas.
Dexamethasone suppresses lymphocyte proliferation through direct cytolysis and inhibits mitosis. It breaks down granulocyte aggregates and improves pulmonary microcirculation.
Dexamethasone is readily absorbed via the gastrointestinal tract and is metabolized in the liver. Inactive metabolites are excreted via the kidneys. The drug lacks the salt-retaining property of hydrocortisone.
Patients can be switched from an IV to a PO regimen in a 1:1 ratio.
Triamcinolone (Aristospan Intralesional, Kenalog)
Triamcinolone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes (PMNs) and reversing capillary permeability. All corticosteroids can reduce symptoms.
Local anesthetics
Class Summary
Analgesics may aid in decreasing the severity of pain.
Lidocaine (Lidoderm)
Lidocaine decreases the permeability of neuronal membranes to sodium ions, thus inhibiting depolarization and blocking the transmission of nerve impulses.
Capsaicin (Aleveer, Qutenza, Salonpas Gel-Patch)
Capsaicin is a natural chemical derived from plants of the Solanaceae family. It penetrates deep for the temporary relief of minor aches and pains of muscles and joints associated with inflammatory reactions. Capsaicin may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.
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Tr B = trochanteric bursa; G Med B = subgluteus medius bursa; G Min B = subgluteus minimus bursa.
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Photo demonstrates method of stretching iliotibial band (ITB) in standing position. One foot is crossed over other, and patient leans away from side being stretched. Exercise is performed by allowing side that will be stretched to lean in toward wall. Patient should feel stretch at lateral aspect of hip that is closest to wall. Stretching should be done in controlled, sustained manner, never a ballistic manner with sudden jerking movements.
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Photo demonstrates method of stretching iliotibial band (ITB) in supine position. Foot ipsilateral to stretch is crossed over contralateral knee. Next, thigh ipsilateral to stretch is pulled across midline (adduction). Patient should feel stretch at lateral aspect of hip, in area shown by dark line. Stretching should be done in controlled, sustained manner, never in ballistic manner with sudden jerking movements.
Tables
For trochanteric bursitis (greater trochanteric pain syndrome [GTPS]), medications are used primarily to decrease pain and inflammation. The most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and focal corticosteroid injections; these are employed in conjunction with the rest of the rehabilitation plan. |
|
Although an off-label use, another option is symptomatic treatment with a topical, sustained-release local anesthetic patch, such as the Lidoderm (lidocaine transdermal) patch, especially when there is an associated sleep disturbance due to the patient lying on the side affected by GTPS. |
