colchicine use in the damaged disk syndrome (dds) · the floor, his rask testi2 was positive (a...
TRANSCRIPT
Colchicine Use in the Damaged Disk Syndrome (DDS)
Report of 50 Patients
MICHAEL R. RASK, M.D.
Colchicine’s effectiveness in the treatment of joint disease may not be limited to gouty arthritis. Its efficacy in the treatment of the acute or chronic damaged disk syndrome (DDS) in 50 patients is reported here. (The term herniated disk disease is applied in this report to patients whose symp- toms are caused by mechanical pathology. There is another group of patients in whom there is little evidence of a mechanical cause of their disk damage; the basis for their lower back pain and sciatica seems to be chemical or autoimmune
Therefore, the term damaged disk syndrome (DDS) is used to describes the whole genre of disk pathology that gives rise to the symptom complex of spinal pain, with or without radiculopathy .)
The following patient histories and the 50 case reports tabulated in Table 1 illustrate the effects of colchicine on the damaged disk syndrome.
CASE REPORTS
Case I. A 46-year-old man injured his lower back and developed immediate right sciatica after lifting a 60-pound portable television camera while he was in an awkward position. Three days later, he was com- pletely disabled by the pain.
On examination, the patient was in marked distress and had a sciatic scoliotic list to the left. Michele’s
Sahara Rancho Medical Center, Suite 108, 2320 Rancho Drive, Las Vegas, NV 89102.
Received: August 31, 1978.
“flip” tesP was positive; with the patient seated, rais- ing his painful leg caused him to lean backward and recreated his sciatica exactly. Demianoff‘s (or Forst’s) test (straight leg raising) caused sciatica on the right side at 20”. and Bragard’s test (dorsiflexion of the foot) redeveloped the patient’s sciatica at 10” of right leg elevation while he was recumbent.
When the patient first attempted to bend to reach the floor, his Rask testI2 was positive (a patient with spinal nerve root damage usually lists to the opposite side of the damage, and when asked to bend over, often flexes the ipsilateral knee of the side of the diskal lesion, giving good objective evidence of his disorder). (See Figure 4 for an illustration of this test).
Thermography revealed increased thermal activity on the right side at L4-5 suggestive of diskal damage at that point (Fig. 1)13 and plain radiographs revealed definite L4-5 intervertebral disk narrowing.
The patient was given 2 cc of intravenous colchicine (1 .O mg) and became asymptomatic in 10 minutes. The next day he had some recurrence of sciatica, which was relieved when he was given colchicine orally. Because of his size he was able to take 1.8 mg per day without side effects. Slight recurrences of lower back discomfort and sciatica have returned sporadically for the past 2 years, but the patient’s herniated disk has healed gradually. The patient lost only the initial 3 days before colchicine therapy from his work.
Repeated serum uric acid determinations, before and after his disk damage episode have always been within normal limits.
Case 2. A 60-year-old man had been in good health except for a large renal cyst discovered on plain lumbo- sacral radiographs taken for severe lower back pain and right sciatica of 3 weeks’ duration. He had injured his lumbosacral disk while lifting heavy objects but had had previous attacks of lower back pain and sciatica on numerous occasions.
0009-921X/79/0900/183 $00.90 @ J . B. Lippincott Co.
183
TA
BL
E 1
. R
espo
nse
of 5
0 Pa
tient
s W
ith D
amag
ed D
isk
to C
olch
icin
e T
hera
py
Dur
atio
n Sc
iatic
a -+
Seru
m U
ric
Patie
nt
Age
S
ex
of S
ympt
oms
Leg
Sign
s Li
st
X-R
ays
Ther
mog
ram
A
cid
Leve
l R
espo
nse
to C
olch
icin
e
1 46
M
2 60
M
3
46
M
4 44
M
5
58
M
6 31
M
7
47
M
8 43
M
9
60
F 10
60
M
11
44
M
12
54
F
13
36
M
14
74
M
15
50
F 16
33
F 17
47
M
18
36 M
19
47
M
20
59
M
21
32
M
22
47
M
23
25
M
5 da
ys
3 w
k 3
wk
3 w
k 4
wk
6 m
o 1
wk
3 Y'
14 y
r 1
wk
3 m
o
5 Y'
2 m
o 7
mo
2 m
o 4
mo
4 m
o
4 m
o
3 Y'
3 Y'
2 m
o 13
yr
6 m
o
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Cer
vica
l di
sk
Left
Non
e Y
es
Yes
Y
es
Yes
Cer
vica
l di
sk
Yes
Y
es
Leg
pain
onl
y N
o
Yes
Y
es
Yes
Y
es
Yes
N
o Y
es
List
Cer
vica
l di
sk
Cer
vica
l di
sk
Yes
Y
es
Yes
M
ild
Yes
M
ild
Neg
ativ
e D
egen
erat
ive
disk
D
isk
narr
owin
g D
isk n
arro
win
g D
isk
narr
owin
g D
isk
narr
owin
g LS
dis
k na
rrow
ing
Neg
ativ
e N
egat
ive
Disk
nar
row
ing
Min
imal
deg
ener
ativ
e
Deg
ener
ativ
e di
sks
spur
s
Non
e D
egen
erat
ive
disk
s
Neg
ativ
e N
egat
ive
Dis
k na
rrow
ing
Prev
ious
com
poun
d
Dis
k na
rrow
ing
Disk
nar
row
ing
frac
ture
Mild
lip
ping
Sp
inal
fus
ion
Neg
ativ
e
Posi
tive
Nor
mal
N
ot d
one
Nor
mal
N
ot d
one
Nor
mal
N
ot d
one
Nor
mal
Po
sitiv
e N
orm
al
Posi
tive
Nor
mal
Po
sitiv
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Not
don
e N
orm
al
Incr
ease
d th
erm
al
Nor
mal
ac
tivity
N
orm
al
Not
don
e N
ot d
one
Nor
mal
Exce
llent
Ex
celle
nt
Exce
llent
Ex
celle
nt
Exce
llent
Ex
celle
nt
Exce
llent
(on
e re
curr
ence
of
pain
5
mon
ths
late
r w
ith g
ood
resp
onse
to
col
chic
ine
agai
n)
Exce
llent
Ex
celle
nt
Exce
llent
Ex
celle
nt
Exce
llent
(al
thou
gh t
he p
atie
nt
did
not
have
gou
t. sh
e re
spon
ded
LO
colc
hici
ne a
nd a
llopu
rino
l)
Exce
llent
N
o re
lief
(pai
n at
site
of
Exce
llent
Ex
celle
nt
Exce
llent
G
ood
(som
e pe
rsis
tent
pai
n)
inje
ctio
n)
Goo
d (s
ome
resi
dual
pai
n)
Fair
(w
ants
sur
gery
)
Exce
llent
G
ood
(som
e re
sidu
al p
ain)
N
ot d
one
Nor
mal
(fa
ther
Ex
celle
nt
has
gout
)
24
25
26
27
28
29
30
31
32
33
34
35
36
31
38
39
40
41
42
43
44
45
46
41
48
49
50
61
M
40
F 53
M
45
M
50
M
38
M
4
4M
34
M
53
M
63
F
50
M
48
M
44
M
44
M
36
F 25
F
40
M
81
M
35
M
54
M
66
M
63
M
46
F 47
M
45
F
43
F
40
M
4 m
o
2 Y'
I Y'
3 m
o 2
mo
18 m
o 4
mo
2 w
k 2
Yr
2 Yr
6
mo
3 w
k I
mo
6 w
k 3
wk
3 m
o 3
wk
6 m
o I
wk
1 Y'
2 m
o 6
mo
2 m
o 3
mo
I yr
3 m
o
3 Y'
Yes
N
o Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Yes
Y
es
Tho
raci
c di
sk
Yes
Y
es
Yes
C
ervi
cal
disk
Y
es
Yes
Cer
vica
l di
sk
Yes
Y
es
No
Yes
Y
es
Yes
Y
es
No
Yes
Y
es
Yes
Y
es
Yes
N
o Y
es
Yes
Y
es
No
Neg
ativ
e Y
es
Yes
Y
es
Yes
Yes
Y
es
Exc
elle
nt =
tota
l re
lief o
f sym
ptom
s G
ood
= m
ost
pain
rel
ieve
d Fa
ir =
som
e re
lief.
