Physical Medicine and Rehabilitation for Myofascial Pain Medication

Updated: Mar 15, 2019
  • Author: Jennifer E Finley, MD, FAAPMR; Chief Editor: Dean H Hommer, MD  more...
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Medication Summary

Muscle relaxant medications [46] and nonsteroidal anti-inflammatory drugs (NSAIDs) can at times be a useful adjunct to active, exercise-based treatment for myofascial pain, but they are helpful only rarely on their own. Medications such as low-dose amitriptyline may help to improve the patient's sleep cycle. Botulinum toxin type A injected into trigger points can reduce muscular contractions through the inhibition of acetylcholine release at the neuromuscular junction and appears to have an antinociceptive effect. [22, 23, 24, 25] Current research suggests that peripheral sensitization is blocked, which indirectly reduces central sensitization. [29] Transdermal lidocaine patches can be helpful. [47]


Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as the inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Ibuprin, Advil)

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

Naproxen (Naprosyn, Anaprox, Naprelan)

For relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by reducing the activity of cyclooxygenase, which results in decreased prostaglandin synthesis.

Ketoprofen (Orudis, Actron, Oruvail)

For relief of mild to moderate pain and inflammation.

Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.

Doses over 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient for a response.


Tricyclic antidepressants

Class Summary

Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. These agents have central effects on pain transmission. They block the active re-uptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

Analgesic for certain chronic and neuropathic pain.