Pars Interarticularis Injury Medication

Updated: Jan 22, 2019
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

Medications recommended for the treatment of pain in spondylolysis include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants. Before prescribing these medications, review the contraindications, adverse side effects, and mode of action.

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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 NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may include leukotriene synthesis inhibition, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation and various cell membrane functions.

Ibuprofen (Ibuprin, Motrin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. The anti-inflammatory dose is higher than the analgesic dose. Newer generation NSAIDs have a lower risk of gastrointestinal risk because they selectively interact with COX–2 receptors. Prolonged use of the medication is generally not recommended.

Celecoxib (Celebrex)

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced by 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.

Naproxen (Naprosyn, Naprelan, Anaprox)

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.

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Muscle Relaxants

Class Summary

Muscle relaxants help to relax tight muscles and can be used in conjunction with NSAIDs.

Cyclobenzaprine (Flexeril)

Muscle relaxants may be helpful in some patients with LBP and seem to have additional benefits when used in conjunction with NSAIDs. Muscle relaxants can be used as short-term adjunctive medications and should be taken hs to take advantage of their sedating side effects.

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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 have sustained trauma or who have sustained injuries.

Acetaminophen (Tylenol, Feverall, Tempra)

Offers pain relief without the increased risk of bleeding for patients with contraindications to the use of NSAIDs.

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