recu
rren
t at
tack
s of
pai
n. n
o cu
re
Poor
= n
o re
lief
Dis
k na
rrow
ing
Neg
ativ
e Pr
evio
us l
amin
ecto
my
Neg
ativ
e Sp
ondy
loly
sis
Neg
ativ
e D
isk
narr
owin
g N
egat
ive
Dis
k na
rrow
ing
Deg
en. s
pond
ylol
isth
esis
N
egat
ive
Neg
ativ
e N
egat
ive
Neg
ativ
e Sp
ondy
loly
sis
LS
Neg
ativ
e N
egat
ive
Deg
ener
ativ
e di
sk
Neg
ativ
e N
egat
ive
Deg
ener
ativ
e di
sk
Deg
ener
ativ
e di
sk
Neg
ativ
e N
egat
ive
Neg
ativ
e D
egen
erat
ive
LS d
isk
Neg
ativ
e
Not
don
e Po
sitiv
e N
ot d
one
Posi
tive
Posi
tive
Not
don
e N
ot d
one
Not
don
e N
ot d
one
Not
don
e N
ot d
one
Not
don
e N
ot d
one
Not
don
e Po
sitiv
e Po
sitiv
e N
egat
ive
Not
don
e Po
sitiv
e Po
sitiv
e N
ot d
one
Not
don
e N
ot d
one
Not
don
e N
ot d
one
Not
don
e
Not
don
e
Gou
t (h
igh)
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
N
orm
al
Nor
mal
Fair
(w
ants
sur
gery
) Te
mpo
rary
rel
ief
only
Te
mpo
rary
rel
ief
only
N
o re
lief
Mild
rel
ief
No
relie
f (h
ad s
urge
ry)
Exce
llent
N
o he
lp
Exce
llent
N
o re
lief
Tem
pora
ry r
elie
f R
ecov
ered
Ex
celle
nt
Exce
llent
N
o re
lief
No
relie
f Ex
celle
nt
Muc
h re
lief
but
not
cure
d R
ecov
ered
H
aste
ned
reco
very
R
ecov
ered
Ex
celle
nt
Rec
over
ed
Nea
rly
reco
vere
d N
o re
lief
Slig
ht r
elie
f. di
d no
t
Aft
er 2
mon
ths,
50%
impr
oved
ha
ve s
urge
ry
(fai
r res
ult)
186 Rask CI nical Onhopaed cs
ano Retat& Researcn
FIG. I . (Patient 1 .) Thermography of the patient’s spine taken 3 days after injury revealed increased ther- mal activity at L4-5 on the right side with a marked sciatic scoliotic list to the left (arrow). The patient may also have another diskal herniation at the lumbosacral level on the same side, but minimal colchicine dosages have made him asymptomatic.
Physical examination revealed positive leg stretch- ing tests (mentioned above) and a depressed ankle jerk deep tendon reflex on the right side indicating spinal nerve root damage (Sl). Radiographs revealed the vac- uum disk of Knuttson6 at the lumbosacral joint, suggest- ing advanced degeneration of the diskal interspace, while numerous serum uric acid determinations made during annual physical examinations were normal.
Two cubic centimeters ( 1 .O mg) of intravenous colchi- cine was given and within 10 minutes his lower back pain and right sciatica were eased. A slight recurrence of pain the following day was controlled with 0.6 mg of colchicine, given orally, twice daily. Within 3 months he was completely asymptomatic and has been well for 3 years. He takes oral colchicine for occasional back discomfort.
Case 3. A 46-year-old man had undergone a lumbar laminectomy for right sciatica 5 years previous to recur- rent disabling discomfort from a lifting injury. Since his operation, the patient had had attacks of back pain and sciatica which usually responded to muscle relax- ants and medication for pain. The present attack of pain did not respond similarly and was more severe than that for which the patient had undergone operation 5 years previously.
Examination 3 weeks after the onset of his disorder revealed positive leg stretching tests for spinal nerve root inflammation on the right side and diminished sensation to light touch and pinwheel pain on the dorsal aspect of the lateral 4 toes and the lateral aspect of his right calf (L5). The muscle strength of the extensor
hallucis longus on the right was one half that of the left, and there was one centimeter of muscle atrophy of the right calf.
Radiographs revealed evidence of the previous bila- minotomy at L4-5 as well as slight disk narrowing at that level. The lumbosacral disk appeared normal and laboratory studies revealed no evidence of gout or other abnormality.
