Therapeutic target
- Pain relief in acute/subacute cervical spine syndrome.
Therapy recommendations
- Analgesia (pain relief) according to WHO staging scheme:
- Non-opioid analgesic (paracetamol, first-line agent).
- Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic.
- High-potency opioid analgesic (eg, morphine) + non-opioid analgesic.
- If necessary, also antiphlogistics / drugs that inhibit inflammatory processes (ie, non-steroidal anti-inflammatory drugs, NSAID), eg, ibuprofen.
- For acute neck pain associated with muscle spasms: use of muscle relaxants/medications that relax the muscles, local anesthetics (local anesthesia).
- In radiculopathy (chronic or acute irritation or damage to a nerve root): glucocorticoids; the effect of intraarticular (“into the joint cavity”) injection is not certain. Note: In patients with myelopathy (damage to the spinal cord) or radiculopathy, surgical intervention is likely to be more effective than nonsurgical intervention in the short term.
- See also under “Other therapy.”
Further notes on muscle relaxants
- A prescription ban has been in place for tetrazepam since August 2013 due to serious skin reactions such as Stevens-Johnson syndrome or erythema multiforme.
- Red-hand letter: tolperisone is approved only for the treatment of post-stroke spasticity in adults. Outside of this approved indication, for example, there is a risk of hypersensitivity reactions (up to and including anaphylactic shock, with no proven benefit.
