Medication Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays in the conservative treatment of overuse injuries. However, considerable evidence has been revealed that true inflammation is rarely a component of these disorders, especially tendinopathies. Consequently, the use of simple analgesics has become more prevalent in the treatment of such disorders.
Muscle relaxants, opiates, corticosteroids, tricyclic antidepressants, and sleep medications have a role in the tailored treatment of individuals with overuse injury.
Injection of involved structures with combinations of corticosteroids and local anesthetics is frequently quite helpful in persons with overuse injuries. Pain relief enables more effective participation in therapy, and it may help to limit the likelihood that the patient will develop a chronic pain syndrome. In most cases, injections should be performed after less invasive measures fail. Rarely, immediate relief of pain may be necessary to allow participation in an athletic or performing arts event, and this can be achieved through injection therapy. Techniques for the injection of specific structures are described in more specific articles in the Medscape Reference Journal (eg, see the related Medscape Drugs & Diseases topic Corticosteroid Injections of Joints and Soft Tissues).
The related Medscape Drugs & Diseases topic Chronic Pain Syndrome may also be of interest.
Nonsteroidal anti-inflammatory drugs
Class Summary
Most commonly used for relief of mild to moderate pain. Effects in treatment of pain tend to be patient-specific.
Diclofenac (Voltaren, Cataflam)
Used to reduce inflammation; inhibits prostaglandin synthesis by decreasing activity of COX enzyme, which, in turn, decreases formation of prostaglandin precursors.
Muscle relaxants
Class Summary
Thought to work centrally by suppressing conduction in the vestibular cerebellar pathways. May have an inhibitory effect on the parasympathetic nervous system.
Cyclobenzaprine (Flexeril)
Acts centrally and reduces motor activity of tonic somatic origins, influencing alpha and gamma motor neurons. Structurally related to TCAs. 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. Often produces a "hangover" effect, which can be minimized by taking the nighttime dose 2-3 h before going to sleep.
Narcotic analgesics
Class Summary
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Many analgesics have sedating properties, which are beneficial for patients who have sustained injuries.
Hydrocodone and acetaminophen (Vicodin, Vicodin ES, Lorcet-HD, Norcet, Lortab)
Drug combination indicated for moderate to severe pain.
Tricyclic antidepressants
Class Summary
Used in the treatment of overuse injury, not for their antidepressant effects but as adjunct pain medications. Act synergistically with narcotic analgesics and appear to alter brainstem pain processing. Their sedating effects also may be used advantageously if the patient's sleep is disrupted.
Amitriptyline (Elavil)
Analgesic for certain chronic and neuropathic pain.
Sedative/Hypnotics
Class Summary
Sleep-inducing medications are used in overuse injury when the patient's sleep is disrupted because of discomfort from the injury.
Trazodone (Desyrel, Desyrel Dividose, Oleptro)
Inhibits serotonin reuptake by antagonizing 5-HT2A/C, which can decrease onset time to sleep and improve slow-wave sleep.
Zolpidem (Ambien)
Structurally dissimilar to benzodiazepine but similar in activity, with the exception of having reduced effects on skeletal muscle and seizure threshold.
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Used for pain relief and reduction of inflammation.
Cortisone (Cortone)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
