Neck pain is one of the main symptoms of cervical disc disease, in which discs between vertebrae become herniated or deteriorate, sometimes pinching nerves.
Several different drugs, from pain relievers to anti-inflammatory drugs such as steroids, can help ease your neck pain while you heal. Depending on the extent of your neck pain and the type of cervical disc disease, you can either take these medications alone or use them together with physical therapy or other treatments.
Drugs typically used to treat cervical disc disease include:
Acetaminophen (Tylenol). Acetaminophen is usually among first-line drug treatments for pain. It can help with neck pain, but don't fall under the common misperception that acetaminophen is completely harmless just because it's readily available over-the-counter. Research shows that regular acetaminophen use can damage the liver, even in people who take the drug at the recommended dose. To make sure you're using acetaminophen as safely as possible, follow the directions carefully and don't take any more than the label suggests and your doctor recommends.
Avoid using alcohol while taking acetaminophen to minimize the risks to your liver. Also, acetaminophen could be an ingredient in some other over-the-counter medications you may be taking. Look at all drug labels to be sure you're not taking too much acetaminophen.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen (Motrin, Advil) and naproxen (Aleve) are staples in the treatment of cervical disc disease because they reduce both pain and inflammation. Like acetaminophen, many NSAIDs are available over-the-counter, but they also need to be taken carefully. NSAIDs can have some serious side effects, such as gastrointestinal bleeding, ulcers, and kidney damage, especially when used for long periods of time. NSAIDs have also been linked to an increased risk of heart attack or stroke.
Select Cox-2 inhibitors are a newer generation of NSAIDs that are available by prescription and may have fewer digestive side effects, but can also increase risk for heart attack or stroke.
It's important to read the labels carefully and never exceed the doctor's recommended dose. You'll also want to avoid taking NSAIDs together with certain other medications because of the possibility of drug interactions. Talk to your doctor about all the drugs you take. Be especially cautious about taking NSAIDS if you are over 65, and/or you have kidney problems.
Your doctor will make the decision as to whether to put you on an NSAID after weighing the benefits against the risks.
Narcotic painkillers. Because of their increased risks, opioids are not a first-line therapy for pain. Opioids such as codeine (contained in Tylenol with codeine), hydrocodone (contained in Vicodin and Lortab), and oxycodone (such as OxyContin, and contained in Percocet and Percodan) can provide significant relief when neck pain is particularly intense and other non-narcotic pain medications aren't sufficient for pain relief. So can tramadol, a narcotic-like analgesic. Although opioids are effective for pain, they should be used with caution because they can lead to drowsiness, nausea, constipation, and depressed breathing. These prescription painkillers also have the potential for abuse and addiction. Narcotic painkillers are best used over the short term (one to two weeks) and under your doctor's guidance.
Steroids. Steroids such as prednisone (Deltasone, Orasone, Sterapred) work by reducing inflammation. Although they can be taken orally, steroids given for neck pain are sometimes delivered directly to the spine via an injection to the area. Research shows that steroid injection does relieve neck pain over the short term, although its effectiveness for chronic pain is unclear. The most common side effects of short-term oral steroids are an increase in blood sugars, water retention and stomach ulcers. For the epidural, the risks are infection, headache, and bleeding. Side effects of oral steroids, which are not generally used, include weight gain, and, less often, high blood pressure and osteoporosis.
Muscle Relaxants. Baclofen and other muscle relaxants calm muscle tightness, and some research suggests they can relieve neck pain within the first few days of an acute injury. When using these drugs, watch out for side effects such as drowsiness, dependence, and urinary retention. These drugs are best used short term under a doctor's guidance.
Anticonvulsants. Although they are approved by the FDA to treat seizures, anticonvulsant drugs such as gabapentin (Neurontin), carbamazepine (Tegretol), and pregabalin (Lyrica) may help with nerve-related neck pain. How exactly anticonvulsants work on neck pain is unknown, but they are believed to affect the way the brain perceives pain. Side effects include dizziness, sleepiness, vision problems, and vomiting. Patients who take these drugs may be at a greater risk of having thoughts or actions of suicide. The risk may be greater in people who have had these thoughts or actions in the past. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur.
Tricyclic Antidepressants. TCA are used off-label to treat chronic pain, especially nerve pain. Examples include amitriptyline and nortriptyline may help with chronic pain and with sleep. It may take several weeks to see an effect. Side effects include drowsiness, dry mouth, constipation, and urinary retention.