Lumbosacral Discogenic Pain Syndrome Medication

Updated: Aug 19, 2016
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) can help decrease pain and inflammation. Various oral NSAIDs can be used, and none of these holds a clear distinction as the drug of choice. 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.

Similarly, narcotics may be indicated for short-term use to help maintain comfort during the acute phase of the injury. Again, no clear drug of choice exists in this category and treatment should be individualized.

Lee et al compared radicular pain reduction from epidural steroid injections administered using interlaminar, caudal, and transforaminal techniques in patients with lumbosacral intervertebral disc herniation. [11] The investigators examined results from 95 such patients who had experienced no decrease in pain following treatment with analgesics, anti-inflammatory agents, or physical therapy. As measured using the Visual Analog Scale (VAS) pain score, the ratio of successful results was higher for epidural injections administered with the interlaminar or transforaminal techniques than it was for those performed with the caudal technique.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) 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.

Celecoxib (Celebrex)

For arthritis. 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.

Ibuprofen (Motrin, Ibuprin)

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

Naproxen (Naprosyn, Naprelan, Aleve, Anaprox)

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of COX, which results in a decrease of prostaglandin synthesis.

Ketoprofen (Orudis, Oruvail, Actron)

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 >75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.

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