Medication Summary
Medications are used to minimize pain and inflammation. In the early phase of a disc herniation, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended. If NSAIDs are not effective, a tapering course of steroids, such as with methylprednisolone, can be used to try to minimize the inflammatory process. In cases of severe pain, narcotics can be used in the acute phases; if pain has become a chronic problem, narcotics then become the primary modality for pain control. Muscle relaxants can be utilized to potentiate the effectiveness of NSAIDs, narcotics, or steroids.
Nonsteroidal anti-inflammatory drugs
Class Summary
NSAIDs are used to decrease the inflammatory process that is involved in disc herniation and nerve root irritation; furthermore, NSAIDs can help to decrease the pain that is associated with disc herniation.
Ibuprofen (Motrin, Ibuprin)
Drug of choice (DOC) for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Naprosyn, Anaprox, Naprelan)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Diclofenac (Voltaren)
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors.
Celecoxib (Celebrex)
Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme; it is 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.
Corticosteroids
Class Summary
Corticosteroids are potent anti-inflammatory agents that are used to relieve inflammation of the nerve roots and surrounding tissue.
Prednisone (Deltasone, Meticorten, Orasone)
May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity.
Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Muscle relaxants
Class Summary
Muscle relaxants reduce muscle spasms in the paraspinal muscles.
Carisoprodol (Soma)
Short-acting medication that may have depressant effects at the spinal cord level.
Cyclobenzaprine (Flexeril)
Skeletal muscle relaxant that acts centrally and reduces the motor activity of tonic somatic origins that influence both alpha and gamma motor neurons.
Structurally related to tricyclic antidepressants and, thus, carries some of their same risks.
Narcotic analgesics
Class Summary
Narcotic analgesics are used for short-term pain control.
Hydrocodone and acetaminophen (Vicodin, Lortab, Norcet)
Drug combination indicated for short-term (< 10 d) relief of moderate to severe acute pain.
Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)
Drug combination indicated for the relief of moderate to severe pain.
