My Treatment: Thoracic Outlet Syndrome - Treatment Options: Medications

Thoracic Outlet Syndrome Medications

Depending on your symptoms and your doctor's evaluation, he or she may recommend anti-inflammatory medicines, muscle relaxants, sleep-aids, and other medications that help to relieve nerve pain.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Traditionally, NSAIDs are used to treat muscle and bone pain. NSAIDS act quickly to relieve pain. There are more than 30 drugs classified as NSAIDs and each has a slightly different chemical structure, is metabolized differently and seems to work differently among patients.

Many of these drugs are household terms, such as ibuprofen (Advil) and naproxen (Aleve). Others are newer and more expensive agents, such as COX-2 inhibitors: celecoxib (Celebrex).

Long-term use of NSAIDs can cause complications. These can range from minor bleeding in the gastrointestinal tract, to liver or kidney toxicity (poisoning). In fact, stomach irritation is so common with frequent NSAID use that some doctors also prescribe misoprostol (Cytotec), a drug that protects the stomach lining. (Misoprostol has its own potential side effects, including nausea, gas, headaches and vomiting; it can cause miscarriage and should never be given to pregnant women). One prescription product, approved in just the past few years, combines the NSAID diclofenac sodium with misoprostol and is marketed under the name Arthrotec. Celecoxib (Celebrex) is reported to be easier on the stomach than older NSAIDs.

NSAIDs also can interact with other drugs, even over-the-counter preparations. Antacids, for example, can decrease the absorption of NSAIDs, reducing their pain-fighting effect. Prescription medicines also can have adverse effects when mixed with NSAIDs. NSAIDs can augment the action of diuretics, lithium, oral hypoglycemic agents and phenytoin (Dilantin).

It is extremely important to follow all the label instructions and cautions when taking NSAIDs and to consult with your health care provider if you have any concerns.

Muscle Relaxants
Some pain medications act more by relaxing muscles than as direct central nervous system pain relievers. Commonly prescribed medications include:

carisoprodol (Soma).

diazepam (Valium).

methocarbamol (Robaxin)

tizanidine (Zanaflex)

cyclobenzaprine (Flexeril). Some drugs such as acetaminophen (Tylenol) and paracetamol (a popular European acetaminophen-like medication) are thought to provide pain relief via central brain mechanisms.

Nerve Pain (Neuropathic)
The treatment for nerve pain focuses on "neuromodulation," which means reprogramming the messages involved in relaying the pain signals. There are specific "transmitters" for each of the nerve pathways that transmit messages from one nerve to another – these are called "neurotransmitters." Some transmitter agents that relay messages from one nerve to another are protein-like substances known as neurotransmitters.

Drugs that may help relieve pain by their affect on neurotransmitters include, but are not limited to, fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), venlafaxine (Effexor), amitriptylene (Elavil), imipramine (Tofranil), desipramine (Norpramine), nortriptylene (Pamelor), doxepin (Sinequan), amoxapine (Ascendin)

Other drugs that are specifically effective in treating nerve pain conditions include: gabapentin (Neurontin), topiramate (Topamax) and pregabalin (Lyrica). Pregabalin is related to gabapentin and is also effective in treating neuropathic pain. It is as effective as gabapentin but at lower doses, which may indicate fewer side effects for patients.