Lumbosacral Facet Syndrome Medication

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Various medications are used in the treatment of LBP secondary to the degenerative changes often observed in Z-joint dysfunction. These include acetaminophen, NSAIDs, muscle relaxants, opioid analgesics, and antidepressants. Before prescribing these medications, the physician should be aware of the contraindications, common adverse effects, and mode of action of each agent.

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Nonsteroidal Anti-inflammatory Drugs

Class Summary

NSAIDs offer anti-inflammatory benefits compared with acetaminophen. The dose needed to achieve an anti-inflammatory benefit is significantly greater than that needed for an analgesic effect. Risks are associated with NSAIDs, especially in elderly persons or persons with peptic ulcer disease, hypertension, or renal insufficiency. Newer-generation NSAIDs selectively interact with the cyclooxygenase (COX)-2 receptors and have a lower GI risk. Prolonged use of these medications is generally not recommended for most low back dysfunctions.

Ibuprofen (Ibuprin, Motrin, Advil)

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

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Muscle Relaxants

Class Summary

Muscle relaxants may be helpful in some patients with LBP and may offer additional benefit when used with NSAIDs. These agents can be used as short-term adjunctive medications and should be taken at bedtime to take advantage of the sedating effects.

Cyclobenzaprine (Flexeril)

Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins, influencing both alpha and gamma motor neurons. Structurally related to TCAs and thus carries some of their same liabilities.

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Opioid Analgesics

Class Summary

Opioid analgesics should be limited to pain that is unresponsive to alternative medication. These agents can be prescribed for acute facet syndrome to facilitate participation in an active rehabilitation program, and they should be used on a defined dosing schedule rather than prn. In addition, an adequate baseline dose should be established to achieve analgesia. Long-acting opioids should be considered in patients who require an opioid for greater than 1-2 weeks.

Oxycodone (OxyContin, OxyIR, Roxicodone)

Indicated for moderate to severe pain.

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Antidepressants

Class Summary

Tricyclic antidepressants (TCAs) can be used as an adjunctive treatment for pain and sleep if they are taken at bedtime. The initial doses should be low, and subsequent doses can be slowly increased to minimize adverse effects.

Amitriptyline (Elavil)

Inhibits reuptake of serotonin and/or norepinephrine at presynaptic neuronal membrane, which increases the concentration in the CNS. Analgesic for certain chronic forms of pain.

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Antidepressant, Selective Serotonin/norepinephrine Reuptake Inhibitor (ssnri)

Class Summary

These agents are a complex group of drugs that inhibit serotonin and norepinephrine reuptake. Some drugs in this class are weak inhibitors of dopamine reuptake with sedative effects.

Duloxetine (Cymbalta)

Duloxetine can be used for chronic musculoskeletal pain or low back pain. It is a potent inhibitor of neuronal serotonin and norepinephrine reuptake.

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