Question

All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The midlevel provider orders a physical therapy (PT) consult to develop a home stretching and back-strengthening exercise program and a dietary consult for weight reduction. J.C. is given prescriptions for cyclobenzaprine (Flexeril) 10 mg tid prn ×3 days only, and celecoxib (Celebrex) 100 mg/day for 3 months. He receives the following instructions: ice packs to the lower back for 20 minutes every hour, no twisting or unnecessary bending, and no lifting more than 10 pounds. J.C. is instructed to rest his back for 1 or 2 days, getting up only now and then to move around to relieve muscle spasms in his back and strengthen his back muscles. He is given an excuse to stay off work for 5 days only, and he is instructed to return to the emergency department (ED) if he gets worse.

4. Why do you think that cyclobenzaprine was prescribed instead of carisoprodol or diazepam?

What points would you include when teaching the patient about muscle relaxants?

5. A PT teaches the patient maintenance exercises he can do on his own to promote back health. Identify two common exercises that would be included.

6. What is celecoxib, and how does it work? What advantage does this medication have over the “older” NSAIDs? Why would the patient want to use an NSAID rather than acetaminophen for pain?

7. In addition to medications what other interventions could the patient do for his back pain?

Answer 1

1. Cyclobenzaprine is used because that acts as a muscle relaxant that may be used for short-term to treat muscle spasms caused by musculoskeletal conditions, as well as to rest and physical therapy. Whereas the other two drugs gives a relief for a very short duration, lack efficacy and has more side effects as compared to cyclobenzapine.

2. These muscle relaxant is used to get relieve from muscle spasm. There are numerous conditions which results in muscle spasm like sclerosis, motor neuron diseases. These spasm may results due to long term injuries as well as short term injuries.

These act as a medicine which lowers spasm and tightness.

3. Two common exercises would be -

1. Passive physical therapy

2. Active physical therapy

4. Celecoxib acts as a nonsteroidal anti-inflammatory drug. It's known mechanism is they reduces hormones which cause inflammation and pain in the body. It is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain.

Nsaids is considered to be more effective than acetaminophen for certain conditions because they reduce inflammation as well as relieve pain. Acetaminophen is more effective for mild pain and easy on the stomach.

Exercises and self management could be done other than taking medication to get relieve from pain.