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| - if no cauda equina or progressive neuro deficit- delay surg for a month
| | #REDIRECT[[Lower back pain]] |
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| - epidural steroids for temporary symptomatic relief
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| - discetomy gives better pain control over 4 yrs but not past 10
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| - microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg
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| SPINAL STENOSIS
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| - avoid alcohol and strengthen legs to prevent falls
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| - exercise bike or walking recommened with rest when pain comes
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| - decompressive laminectomy for severe persistent pain
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| - adding spinal fusion to decompression improves outcome
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| - even with surg, sxs may reoccur in a few years
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| CHRONIC LBP
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| - neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain
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| - intensive exercise helps
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| - antidepressants especiallly tricyclics (better than SSRI), also helpful
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| - no long term opioids
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| - goals may need to be refocused
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| - multiple surgical precedures no helpful
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| PREVENTION
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| - corsets and education not helpful
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| - wt loss, excersice, stop smoking helpful
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| 7/2/09 PANI
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| [[Category:Neuro]] | |
