From the Guidelines
The treatment regimen prescribed for this 43-year-old male with cervical radiculopathy and heartburn appears appropriate, with a short course of prednisone, methocarbamol, and famotidine addressing both the neurological pain and muscle tension while protecting the gastrointestinal system. The short course of prednisone 40 mg every morning for 5 days will help reduce inflammation around the cervical nerve roots causing the shooting arm pain, as supported by the expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1. Methocarbamol 1000 mg three times daily as needed for 14 days provides muscle relaxation to alleviate muscle spasms contributing to the cervicalgia. Famotidine 20 mg every morning addresses the heartburn symptoms and also helps prevent gastric irritation that could be caused by the prednisone.
For optimal results, the patient should complete the full prednisone course without stopping early, take the methocarbamol as needed for muscle tension, and consider physical therapy after the acute pain subsides. Heat or ice application to the neck may provide additional relief, and the patient should avoid activities that worsen symptoms. If symptoms don't improve within two weeks, further evaluation including imaging may be warranted to rule out more serious cervical pathology, as recommended for patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis 1.
It is also important to note that systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, but in this case, the short course of prednisone is aimed at reducing inflammation around the cervical nerve roots, which is a different condition 1. The patient's response to the treatment should be closely monitored, and adjustments made as necessary to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Gastric irritation may be reduced if taken before, during, or immediately after meals or with food or milk. The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT 3 Symptomatic Gastroesophageal Reflux Disease (GERD) Orally-administered Famotidine was compared to placebo in a U. S. trial that enrolled patients with symptoms of GERD and without endoscopic evidence of esophageal erosion or ulceration. As shown in Table 6, patients treated with Famotidine 20 mg twice daily had greater improvement in symptomatic GERD than patients treated with 40 mg at bedtime or placebo
The patient is being prescribed prednisone 40 mg every morning for 5 days, which is within the recommended dosage range of 5 mg to 60 mg per day, depending on the specific disease entity being treated 2. The patient is also being prescribed methocarbamol 1000 mg three times a day as needed for 14 days, but there is no information in the provided drug labels about methocarbamol. The patient is being prescribed Famotidine 20 mg every morning, which may not be the most effective dosage for symptomatic GERD, as the trial showed that patients treated with Famotidine 20 mg twice daily had greater improvement in symptomatic GERD than patients treated with 20 mg once daily or 40 mg at bedtime 3. Key points to consider in the treatment of this patient include:
- The dosage of prednisone is within the recommended range, but the specific disease entity being treated is not specified.
- The patient is experiencing heartburn, and Famotidine 20 mg twice daily may be more effective than 20 mg once daily.
- The patient is being prescribed methocarbamol, but there is no information in the provided drug labels about this medication.
- Gastric irritation may be reduced if prednisone is taken with food or milk.
- Dosage adjustments may be necessary based on the patient's response to treatment and the specific disease entity being treated.
From the Research
Diagnosis and Treatment of Cervical Radiculopathy
The patient's symptoms of shooting pain down the right arm and cervicalgia (cervical spine pain) are consistent with cervical radiculopathy, which is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine 4, 5. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis.
Non-Surgical Treatment Options
Non-surgical treatments are recommended as an initial management for cervical radiculopathy, and may include:
- Medications such as prednisone to alleviate symptoms and manage pain 5, 6
- Muscle relaxants such as methocarbamol to relieve muscle spasm 6, 7
- Physical therapy involving strengthening, stretching, and potentially traction 6, 7
- Nonsteroidal anti-inflammatory drugs to reduce pain and inflammation
Treatment of Heartburn
The patient's complaint of heartburn can be treated with medications such as Famotidine, a histamine-2 (H2) blocker that reduces stomach acid production.
Imaging Studies
Imaging studies such as x-ray, computed tomography, or magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis and identify the underlying cause of cervical radiculopathy 4, 5, 8. In this case, an x-ray of the cervical spine has been requested.
Key Points to Consider
- Cervical radiculopathy is a common condition that can cause neck and arm pain, sensory loss, motor dysfunction, and reflex changes 4, 5
- Non-surgical treatments are often effective in managing symptoms and improving function 5, 6, 7
- Imaging studies can help confirm the diagnosis and identify the underlying cause of cervical radiculopathy 4, 5, 8
- Treatment should be individualized based on the patient's specific symptoms, medical history, and response to treatment 4, 5, 8