Is dexamphetamine (dextroamphetamine) associated with back and neck pain?

Dextroamphetamine's Association with Back and Neck Pain

Dextroamphetamine can cause back and neck pain through muscle stiffness and pain as a side effect, though in rare cases it may paradoxically help relieve certain types of chronic pain through its sympathomimetic effects.

Dextroamphetamine and Muscle Pain

• Dextroamphetamine and other methylphenidates can cause severe muscle pain and stiffness as a side effect 1
• These medications stimulate adrenergic receptors directly as agonists and indirectly cause the release of dopamine and norepinephrine from presynaptic terminals, which can affect muscle tone 2
• Common side effects of dextroamphetamine include jitteriness and hyperactivity, which may contribute to muscle tension and subsequent pain 2

Documented Cases of Dextroamphetamine-Related Pain

• Case reports have documented severe muscle pain associated with dexmethylphenidate (a related compound to dextroamphetamine) 1
• There is a documented case of rhabdomyolysis (severe muscle breakdown) in a patient taking dextroamphetamine who engaged in intense physical exercise, which resulted in severe low back pain 3
• The American Society of Anesthesiologists guidelines for chronic pain management do not include dextroamphetamine as a recommended treatment for back or neck pain 2

Paradoxical Pain Relief in Specific Cases

• Interestingly, some case reports suggest that dextroamphetamine may actually help relieve certain types of chronic pain in specific circumstances:
  • One case report documented relief of chronic back pain and sciatica with dextroamphetamine sulfate (25 mg twice daily) when conventional treatments including surgery had failed 4
  • Another case showed improvement in fibromyalgia pain with dextroamphetamine sulfate extended release (25 mg daily) 5
  • These cases suggest that in some patients with sympathetic nervous system hypofunction, dextroamphetamine may provide pain relief 4, 6

Clinical Implications

• Dextroamphetamine is not recommended as a standard treatment for back or neck pain in any major pain management guidelines 2
• For back and neck pain, guidelines recommend:
  • NSAIDs as first-line pharmacological treatment for acute and chronic low back pain 2, 7
  • Muscle relaxants like tizanidine (not dextroamphetamine) for short-term relief 8, 7
  • Gabapentin for radicular pain 8
  • Tricyclic antidepressants for chronic low back pain 2, 7

Monitoring and Considerations

• If a patient on dextroamphetamine reports new or worsening back or neck pain, consider:
  • Evaluating for muscle stiffness or tension as a medication side effect 1
  • Assessing for rhabdomyolysis if pain is severe, especially if combined with intense physical activity 3
  • Dose reduction or medication change if symptoms persist 2
• The rare cases where dextroamphetamine helped pain appear to be exceptions rather than the rule, and should not guide standard practice 4, 6, 5

Conclusion

While dextroamphetamine is more commonly associated with causing rather than relieving back and neck pain, individual responses may vary. For standard management of back and neck pain, evidence-based approaches using NSAIDs, appropriate muscle relaxants, anticonvulsants, or antidepressants should be prioritized according to established guidelines 2, 8, 7.