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Neck and back pain – mechanical strain
MICHAEL TURTURRO
n Agents
n NSAIDs
n Opioids
n Skeletal muscle relaxants
n Benzodiazepines
n Corticosteroids
n Local anesthetics
n Evidence
Because of different therapeutic approaches, this text separates mechanical
strain spinal pain (MSSP) from neck and back pain of other etiologies
(e.g. spondylosis, radiculopathy). There may be some overlap in presentation,
so referral to other chapters of this text addressing neck and back pain
may be useful.
The NSAIDs are the mainstay of therapy for nonradiating mechanical
back pain, and also – by extrapolation of evidence from back pain
studies – for neck strain. 1–4 Cochrane review of the relevant evidence
(from over 50 trials) addressing MSSP pain relief concluded that NSAIDs
are probably more effective than placebo; there is conflicting evidence
as to whether NSAIDs are consistently better than other MSSP treatment
alternatives. 4
There are good data supporting a contention that there are no differences
in the analgesic efficacies of the different NSAIDs for MSSP. 4 In most cases,
because of its wide availability and low cost, ibuprofen (600 mg PO QID or
800 mg PO TID) is a reasonable first-line therapy.
Opioids are the preferred treatment for MSSP in patients who have not
responded to, or who cannot take, NSAIDs. Although RCTs have not specifically
evaluated opioid therapy for MSSP, support for their use can be
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