MEDICATIONS

The aim of medications is to help with pain and reduce/eliminate inflammation that might be contributing to your symptoms.  The typical medications that Dr. Garala prescribes are discussed below, however there are others that you might benefit from as well.

Anti-inflammatory Medications

Medrol Dosepak: This is a steroid taper that is typically taken over the course of six days.  It is a strong oral anti-inflammatory medication.  There may be contraindications of taking this medication if someone has diabetes, osteoporosis, or GI ulcer. 

NSAIDS (non-steroid antiinflammatory drugs): Naproxen, Meloxicam, Diclofenac, Celebrex, Aleve, or Ibuprofen are just a few examples of medications you can take.  They do not have as strong of an anti-inflammatory effect as a medrol dosepak, but may be better tolerated.  People with heart disease, stroke, renal disease, high blood pressure, GI ulcers and/or those who are on a blood thinner should discuss with Dr. Garala if this medication is right for them.

There are times that Dr. Garala will prescribe both a Medrol dosepak as well as an NSAID.  A patient should take the steroid taper first and then the NSAID afterwards.  They should not be taken together because of the increased risk of developing a GI ulcer.  If prescription strength NSAIDs are taken, over-the-counter (OTC) Advil or Aleve should not be taken as well (they are redundant, don’t provide an additive effect, and increase the risk of a stomach ulcer).

OTC Pain Medications/Measures

Acetaminophen (Tylenol): This medication can help with pain  without having an anti-inflammatory effect on the body.  If you do not have an underlying liver disease, the maximum dosage in a day is three grams.  Extra Strength Tylenol comes in 500 mg tablets.  You can theoretically take two tablets every eight hours if necessary to help with your pain.  This medication can be taken in conjunction with either a Medrol dosepak or NSAIDs.  It can also be taken by itself.

OTC lidocaine patches: These are topical pain patches that can be applied to an affected muscle area that is painful, especially if there is superficial discomfort.

Icing/Heating: Applying either a cold compress or a heating pad to the affected area can help with pain.  Patients can alternate between the two if they find it helps more.  Either of these modalities can be applied for 20 minutes at a time.  Make sure to monitor for any skin changes (irritation, burn) that can occur if left on the skin for too long.

Muscle Relaxants

There are many muscle relaxants on the market.  Dr. Garala typically prescribes Cyclobenzaprine (Flexeril).  There is much to be learned about the way muscle relaxants work.  There is a theory that they work more at the central level (brain and spinal cord level) than at the muscle level.  One of the side effects of the medication is sedation.  As a result, if a patient has difficulty sleeping at night because of pain, a muscle relaxant may help the patient sleep.  There may be potential interactions with other medications, specifically for anxiety/depression.  Please let Dr. Garala know all of the medications that you are currently taking to reduce the risk of any interactions.

Opioids

Tylenol #3, Tramadol, Norco, and Percocet are examples of strong pain medications.  Unfortunately, they belong to the class of medications for which there is an epidemic in this country.  Their prescriptions are not typical first line treatment, however if written for, they should be taken only for a short period of time and only for severe pain.  Opioids have many adverse effects, such as sedation, confusion, nausea, constipation, respiratory depression, tolerance, dependence, and potential for abuse.  They should not be taken when operating heavy machinery or when driving. 

Typical prescription recommendation for severe neck or low back pain (without any significant medical contraindication) and ONLY IF advised by Dr. Garala:

  1. Take the Medrol dosepak as directed over the course of six days.  The following day after finishing the dosepak, begin to take one tablet of 500 mg naproxen twice a day with food.
  2. Take two tablets of extra strength Tylenol every six-eight hours for additional pain control irrespective of when you take either the Medrol dosepak or Naproxen.  
  3. If your pain is localized to a region (i.e. neck or low back), you can apply an OTC lidocaine patch to the affected area on a daily basis.
  4. If you have problems sleeping at night secondary to your pain, take one-two tablets of five mg (or 10 mg) of cyclobenzaprine (Flexeril) at bedtime.