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The etiologic differences between radiating spine pain (RSP) and other causes of neck and back pain translate into differences in therapeutic approach. This chapter focuses on pharmacologic treatment modalities for RSP. Patients with refractory RSP often require opioid therapy, but available evidence does not support specific recommendations. Studies suggest no incremental benefit, compared with NSAIDs, for PO low-potency opioids (e.g. codeine) or agonist-antagonist agents (e.g. meptazinol, ethoheptazine). The authors believe that the main role for low-potency opioids in RSP is for use in patients who fail, or do not tolerate, other therapies such as NSAIDs. Corticosteroids have been used for the treatment of acute RSP since 1960s. The injection of corticosteroids into the epidural space is a commonly used approach. A single dose of methylprednisolone significantly reduces pain scores in RSP, but the effect is small in magnitude and limited in duration.
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