From the Guidelines
Ariana Gomez should be referred to physical therapy for her persistent neck and back pain following the motor vehicle accident, as this approach is associated with small to moderate benefits for patients with low back pain, as noted in studies such as 1 and 1. She should also pick up and begin taking the prescribed muscle relaxant as directed, while continuing with over-the-counter pain management using Tylenol (acetaminophen) and/or ibuprofen as needed. The recommended dosing for Tylenol is 650-1000mg every 6 hours as needed (not exceeding 3000mg daily), and for ibuprofen 400-600mg every 6 hours with food (not exceeding 2400mg daily). Some key points to consider in her treatment include:
- Application of heat or ice to the affected areas for 15-20 minutes several times daily may provide additional relief.
- Given her difficulty carrying her infant, she should be instructed on proper body mechanics when lifting and holding her baby to avoid exacerbating her injuries.
- Physical therapy will be beneficial in addressing her musculoskeletal pain through targeted exercises, manual therapy, and education on proper posture and body mechanics.
- The absence of neurological symptoms (numbness, tingling, weakness) and bowel/bladder issues is reassuring, suggesting this is likely a soft tissue injury without nerve involvement. However, if symptoms worsen or neurological symptoms develop, she should seek immediate medical attention as imaging studies may become necessary, as suggested by studies such as 1 and 1. It's also important to note that while medications like gabapentin and opioids may be considered for some patients with low back pain, the evidence for their effectiveness is limited, and they should be used with caution, as noted in studies such as 1. Overall, a multidisciplinary approach that includes physical therapy, education on proper body mechanics, and careful management of pain and other symptoms is likely to be the most effective way to manage Ariana's condition and improve her quality of life.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions The patient was prescribed a muscle relaxer, likely cyclobenzaprine, for neck and back pain after a motor vehicle accident.
- Indication: The patient's condition, muscle spasm associated with acute, painful musculoskeletal conditions, matches the indication for cyclobenzaprine.
- Use: Cyclobenzaprine should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available. The patient has not yet started taking the medication, but it may be beneficial for relief of muscle spasm associated with her condition 2.
From the Research
Patient Presentation and History
- Ariana Gomez, a 37-year-old female, presents with neck and back pain after a motor vehicle accident (MVA) where she was a restrained passenger.
- The patient denies airbag deployment, loss of consciousness (LOC), or hitting her head, but endorses neck and back pain.
- No imaging was done at the initial ER visit, and the patient was recommended to take Tylenol and/or ibuprofen for pain management.
- A muscle relaxer was prescribed but not picked up by the patient due to lack of awareness.
Current Symptoms and Requests
- The patient continues to experience neck and back pain, which sometimes makes it difficult to carry her almost 3-month-old baby boy.
- She denies any urinary/bowel incontinence, loss of sensation, numbness, tingling, or weakness.
- The patient is requesting a referral to physical therapy (PT) for her ongoing symptoms.
Relevant Studies on Pain Management
- A study on ibuprofen 3 highlights its efficacy and safety in managing pain and inflammation, with a good safety profile at low doses (800-1,200 mg/day).
- Another study on pharmacologic therapy for acute pain 4 recommends acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment options for most patients with acute mild to moderate pain.
- A randomized, double-blinded trial comparing acetaminophen, ibuprofen, and oxycodone for pain management after hand surgery 5 found no clinically significant difference in pain experience or capsule consumption between the groups, with adverse events being highest in the oxycodone group.
- There is no direct evidence from the provided studies to support the use of imaging-related medications in this patient's case, as the focus is on pain management and not imaging 6.