Medication management of axial LBP

clubdeac said:

Other than opioids, just curious what meds you all are using for axial low back pain and have had success with. I usually try some neurontin and pamelor but rarely see much improvement. Any AEDs, TCAs, SNRIs etc that you have had good success with for this common problem. I usually don't use muscle relaxers much if you've had good success with any of them I'd be interested. Danke schoen

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I don't know how neurontin or pamelor would help for axial back pain... I use mobic, skelaxin, robaxin, tramadol

just really high doses of oxyxontin 6 times aday. From what patients tell me, this seems to be most effective...

NFW

Nothing freakin works

I assume axial is nociceptive most of the time. I use tylenol, NSAIDs, tramadol primarily, although I've got a couple patients that are trying Cymbalta due to the new indication. Topicals like Flector patch and Voltaren gel, or even Lidoderm patches.

I avoid muscle relaxers, as they generally have no effect on muscle and patients are often taking them for their sedative properties, whether they realize it or not.

what about the axial back pain where the patient screams/hollers/falls to the floor in tears just before you touch the skin of their back?

Ah yes, the dreaded aura of allodynia.

i find that when I titrate gabapentin/pregabalin or Cymbalta up to 600-900 tid or 60 mg qd and leave it there for a few weeks the patients often feel it didn't work. I tell them to taper slowly and see if the pain returns and I get a lot more positive hits. "I guess it was making a difference after all" and the patient stays on it.

After than, IT Dilaudid at 4 mg per day seems to do the trick.

Pain_doc said:

Ah yes, the dreaded aura of allodynia.

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That made me laugh.

drf said:

i find that when I titrate gabapentin/pregabalin or Cymbalta up to 600-900 tid or 60 mg qd and leave it there for a few weeks the patients often feel it didn't work. I tell them to taper slowly and see if the pain returns and I get a lot more positive hits. "I guess it was making a difference after all" and the patient stays on it.

After than, IT Dilaudid at 4 mg per day seems to do the trick.

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chymopapain ID q 12 months.

I also saw a case of axial back pain with severe allodynia. She is 13 y/o feamle with h/o some viral illness before her backache. I have put her on NSAIDS, Gabapantin 100 mg BD and a pulse therapy of steroids, hope she will be better.

Tenesma said:

what about the axial back pain where the patient screams/hollers/falls to the floor in tears just before you touch the skin of their back?

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guarding = perforated facet joint