Medication Summary

NSAIDs are commonly prescribed for their effects on pain and inflammation. In cervical radiculopathy, much of the pain is secondary to inflammation of the nerve root, usually due to a mechanical irritation of the nerve. In general, 10-14 days of regular dosing of an NSAID is all that is needed to control the pain and inflammation in cervical radiculopathy.

Oral steroids have been used to reduce the associated inflammation from compression. No controlled study exists to support the use of oral steroids in the treatment of cervical radiculopathy; however, these agents have been found to be clinically useful. Doses as high as 60 mg daily for 7 days and continuing for 5 days have been used without evidence of adrenal suppression. Longer-term use is not recommended. Tricyclic antidepressants can be a useful adjunct in controlling radicular pain. Opioid medications are generally not necessary for pain relief, but these drugs can be used when other medications fail to provide adequate relief or if other agents are contraindicated. When opioid medications are prescribed, adequate doses and appropriate dosing schedules should be used.

Class Summary

Various NSAIDs are available either over the counter or by prescription. Proper doses should be used in the acute phase around the clock for approximately 7-10 days.

Ibuprofen (Motrin, Ibuprin)

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

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 and block the active reuptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

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By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, may increase the synaptic concentration in the CNS. Useful as an analgesic for certain chronic and neuropathic pain.

Nortriptyline (Pamelor, Aventyl HCl)

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Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase synaptic concentration in the CNS.

Pharmacodynamic effects, such as the desensitization of adenylate cyclase and downregulation of beta-adrenergic receptors and serotonin receptors, also appear to play a role in its mechanisms of action.

