Neck and back pain – mechanical strain

Summary

This chapter separates mechanical strain spinal pain (MSSP) from neck and back pain of other etiologies (e.g. spondylosis, radiculopathy), as there are different therapeutic approaches. The NSAIDs are the mainstay of therapy for non-radiating mechanical back pain, and by extrapolation of evidence from back pain studies, for neck strain. Opioids are the preferred treatment for MSSP in patients who have not responded to, or who cannot take, NSAIDs. Muscle relaxants are often prescribed for sprains and strains of the neck and back. Commonly used muscle relaxants include cyclobenzaprine, orphenadrine, metaxolone, methocarbamol, carisoprodol, and chlorzoxazone. Benzodiazepines have skeletal muscle-relaxing properties, and so this class (most notably diazepam) is occasionally prescribed for MSSP. Trigger point injection with local anesthetics is occasionally effective for some patients with neck or back pain, but injection therapy for MSSP has been insufficiently studied to recommend its routine use.