Cervical Facet Syndrome Medication

Updated: Aug 28, 2018
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful in reducing pain and inflammation, and cyclooxygenase (COX-II) inhibitors have been introduced as alternative agents that cause less gastric irritation. Tricyclic antidepressants, such as amitriptyline and doxepin, and some antiseizure medications, such as gabapentin, carbamazepine, and divalproex, are useful in alleviating neuropathic pain. Nonnarcotic and narcotic pain medications may be needed for moderate to severe pain. Muscle relaxants, such as baclofen and tizanidine, are very helpful in reducing the associated muscle spasm that often accompanies facet pain. If the patient is having problems sleeping, then a short course of a sleeping aid, such as zolpidem, temazepam, and zaleplon may be of benefit.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

Oral NSAIDs can help decrease pain and inflammation. Various oral NSAIDs can be used and none of these agents holds a clear distinction as the drug of choice. The choice of NSAID is largely a matter of convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost. NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Motrin, Ibuprin)

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

Ketoprofen (Actron, Orudis, Oruvail)

For the relief of mild to moderate pain and inflammation.

Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects.

Administer high doses with caution and closely observe the patient for a response.

Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)

For the relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

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Cyclooxygenase (COX-2) Inhibitors

Class Summary

COX-2 inhibitors aid in control of pain and inflammation, especially in cases in which there is a contraindication to conventional anti-inflammatories. Although increased cost can be a negative factor, the incidence of costly and potentially fatal gastrointestinal (GI) bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.

Celecoxib (Celebrex)

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

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