This Page Intentionally Left Blank - Int Medical

Neck and back pain – spinal spondylitic
syndromes
MICHAEL WALTA AND STEPHEN H. THOMAS
n Agents
n NSAIDs
n Opioids
n Tricyclic antidepressants
n Antiepileptics
n Corticosteroids
n Evidence
In this chapter, neck and back pain from spinal stenosis, intervertebral disk
disease, or arthritis is grouped into the category of spinal spondylitic syndromes
(SSS). Acute care provider familiarity with treating SSS pain is
important. Only half of medically managed patients achieve adequate outpatient
analgesia, and there is little evidence to support surgical intervention
for the sole purpose of obtaining pain relief. 1–4 Injection therapy (into
the facet joint, epidural space, or locally) has little supporting evidence for
use in SSS. 5
Despite scant evidence support for their use in SSS, NSAIDs are frequently
used to treat pain from these disorders. Recommendation for NSAID use in
SSS, after acetaminophen (paracetamol) has failed, is based upon a presumed
inflammatory component to the pain. 6,7 Since Cochrane review provides
inconclusive evidence of NSAIDs’ overall efficacy in spinal pain
syndromes, and since patients with SSS tend to be relatively older and
more susceptible to NSAID side effects, NSAIDs should be used with caution
in SSS. 8 However, NSAIDs’ common use with anecdotal success for some
patients with SSS means that the acute care clinician should keep this class in
mind for occasional use. COX-2 selective NSAIDs (the risks of which are
addressed in the chapter on Arthritis) have not been studied in SSS. These
agents appear to have little role in acute care management of SSS.
273