From the Guidelines
For a patient with cervical radiculopathy in the ED, I would prescribe a short course of gabapentin, as it is associated with small, short-term benefits in patients with radiculopathy. This recommendation is based on the study by 1, which suggests that gabapentin has not been directly compared with other medications or treatments, but it has shown some benefits in patients with radiculopathy. Some key points to consider when prescribing gabapentin for cervical radiculopathy include:
- Starting with a low dose and titrating up as needed to minimize side effects
- Using gabapentin in conjunction with other treatments, such as physical therapy or activity modification, to help manage symptoms
- Monitoring patients for potential side effects, such as dizziness or drowsiness, and adjusting the dose or discontinuing the medication as needed
- Considering alternative treatments, such as oral NSAIDs or muscle relaxants, for patients who do not respond to gabapentin or who have contraindications to its use. It's also important to note that benzodiazepines, such as those used for muscle relaxation, should be used with caution and only for a time-limited course of therapy due to the risks of abuse, addiction, and tolerance, as mentioned in the study by 1. Additionally, systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo, according to the study by 1. Overall, the goal of treatment for cervical radiculopathy is to reduce pain and inflammation, while also promoting activity modification and gentle range of motion exercises to help manage symptoms and improve quality of life.
From the Research
Short Course Prescription for Cervical Radiculopathy in the Emergency Department (ED)
- A short course of oral steroid therapy with prednisolone can be effective in reducing pain in patients with uncomplicated cervical radiculopathy 2
- The prescription may include prednisolone 50 mg/day for 5 days, tapered within the following 5 days, in addition to acetaminophen and ranitidine 2
- Nonoperative treatment, including physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage, can also be considered 3, 4
- Epidural steroid injections may be helpful but have higher risks of serious complications and are not considered a first-line treatment 3, 4, 5
- A multimodal approach to treatment, including medications, physical therapy, and guided corticosteroid injections, may help patients improve 6
- Patients should be reassured that most cases of cervical radiculopathy will resolve regardless of the type of treatment 3, 4
Key Considerations
- Diagnosis of cervical radiculopathy can be made with a thorough history and physical examination, and confirmed with magnetic resonance imaging (MRI) or computed tomographic myelogram if necessary 3, 4, 6
- Patients with red flag symptoms or persistent symptoms after four to six weeks of treatment may require further evaluation and consideration of alternative treatments 3, 4