From the Guidelines
The most effective approach to managing neck, shoulder, head, and back pain associated with degenerative disc disease (DDD) and spondylosis involves a combination of non-pharmacologic and pharmacologic therapies, with a focus on remaining active and using evidence-based self-care options. According to the American College of Physicians and the American Pain Society 1, patients with acute or subacute low back pain should be advised to remain active, as this is more effective than resting in bed.
Non-Pharmacologic Therapies
- Physical therapy focusing on neck and back strengthening exercises is crucial, aiming for 2-3 sessions weekly for 6-8 weeks.
- Daily gentle stretching and proper posture maintenance can significantly reduce pain.
- Heat therapy (15-20 minutes, 3-4 times daily) helps relax muscles, while cold packs (15 minutes every 2-3 hours) reduce inflammation during flare-ups.
- Lifestyle modifications including weight management, ergonomic workspace setup, and avoiding prolonged sitting are essential.
Pharmacologic Therapies
- Over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) can be used for inflammation and pain relief.
- For persistent pain, prescription medications like muscle relaxants (cyclobenzaprine 5-10mg) or gabapentin (starting at 300mg daily) may be prescribed.
Imaging and Interventional Options
- For patients who do not improve with self-care options, imaging with MRI or CT may be considered to identify potential actionable pain generators 1.
- If pain persists despite these measures, consult a specialist about interventional options like epidural steroid injections or advanced treatments.
It's essential to note that the evidence for these recommendations is based on moderate-quality evidence, and the benefits of different therapies may vary from small to moderate. However, remaining active and using evidence-based self-care options is the most effective approach to managing pain from DDD and spondylosis.
From the FDA Drug Label
In three of these studies there was a significantly greater improvement with cyclobenzaprine than with diazepam, while in the other studies the improvement following both treatments was comparable The efficacy of cyclobenzaprine hydrochloride tablets 5 mg was demonstrated in two seven-day, double-blind, controlled clinical trials enrolling 1405 patients. Analysis of the data from controlled studies shows that cyclobenzaprine produces clinical improvement whether or not sedation occurs. Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain.
The treatment options for managing neck, shoulder, head, and back pain associated with degenerative disc disease (DDD) and spondylosis include:
- Cyclobenzaprine: 5 mg to 10 mg, three times a day, as it has been shown to produce clinical improvement in patients with musculoskeletal conditions 2
- Ibuprofen: 400 mg every 4 to 6 hours as necessary for relief of pain, for mild to moderate pain 3
From the Research
Treatment Options for Degenerative Disc Disease (DDD) and Spondylosis
The treatment options for managing neck, shoulder, head, and back pain associated with DDD and spondylosis include:
- Conservative management strategies, such as non-narcotic and narcotic pain medications, epidural steroid injections, transforaminal injections, and physical therapy 4
- Surgical management, including decompression and/or fusion, for patients who fail conservative management strategies 5, 4
- Physical rehabilitation with active patient participation, including physical therapy, occupational therapy, and kinesitherapy, to improve muscle strength, endurance, and flexibility 6
- Disc surgery, if surgical intervention is required 6
Conservative Treatment
Conservative treatment consists of:
- Rest
- Physical therapy
- Pharmacological therapy
- Injection therapy, including epidural corticosteroid injections, which can provide significant but temporary pain relief 7
- Intradiscal steroid injections, which can lead to significant improvement in patients with inflammatory end-plate changes 8
Surgical Treatment
Surgical treatment is indicated when conservative treatment fails, and may include:
- Decompression, for central and lateral stenosis, and disc herniation 5
- Fusion, for lytic and degenerative spondylolisthesis, after facetectomy, and in some cases of scoliosis 5
- Simple degenerative disc disease, in the absence of herniation, nerve compression, or instability, is not an indication for surgery 5
Risks and Complications
There are risks and complications associated with treatment options, including: