Hip Tendonitis and Bursitis Medication

Updated: Oct 12, 2018
  • Author: Jeffrey Rosenberg, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Medication

Medication Summary

For patients with hip overuse syndrome, medications are used primarily to decrease pain and inflammation. These agents are best used for short time periods in the acute setting after an injury to prevent further swelling and pain.

Inflammation is part of the normal healing response and may be necessary to allow for complete tissue recovery. Some theories regarding tendinopathy involve the belief that stopping the healing response by halting all inflammation prevents the eventual recovery of tendons by interfering with normal collagen deposition and alignment. By preventing new blood-vessel formation into an injured area, complete healing does not occur.

In patients without known contraindications, nonsteroidal anti-inflammatory medications (NSAIDS) are preferred for short time periods for pain and inflammation control. Providers can decide which NSAIDS are the ones they are most comfortable using.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well; these may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Excedrin IB, Ibuprin, Advil)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprosyn, Anaprox, Aleve, Naprelan)

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Ketoprofen (Actron, Orudis, Oruvail)

For relief of mild to moderate pain and inflammation.

Small dosages initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe patient for response.

Nabumetone (Relafen)

Nonacidic NSAID that is rapidly metabolized after absorption to a major active metabolite that inhibits cyclooxygenase enzyme, which in turn inhibits inflammation.

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Cyclooxygenase-2 (COX-2) Inhibitors

Class Summary

COX-2 inhibitors are a class of NSAIDs that have a decreased incidence of adverse GI effects, such as gastritis and ulcers. COX-2 inhibitors may be indicated in patients with a history of gastric ulcers, who require anti-inflammatory medications.

Celecoxib (Celebrex)

Inhibits primarily COX-2, an isoenzyme that is induced during pain and with inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, the COX-1 isoenzyme not inhibited; therefore, GI toxicity may be decreased. Seek the lowest dose for each patient.

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Analgesics

Class Summary

Simple analgesics like acetaminophen may be preferred for conditions in which NSAID use is not advised or in which there is little suspicion of an underlying inflammatory process.

Tramadol hydrochloride is an opioid analgesic that has noradrenergic and serotonergic properties that may contribute to its analgesic activity. Tramadol is used for moderate to severe pain or in cases wherein NSAIDs cannot be taken. The potency of this agent is less than that of traditional opioids, and there is less (but not zero) addiction potential.

Acetaminophen (Aspirin-free Anacin, Tylenol, Feverall, Tempra)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, or those taking oral anticoagulants.

Tramadol (Ultram, Ultram ER)

Inhibits ascending pain pathways, altering perception of and response to pain. Also inhibits reuptake of norepinephrine and serotonin.

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