Lumbar Disk Problems in the Athlete Medication

Updated: May 17, 2017
  • Author: Luis E Palacio, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Medication

Medication Summary

See the list below:

  • NSAIDs are used to for LBP.

  • Muscle relaxants (eg, cyclobenzaprine) show some benefit in controlling LBP, but the use of these agents should be limited to the acute phase (ie, the first 4-7 d). Side effects such as drowsiness limit the use of muscle relaxants, but they may be helpful for patients with night symptoms.

  • Tramadol is effective for pain control in chronic LBP and can be safely used in combination with NSAIDs.

  • Acetaminophen is effective for pain control in chronic LBP, although NSAIDs may be superior. Acetaminophen may also be used as an adjunct to the analgesic properties of NSAIDs (not to exceed 4 g/d).

  • Narcotic medications may be helpful in severe cases that involve functional limitations, but long-term use should be avoided.

  • Selective serotonin reuptake inhibitors (SSRIs) may have a role in managing chronic radicular symptoms.

  • Tricyclic  and tetracyclic antidepressants (TCAs) have shown moderate symptom reduction that is independent of the patient's depression status in chronic pain cases.

  • Oral steroids help reduce acute pain and swelling; however, no study has shown benefit over the potential harmful side effects of steroid use.

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Analgesics

Class Summary

Because pain is usually the most debilitating symptom of lumbar disc disease, pharmacologic therapy is directed at alleviating the patient's pain.

Acetaminophen (Tylenol)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, or who are taking oral anticoagulants.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

This class of medications provides analgesia to the low back and reduces inflammation surrounding a herniated nucleus pulposus.

Ibuprofen (Motrin)

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

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Muscle relaxants

Class Summary

These agents are indicated for severe muscle spasms that are associated with LBP; little evidence exists to support universal use in lumbar disc disease.

Cyclobenzaprine HCl (Flexeril)

Skeletal muscle relaxant that acts centrally and reduces the motor activity of tonic somatic origins that influence both alpha and gamma motor neurons.

Structurally related to tricyclic antidepressants and, thus, carries some of the same liabilities.

One of the least expensive and least addictive options in this class.

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Antidepressant, Tricyclic

Class Summary

These agents are used in the treatment of depression.

Amitriptyline (Elavil)

Analgesic for certain chronic and neuropathic pain. Blocks reuptake of norepinephrine and serotonin, which increases concentrations in the CNS. Decreases pain by inhibiting spinal neurons that are involved in pain perception. Highly anticholinergic. Often discontinued because of somnolence and dry mouth.

Cardiac arrhythmia, especially in overdose, has been described; monitoring the QTc interval after reaching the target level is advised. Up to 1 mo may be needed to obtain clinical effects.

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Analgesic, Miscellaneous

Tramadol

Inhibits ascending pain pathways, altering perception of and response to pain. Inhibits also reuptake of norepinephrine and serotonin.

Tramadol

Inhibits ascending pain pathways, altering perception of and response to pain. Inhibits also reuptake of norepinephrine and serotonin.

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