Two cubic centimeters of colchicine ( 1 .O mg) was given intravenously, and within ten minutes the patient was free of all pain. Although there was slight recur- rence of back pain and sciatica the following day, it was controlled with 1.2 mg of oral colchicine daily. The patient returned to work the following day without pain.
Case 4 . A 44-year-old man experienced disabling lower back pain and left sciatica after lifting heavy rocks. Chiropractic treatments, medication for pain and muscle relaxants did not relieve his intense discomfort. On examination, after 3 weeks of pain, the patient
had a marked sciatic scoliotic list to the right, and the slightest degree of sciatic nerve stretch intensified the already severe pain. Diminished sensation was found on the lateral aspect of the left calf and dorsum of the left foot (L5), and the tibialis anterior muscle was weakened, adding steppage to his antalgic left limp.
Radiographs revealed L4-5 disk narrowing. Labora- tory studies, including uric acid level determinations, revealed no abnormalities.
Two cubic centimeters of colchicine administered intravenously (1 .O mg) relieved his sciatica within 10 minutes; a slight recurrence of pain was relieved with 1.2 mg of colchicine taken orally the next day. The patient continued this dosage and became painfree in 3 weeks. He returned to his regular work, which necessi- tated heavy lifting and has not had a recurrence of back discomfort in 2 years. He continues to take 0.6 mg of colchicine, 2 to 3 times per week.
Case 5. A 50-year-old man had been in good health except for 50 pounds of overweight. He had injured his lower back while lifting cartons. Lower back pain and right sciatica developed and lasted for one month despite administration of muscle relaxants and medica- tion for pain. Despite severe discomfort, he continued to work.
On examination 4 weeks after his injury, the patient had a marked list to the left and a diminished ankle jerk reflex on the right. Deficient light touch and pin- wheel pain sensation were present on the lateral aspect of his right calf and sole of his right foot. Leg stretching, especially on the right side, increased his leg discom- fort.
Roentgenograms revealed lumbosacral disk narrow- ing (Fig. 2 ) , and thermography of the lumbar spine showed increased thermal activity in the damaged disk (Fig. 3). Laboratory studies, including uric acid level determination, revealed no abnormality.
The patient responded immediately to 1 .0 mg of colchicine administered intravenously, but the pain
Number 143 September, 1979 Colchicine Use In Damaged Disks 187
FIG. 2. (Patient 5.) Lateral radiograph of the pa- tient's lumbosacral spine reveals moderately advanced disk narrowing of the lumbosacral joint and some hyper- trophic lipping at L4-5 without much narrowing.
recurred on the following day. Colchicine therapy was continued at the rate of 1.2 mg orally administered daily in divided doses, but the patient's symptoms persisted, although they improved considerably. Weight reduc- tion was begun with the patient continuing to receive oral colchicine. (Dieting aggravates gouty arthritis; patients should be observed closely even though they may not have true gout).I4 The patient continued to work, but did not become painfree after 6 weeks of regular colchicine use. Allopurinol (Zyloprim), 100 mg twice daily, was then added to the medical regimen. I believe that this patient had seronormal gouty ~pondylitis,'~ as well as diskal damage at the lumbosacral joint; within 2 weeks of combined colchi- cine-allopurinol therapy, he became asymptomatic. He has remained well for one year and continues to take 100 mg of allopurinol and 0.6 mg of colchicine daily. His body weight is now normal and he watches his food intake carefully.
Case 6. A 31-year-old man had injured his lower back 8 months previously while playing basketball. Since graduation from high school, where he was a star athlete, he had gained 40 pounds and smoked 2 packs of cigarettes per day.
Soon after back injury, left sciatica developed and despite physical therapy, chiropractic measures and
FIG. 3. (Patient 5.) Thermography of the patient's spine taken on the day when first seen by the author revealed increased thermal activity at the lumbosacral joint on the right side especially and a marked sciatic scoliotic list to the left. Thermography is extremely useful in documenting sciatic list, but should be done with the patient erect.
treatment by his family practitioner, the back pain continued until the patient was disabled.
On examination 8 months after injury, the patient had marked muscle spasm of his lumbar spine and positive leg stretching tests (Fig. 4). Radiographs of his lumbar spine revealed the LA5 disk to be narrowed. Inverted grey tone thermography showed increased thermal activity at L4-5 on the left side, indicating disk damage at that level (Fig. 5).
