Do not consider starting patients on medications unless they will definitely obtain good follow-up
First line medication options (all have NNT from ~2-3 or better)
Antiepileptics - gabapentin, topiramate
TCAs - amitriptyline, nortriptyline
Duloxetine (especially if TCAs contraindicated)
Pregabalin
NSAIDs and Tylenol
Second line medications (temporary relief, not long term)
Tramadol
Muscle relaxants - cyclobenzaprine, methocarbamol, diazepam
Refer to pain specialist for multidisciplinary approach
Pain specialists can offer (discussion with patient in ED):
Injections - trigger point, epidural steroid injections, facet injections, medial branch blocks, joint steroid injections
Radiofrequency ablations
Spinal implants
Determination of long-term opioids
Pain psychology
Spinal manipulation
Lifestyle changes
Weight loss
Sobriety, reduction of polypharmacy, smoking cessation
Exercise, avoidance of bed rest, core strengthening
Antiepileptics - gabapentin, topiramate
TCAs - amitriptyline, nortriptyline
Duloxetine (especially if TCAs contraindicated)
Pregabalin
NSAIDs and Tylenol
Tramadol
Muscle relaxants - cyclobenzaprine, methocarbamol, diazepam
Injections - trigger point, epidural steroid injections, facet injections, medial branch blocks, joint steroid injections
Radiofrequency ablations
Spinal implants
Determination of long-term opioids
Pain psychology
Spinal manipulation
Weight loss
Sobriety, reduction of polypharmacy, smoking cessation
Exercise, avoidance of bed rest, core strengthening
Neuropathic pain
Myalgia
Axillary neuropathy
Autonomic dysreflexia
Meralgia paresthetica
Peripheral nerve syndromes
Venous stasis
Back pain 