Lumbosacral Disc Injuries Medication

Updated: Oct 12, 2015
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Oral NSAIDs can help decrease pain and inflammation. Various oral NSAIDs can be used, but none of these agents holds a clear distinction as the drug of choice. The selection of an NSAID is largely a matter of convenience (eg, how frequently the doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.

Opioid analgesics may also be used to help control pain for short durations during treatment. These drugs should not be used long term, and there is not a clear drug of choice. Treatment should be individualized.

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Nonsteroidal Anti-inflammatory Drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well; these may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

COX-2 inhibitors are equally effective. 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)

For arthritis. Inhibits primarily COX-2, which is considered an inducible isoenzyme and is 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 the lowest dose of celecoxib for each patient.

Ibuprofen (Motrin, Addaprin, Caldolor, NeoProfen, Provil)

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

Ketoprofen

For 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 the therapeutic effects. Administer high doses with caution and closely observe patient for response.

Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)

For 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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