Questions

Bogduk N, Twomey LT. Clinical Anatomy of the Lumbar Spine. 2nd ed. Edinburgh, UK: Churchill Livingstone Inc; 1991.
Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994 Mar. 75(3):342-52. [QxMD MEDLINE Link].
Malanga GA. The diagnosis and treatment of cervical radiculopathy. Med Sci Sports Exerc. 1997 Jul. 29(7 suppl):S236-45. [QxMD MEDLINE Link].
Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr. 117(pt 2):325-35. [QxMD MEDLINE Link].
van Gijn J, Reiners K, Toyka KV, Braakman R. Management of cervical radiculopathy. Eur Neurol. 1995. 35(6):309-20. [QxMD MEDLINE Link].
White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1990. 102.
Parminder SP. Management of cervical pain. Delisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1988. 753.
Murphey F, Simmons JC, Brunson B. Chapter 2. Ruptured cervical discs, 1939 to 1972. Clin Neurosurg. 1973. 20:9-17. [QxMD MEDLINE Link].
Shelerud RA, Paynter KS. Rarer causes of radiculopathy: spinal tumors, infections, and other unusual causes. Phys Med Rehabil Clin N Am. 2002 Aug. 13(3):645-96. [QxMD MEDLINE Link].
Soubrier M, Dubost JJ, Tournadre A, et al. Cervical radiculopathy as a manifestation of giant cell arteritis. Joint Bone Spine. 2002 May. 69(3):316-8. [QxMD MEDLINE Link].
Furusawa N, Baba H, Miyoshi N, et al. Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production. Spine. 2001 May 15. 26(10):1110-6. [QxMD MEDLINE Link].
Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine. 1997 May 15. 22(10):1065-73. [QxMD MEDLINE Link].
Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989 Mar. 14(3):253-7. [QxMD MEDLINE Link].
Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J. 2006 Jun. 15(6):794-801. [QxMD MEDLINE Link].
Sasso RC, Macadaeg K, Nordmann D, Smith M. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging. J Spinal Disord Tech. 2005 Dec. 18(6):471-8. [QxMD MEDLINE Link].
Anderberg L, Annertz M, Brandt L, Säveland H. Selective diagnostic cervical nerve root block--correlation with clinical symptoms and MRI-pathology. Acta Neurochir (Wien). 2004 Jun. 146(6):559-65; discussion 565. [QxMD MEDLINE Link].
Huston CW, Slipman CW. Diagnostic selective nerve root blocks: indications and usefulness. Phys Med Rehabil Clin N Am. 2002 Aug. 13(3):545-65. [QxMD MEDLINE Link].
Chesnut RM, Abitbol JJ, Garfin SR. Surgical management of cervical radiculopathy. Indication, techniques, and results. Orthop Clin North Am. 1992 Jul. 23(3):461-74. [QxMD MEDLINE Link].
Johnson EW, ed. Practical Electromyography. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1979. 229-45.
Mansfield M, Smith T, Spahr N, Thacker M. Cervical spine radiculopathy epidemiology: a systematic review. Musculoskeletal Care. 2020 Dec. 18 (4):555-67. [QxMD MEDLINE Link].
Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine. 2002 Jan 15. 27(2):156-9. [QxMD MEDLINE Link].
Fryholm R. Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis. Acta Chiru. Scand. 1951. 160(suppl):1-149.
Letchuman R, Gay RE, Shelerud RA, VanOstrand LA. Are tender points associated with cervical radiculopathy?. Arch Phys Med Rehabil. 2005 Jul. 86(7):1333-7. [QxMD MEDLINE Link].
Nordin M, Carragee EJ, Hogg-Johnson S, et al for the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15. 33(4 suppl):S101-22. [QxMD MEDLINE Link].
American College of Radiology. ACR Appropriateness Criteria: chronic neck pain. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=8297. Accessed: March 24, 2009.
Cantu RC. Cervical spine injuries in the athlete. Semin Neurol. 2000. 20(2):173-8. [QxMD MEDLINE Link].
Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Sep. 72(8):1178-84. [QxMD MEDLINE Link]. [Full Text].
Romeo A, Vanti C, Boldrini V, Ruggeri M, Guccione AA, Pillastrini P, et al. Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2018 Apr 1. 98 (4):231-242. [QxMD MEDLINE Link].
Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009 Oct 7. 339:b3883. [QxMD MEDLINE Link]. [Full Text].
Cohen SP, Gupta A, Strassels SA, Christo PJ, Erdek MA, Griffith SR, et al. Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections: A Multicenter, Randomized Controlled Trial. Arch Intern Med. 2011 Dec 12. [QxMD MEDLINE Link].
Friedly J, Deyo RA. Imaging and Uncertainty in the Use of Lumbar Epidural Steroid Injections: Comment on "Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections". Arch Intern Med. 2011 Dec 12. [QxMD MEDLINE Link].
American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=10531. Accessed: March 25, 2009.
Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol. 2009 Mar. 30(3):507-11. [QxMD MEDLINE Link].
Engel A, King W, MacVicar J. The effectiveness and risks of fluoroscopically guided cervical transforaminal injections of steroids: a systematic review with comprehensive analysis of the published data. Pain Med. 2014 Mar. 15(3):386-402. [QxMD MEDLINE Link].
Council of Acupuncture and Oriental Medicine Associations. Acupuncture and electroacupuncture: evidence-based treatment guidelines. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=9343. Accessed: March 24, 2009.
Van Zundert J, Patijn J, Kessels A, Lamé I, van Suijlekom H, van Kleef M. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain. 2007 Jan. 127(1-2):173-82. [QxMD MEDLINE Link].
Plener J, Csiernik B, To D, et al. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain. 2023 Mar 1. 39 (3):138-46. [QxMD MEDLINE Link].
Griffiths C, Dziedzic K, Waterfield J, Sim J. Effectiveness of specific neck stabilization exercises or a general neck exercise program for chronic neck disorders: a randomized controlled trial. J Rheumatol. 2009 Feb. 36(2):390-7. [QxMD MEDLINE Link].
Borrella-Andrés S, Marqués-García I, Lucha-López MO, et al. Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review. Biomed Res Int. 2021. 2021:9936981. [QxMD MEDLINE Link]. [Full Text].
Alshami AM, Bamhair DA. Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials. 2021 Oct 18. 22 (1):716. [QxMD MEDLINE Link]. [Full Text].
Gutman G, Rosenzweig DH, Golan JD. Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2018 Mar 15. 43 (6):E365-E372. [QxMD MEDLINE Link].
Findlay C, Ayis S, Demetriades AK. Total disc replacement versus anterior cervical discectomy and fusion. Bone Joint J. 2018 Aug. 100-B (8):991-1001. [QxMD MEDLINE Link].
Skeppholm M, Lindgren L, Henriques T, Vavruch L, Löfgren H, Olerud C. The Discover artificial disc replacement versus fusion in cervical radiculopathy--a randomized controlled outcome trial with 2-year follow-up. Spine J. 2015 Jun 1. 15 (6):1284-94. [QxMD MEDLINE Link].
Engquist M, Löfgren H, Öberg B, Holtz A, Peolsson A, Söderlund A, et al. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone. J Neurosurg Spine. 2016 Aug 26. 1-9. [QxMD MEDLINE Link].

Media Gallery

Sagittal magnetic resonance image of the cervical spine. This image reveals a C6-C7 herniated nucleus pulposus.
Axial magnetic resonance image of the cervical spine. This image reveals a C6-C7 herniated nucleus pulposus.

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Author

Gerard A Malanga, MD † Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Michael A Romello, MD Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Disclosure: Nothing to disclose.

Cervical Radiculopathy Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs