Lumbosacral Radiculopathy Medication

Updated: Jan 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of the initial treatment for LBP. With the use of all NSAIDs, elderly patients should be monitored for gastrointestinal (GI) and renal toxicity. Pain control with acetaminophen or a suitable narcotic may be more appropriate for elderly patients.

Muscle relaxant drugs are not first-line agents, but they may be considered for patients who are experiencing significant spasms. No studies have documented that these medications change the natural history of the disease. Because muscle relaxant drugs may cause drowsiness and dry mouth, the clinician may find it useful to recommend that these medications be taken at least 2 hours before bedtime.

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Nonsteroidal Anti-inflammatory Agents (NSAIDs)

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 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.

Diclofenac (Voltaren, Cataflam)

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which in turn decreases the formation of prostaglandin precursors.

Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)

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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Muscle Relaxants

Class Summary

Muscle relaxant medications are used for radiculopathy that has a significant component of muscle spasm.

Cyclobenzaprine (Flexeril)

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

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who are in pain.

Oxycodone (OxyContin)

Indicated for the relief of moderate to severe pain.

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

Drug combination indicated for the relief of moderate to severe pain.

Tramadol (Ultram)

Inhibits the ascending pain pathways, altering perception of and response to pain. Also inhibits the reuptake of norepinephrine and serotonin.

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Anticonvulsant

Class Summary

Some agents in this category are used to manage pain.

Gabapentin (Neurontin)

Membrane stabilizer, a structural analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which paradoxically is thought not to exert effects on GABA receptors. Appears to exert action via the alpha(2)-delta1 and alpha(2)-delta2 auxiliary subunits of voltage-gaited calcium channels.

Used to manage pain and provide sedation in neuropathic pain.

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