Disc disease

- if no cauda equina or progressive neuro deficit- delay surg for a month

- epidural steroids for temporary symptomatic relief

- discetomy gives better pain control over 4 yrs but not past 10

- microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg

SPINAL STENOSIS

- avoid alcohol and strengthen legs to prevent falls

- exercise bike or walking recommened with rest when pain comes

- decompressive laminectomy for severe persistent pain

- adding spinal fusion to decompression improves outcome

- even with surg, sxs may reoccur in a few years

CHRONIC LBP

- neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain

- intensive exercise helps

- antidepressants especiallly tricyclics (better than SSRI), also helpful

- no long term opioids

- goals may need to be refocused

- multiple surgical precedures no helpful

PREVENTION

- corsets and education not helpful

- wt loss, excersice, stop smoking helpful

7/2/09 PANI