Two cubic centimeters of colchicine (1 .O mg) was given intravenously, and the patient became painfree in 15 minutes. His Rask test" was no longer positive (Fig. 6). Within 4 weeks of oral colchicine therapy (0.6 mg mice a day) he returned to active sports without pain. After 3 months of oral colchicine in the dose mentioned, he was asymptomatic and could touch the ground without difficulty (Fig. 7).
RESULTS
Figure 8 graphically demonstrates the overall results in this group of 50 patients with acute and chronic disk syndromes. Sixty-eight per cent had an excellent (44%) or good (24%) result. Thirty- two per cent had either a fair ( 16%) or a poor ( 16%) result after both intravenous or oral colchicine
188 Rask Clinical Orlhopaedics
and Related Research
FIG. 4. (Patient 6.) A 31-year-old man who injured his lower back while playing bas- ketball is shown after 6 months of severe left sci- atica with a positive Rask tesP (knee flex- ion test with sciatica) on the left side. He lists to the left and must sup- port his torso body weight with his hands on his thighs when he bends.
therapy in the control and healing of their herni- ated disk syndromes.
Twenty patients had acute damaged disk symp- toms and 30 had chronic disease (of over 6 months’ duration). Sixty-three per cent (19) of the acute disk group had excellent results from colchicine use, and 13% (4) had good results, giving a total of 76% with good or excellent result from colchicine use for acute disk rupture syn- dromes.
Fifty-five per cent of the group with chronic disk syndromes had either a good or excellent result (8 patients had excellent results and 3 good), while 45% of the chronic group had either a poor or fair response to colchicine therapy (5 fair results and 4 poor). Only 24% of the group with acute disk symptoms had fair or poor re- sponse to colchicine (3 fair and 4 poor). Appar- ently, when the patient has had disk symptoms for a long time, there is less likelihood of a dra- matic response to colchicine.
In this series, an excellent result was one in which the patient obtained complete relief of his symptoms (particularly pain); a good result was one in which there was moderate and tolerable relief of pain, obviating the necessity for surgical measures; a fair result meant that the patient merely had the “edge” taken off of his pain, or that he had recurrent attacks of pain, and was never entirely painfree; and a poor result was one in which the patient had no relief or subsequently had surgery.
Thirty-nine of the patients were men and 11 were women. All but 2 patients had normal serum uric acid determinations (some patients had had repeated examinations in their annual physicals). The age range in this series was 25 to 8 1 and the mean age was 48.5 years.
DISCUSSION
The effectiveness of intravenous colchicine in the treatment of acute or chronic disk syndrome is so dramatic that I had first decided that the reason for this response was that the patient had gout,I4 albeit, a seronormal variety. But there were so many instances of herniated disk symp- toms in which the patient never again had symp- toms of gouty arthritis or disk damage pain after discontinuing the use of colchicine, that I gradu- ally became convinced of the therapeutic value of colchicine, for intervertebral disk herniation or damage.
In addition I have found that the intravenous
FIG. 5 . Thermography of the lumbarspine (Patient 6 shown in Fig. 4) taken on the day when first examined by the author (6 months after injury) reveals marked increased thermal activity at LA-5 on the left side with some evidence of lumbosacral disk disease. The patient lists to the same side as the herniation (arrow): this occurs in only 20% of patients who list from spinal nerve root compression; that is, the list from spinal nerve root compression is usually contralateral to the herniation (80%).12
Number 143 September, 1979 Colchicine Use In Damaged Disks 189
route of colchicine appears to have more effect on diskal pain than the oral, but it is almost as effective in controlling disk symptoms until such time as diskal healing ensues. The results pre- sented in this series show that colchicine is as effective in the treatment of acute and chronic disk herniation disorders as operation,1° therapy with chymopapain," or intradiskal corti~one,~ without their harmful side effects.
In 1978 Liu' reported an instance of marrow aplasia, thought to be induced by heavy dosages of colchicine (20 mg in 5 days); however, the patient was also receiving phenbutazone (a known marrow-suppressant) and many other medications. Permission for autopsy was not granted. In my opinion this is a weak case for colchicine as a cause for marrow suppression. There have been only 5 other instances of reported marrow suppression from colchicine in the litera- ture,1*2$3*1' but none present substantial evidence that colchicine usage is the cause.
