Neck and back pain – radicular syndromes

Adam C. Levine, Stephen H. Thomas
In: Emergency Department Analgesia · 2008 · pp. 268–272 · doi:10.1017/cbo9780511544835.038 · W177487695
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Abstract

NSAIDs are widely considered as the first-line therapy for the pain associated with endometriosis. Combined oral contraceptive pills (COCPs) are generally recommended as the second-line therapy for endometriosis pain. A 2007 Cochrane review concluded that COCPs are at least as effective as gonadotropin-releasing hormone (GnRH) agonists. Medroxyprogesterone acetate is comparable to the androgen danazol, with both agents reducing pain scores by 50-74% compared with placebo. An SC form of depot medroxyprogesterone appears to relieve endometriosis as effectively as the proven approach of the GnRH agonist leuprolide acetate. Cochrane review has shown that there is generally equivalent pain relief achieved with multiple endocrine therapies for endometriosis. The myriad menopausal, androgenic, and hepatic side effects from some of the endocrine agents (e.g. danazol) used to treat endometriosis should serve to underline the importance of ED physician communication and follow-up arrangements with longitudinal care providers.

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endometriosis

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