From the Guidelines
High-dose ibuprofen is not recommended for cervical degenerative stenosis due to potential side effects and lack of evidence supporting its long-term efficacy. For mild to moderate pain, standard doses of ibuprofen (400-800mg every 6-8 hours, not exceeding 3200mg daily) can help reduce inflammation and discomfort, as supported by studies such as 1 and 2. However, the use of high-dose ibuprofen is associated with increased risks of gastrointestinal bleeding, kidney problems, and cardiovascular events, as noted in 3.
Key Considerations
- Ibuprofen should be taken with food to minimize stomach irritation
- The medication should not be used for extended periods without medical supervision
- A comprehensive approach to managing cervical stenosis typically includes physical therapy, posture modification, and possibly other pain management strategies
- The medication works by inhibiting prostaglandin production, which reduces inflammation and pain, but it doesn't address the structural narrowing of the spinal canal that characterizes stenosis
Important Risks and Benefits
- Nonselective NSAIDs, such as ibuprofen, are more effective for pain relief than acetaminophen, but are associated with well-known gastrointestinal and renovascular risks, as discussed in 1 and 2
- Clinicians should assess cardiovascular and gastrointestinal risk factors before prescribing NSAIDs and recommend the lowest effective doses for the shortest periods necessary, as recommended in 3
- There is insufficient evidence to recommend for or against analgesic doses of aspirin in patients with low back pain, as noted in 1 and 2
Alternative Treatment Options
- Acetaminophen is a reasonable first-line option for treatment of acute or chronic low back pain due to its more favorable safety profile and low cost, as discussed in 1 and 2
- Opioid analgesics or tramadol are an option when used judiciously in patients with acute or chronic low back pain who have severe, disabling pain that is not controlled with acetaminophen and NSAIDs, as noted in 1 and 2
From the Research
Treatment Options for Cervical Degenerative Stenosis
- The available scientific data are too sparse to enable evidence-based treatment of cervical myelopathy 4.
- Surgical treatment reliably arrests the progression of myelopathy and often even improves the neurological deficits 4.
- Early surgical intervention is often recommended in the literature, but controversy remains regarding the choice of the appropriate surgical procedure 4.
Nonsurgical Treatment
- Nonsurgical treatment is an option for moderate symptoms without neurological deficits 5.
- There is no mention of high dose ibuprofen as a treatment option for cervical degenerative stenosis in the provided studies.
Surgical Treatment
- Surgical decompression of the spinal cord or nerve roots can lead to an improvement of the neurological symptoms 5.
- The primary aim of surgical treatment is to avoid deterioration of the neurological deficits 5.
- Anterior or posterior surgical approaches that effectively decompress the cervical canal promote short-term improvements in outcome 6.
Outcome and Prognosis
- The duration of symptoms, and possibly advancing age, negatively affect outcome in patients with cervical spondylotic myelopathy (CSM) 6.
- Electromyographic abnormalities and the presence of radiculopathy are predictive of the development of myelopathy in minimally symptomatic patients with cervical stenosis and spinal cord compression 6.