Therapy goals
- Analgesia (pain relief)
- Restitutio ad integrum (complete healing).
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.
- Muscle relaxants (eg, tolperisone) for painful muscle tension.
- Antidepressants (eg amitriptyline) or even lidocaine (per trigger point) i. m. in the area of the neck muscles – as pain-modeling medication in chronicity.
* 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) without proven benefit.
Further recommendations [S1 Guideline]
- Methylprednisolone (within 8 hours, 30 mg/kg bw as a bolus plus 5.3 mg/kg bw over 23 hours i. v.) (exceptional)