In my opinion large "rheumatologic" dosages of colchicine are not required to bring about thera- peutic results in either the disk syndrome or in gouty arthritis. In this series, the largest dose of intravenous colchicine used was 3 1 .O mg doses in patient 6. Oral colchicine supplants the initial
FIG. 6. Patient 6 15 minutes after receiving 1 .O nig colchicine intra- venously. Pain relief and lessening of mus- cle spasm were immedi- ate; the patient had less difficulty in bending, and the Rask test" was no longer positive. When this occurs, the result is almost as dra- matic as that obtained by patients with severe gouty arthritis after in- travenous administra- tion of colchicine.
FIG. 7. Patient 6 after receiving oral col- chicine, 0.6 mg twice a day, for 3 months. The patient is completely asymptomatic now, has lost 20 pounds and has returned to active sports. The Rask test" is no longer positive and the patient no longer lists to the left when he bends.
intravenous therapeusis, and even then, should be used in very sparing therapeutic dosages (maxi- mum 1.8 mg per day orally; the usual dose is 0.6 mg per day). There is no need to administer large doses of colchicine, with the attendant haz- ards of sensitizing the patient or causing toxicity; small doses possess a high therapeutic index.
One complication from administration of intra- venous colchicine is pain at the injection site. This complication did not occur in this series. I have seen 3 instances of severe pain at the site of injec- tion even though I was sure of the intravenous location of the needle, and certain that there was no sign of thrombophlebitis after the injection." The pain resembled a neuralgia; there was no other sign of inflammation at the injection site. In each instance, the pain was severe. In one patient, the pain crossed over from the limb that was injected, went through the patient's neck and into the other arm ending in the antecubital space.
Care should be taken not to give colchicine intravenously to patients with veins that appear to be delicate or fragile for fear of damaging the other side of the vein wall and allowing themedica-
Clinical Orthopedics 190 Rask and Related Research
'OO-1
l l r ; 16% N 0
RESULTS 50 "DISK" PATIENTS FIG. 8. Graph summarizing the findings of the 50
patients in this series who were given colchicine for acute or chronic disk syndromes. Sixty eight per cent of these patients had either a good or excellent result, comparing favorably with results of surgical interven- tion,'" chemonucleosis therapy: or intradiskal corti- sone the rap^.^ Colchicine was less effective in 32% (16 patients). (F = fair result; P = poor result).
tion to leak. If postinjection pain should develop following administration of colchicine in a pa- tient with fragile veins, the pain is self-limiting, lasting one to 2 weeks. It is important to use warm compresses on the injection site and oral diphenhy- dramine (Benadryl25-50 mg three times a day) in order to hasten healing.
I have not as yet tried trimethylcolchicinic acid (TMCA), a colchicine analogue, for treatment of the damaged disk syndrome, although its effec- tiveness in gouty arthritis15 has been demon- strated.
The dramatic manner in which the patient with an acute disk herniation responds to colchicine given intravenously, with total relief of pain and muscle spasm within a few minutes, does not overshadow the complete relief of pain that can be obtained in the patient who has had diskal symptoms for many years and who obtains pain relief through intravenous administration of colchi- cine. I believe strongly that every patient with the acute or chronic disk syndrome should have a 4- to 6-week trial on colchicine medication (0.6 to 1.2 mg per day orally with one or 2 1 .O mg intravenous injections. Further, in the patient who does not respond to surgical intervention, chymopapain therapy, or other measures, a simi- lar colchicine therapeutic trial should be em-
ployed by the clinician. A trial of the use of colchi- cine in the treatment of herniated disks follows closely the Hippocratic dictate, "Primum, nulli non nocere . "
SUMMARY
Fifty patients with acute and chronic damaged disk syndromes responded (68% good or excel- lent results) to minimal colchicine usage (0.6 to 1.2 mg per day), indicating that more complicated measures may be avoided in many distressed pa- tients who suffer from disk disease. The useful- ness of colchicine is slightly better in the acute than in the chronic disk syndrome, but any disk- suffering patient deserves a therapeutic trial of this possibly valuable medicament, before pro- gressing to more complex, invasive procedures.
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