Lumbosacral Spondylolysis Medication

Updated: Sep 05, 2018
  • Author: Achilles Litao, MD; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Tylenol (acetaminophen) and NSAIDs are the mainstays of pain control in those with lumbosacral spondylolysis (lumbar spondylolysis). Moreover, a short course of narcotic analgesics can help those who are in significant acute pain initially.

Muscle relaxants are overprescribed and have not been demonstrated to be of significant help in this condition.

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Analgesics

Class Summary

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

For the relief of moderate to severe pain, a short course of a narcotic analgesic may be warranted. Opiates exert their effects by binding to different opioid receptors throughout the body, which produces a wide range of effects such as analgesia, euphoria, constipation, and respiratory depression.

Acetaminophen (Tylenol, Feverall, Aspirin-Free Anacin)

Effective analgesic-antipyretic but only has weak anti-inflammatory effects. Inhibits prostaglandin synthetase. Well absorbed from gastrointestinal tract. Peak concentrations in serum are reached within 2 h.

Acetaminophen and codeine (Tylenol #3)

Indicated for the treatment of mild to moderate pain.

Hydrocodone and acetaminophen (Lortab, Lorcet-HD, Vicodin, Norcet)

Drug combination indicated for moderate to severe pain. Available in different strengths.

Hydrocodone and ibuprofen (Vicoprofen)

Drug combination indicated for short-term (< 10 d) relief of moderate to severe acute pain.

Propoxyphene/acetaminophen (Darvocet-N100, Wygesic)

Drug combination indicated for mild to moderate pain.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs 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.

Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)

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

Ibuprofen (Motrin, Ibuprin, Advil)

NSAIDS exert their main therapeutic effect on pain and inflammation principally by inhibition of prostaglandin synthesis.

Mefenamic acid (Ponstel)

Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Ketoprofen (Orudis, Oruvail, Actron)

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

Celecoxib (Celebrex)

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 the lowest dose of celecoxib for each patient.

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Muscle Relaxants

Class Summary

Muscle relaxants are overprescribed and have not been demonstrated to be of significant help in cases of lumbosacral spondylolysis (lumbar spondylolysis).

Methocarbamol/aspirin (Robaxisal)

Used mainly as adjunctive treatment of muscle spasm associated with acute painful musculoskeletal conditions. Causes musculoskeletal relaxation by decreasing impulse transmission from the spinal cord to the muscle.

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