Back Pain Back Pain Medications and Therapies 2 — Questions and Answers
Question 1: Which topical medication is available over the counter and approved for localized back pain relief in the US?
- Fentanyl patch
- Diclofenac gel (Voltaren) (Correct answer)
- Cyclobenzaprine cream
- Lidocaine 10% patch
Correct answer: Diclofenac gel (Voltaren)
Diclofenac gel (Voltaren Arthritis Pain) is an OTC topical NSAID that provides localized anti-inflammatory analgesia with minimal systemic absorption.
Question 2: Gabapentin and pregabalin reduce neuropathic back pain by blocking which ion channels?
- Sodium channels
- Potassium channels
- Voltage-gated calcium channels (alpha-2-delta subunit) (Correct answer)
- NMDA receptors
Correct answer: Voltage-gated calcium channels (alpha-2-delta subunit)
Gabapentinoids bind to the alpha-2-delta subunit of voltage-gated calcium channels, reducing release of excitatory neurotransmitters from sensitized neurons.
Question 3: Which injection technique delivers medication directly into the epidural space via the sacral hiatus?
- Interlaminar epidural
- Transforaminal epidural
- Caudal epidural (Correct answer)
- Facet joint injection
Correct answer: Caudal epidural
Caudal epidural injections use the sacral hiatus as an entry point into the epidural space, providing a safe approach to deliver corticosteroids in lumbar/sacral pain.
Question 4: What is the mechanism of action of lidocaine trigger point injections for myofascial back pain?
- Blocking COX enzymes
- Disrupting the trigger point and blocking sodium channels to reduce pain signaling (Correct answer)
- Strengthening muscle fibers
- Promoting disc healing
Correct answer: Disrupting the trigger point and blocking sodium channels to reduce pain signaling
Lidocaine injected into trigger points disrupts the taut band cycle, blocks Na+ channels in nociceptors, and reduces sensitization of the trigger point.
Question 5: Intrathecal drug delivery systems (pain pumps) for chronic back pain deliver medication to which location?
- Directly into the paraspinal muscles
- Into the intrathecal (subarachnoid) space surrounding the spinal cord (Correct answer)
- Into the epidural space
- Into the intervertebral disc
Correct answer: Into the intrathecal (subarachnoid) space surrounding the spinal cord
Intrathecal pumps deliver medication (opioids, baclofen, ziconotide) directly into the CSF surrounding the spinal cord, achieving analgesia at much lower doses.
Question 6: Which supplement has the most evidence for modest benefit in reducing inflammatory back pain?
- Vitamin E
- Glucosamine only
- Omega-3 fatty acids (fish oil) (Correct answer)
- Calcium
Correct answer: Omega-3 fatty acids (fish oil)
Omega-3 fatty acids have anti-inflammatory properties and several studies show modest reductions in back pain and NSAID use when taken regularly.
Back Pain Back Pain Medications and Therapies 2
Which topical medication is available over the counter and approved for localized back pain relief in the US?