conservative treatment of low back pain
DESCRIPTION
Conservative Treatment of Low Back PainTRANSCRIPT
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Conservative Tx of Low Back Pain
Seoul Naeun HospitalKise Nam M.D. Ph.D.
E-Mail: [email protected]://www.seoulnaeunhospital.com
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Low Back Pain
• LBP : 80 % experience in their life.
• Sciatica : 13-40% experience.(Frymoyer JW : JBJS, 1983)
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Natural History
• LBP : 50% resolve within 1 week, 95% within 3months
• Sciatica :50% resolve within 1 month, 75% within 3months (Bush K : Spine, 1992)
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OP vs Conservative
• The controlled trial showed a statisti-cally significant better resull in the surgically treated group at the one-year follow-up examination.
• After four years the operated pa-tients still showed better results, but the difference was no longer statisti-cally significant (Weber H : Spine, 1983)
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Etiology of LBP
• Spondylogenic• Neurogenic• Viscerogenic• Vasculogenic• Psychogenic
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Common Ex of LBP
• Sprain• HIVD (Herniated interverteral disc)• Spinal Stenosis• Instability
Spondylolisthesis, Retrolisthesis.• Scoliosis, Kyphosis• Osteoporosis, Comp. Fx
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Conservative Tx
• Bed rest for 3~5 days
• MedicationNSAID, M relexant, Antidepressant.
• Manipulation (chiropractic)• Back brace
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Conservative Tx
• Physical TherapyHot pack, TENS, Traction, ESWT, Pain Scrambler
• InjectionTPI. Epidural Steroid Injection, Facet joint injection. Medial branch block.
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Conservative Tx
• ExerciseFlexion, Extension exerciseAerobic exercise
• Back School.
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Local Procedure
• Percutaneous Neurolysis• Nucleoplasty• IDET• Percutaneous Endoscopic Discectomy
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Bed Rest
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Medication
• NSAIDCelebrex 200mg qdNaxozol (naproxen 500mg esomeprazole 20mg)
• M relexant, • Antidepressant
Tricyclic antidepressants : amitriptylineSNRIs (duloxetine Cymbalta)
• Anti-convulsant medications : gabapentinoids (gabapentin/pregabalin)
• Opioid analgesics: oxycodone, tramadol
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Manipulation
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Physical Therapy
• Hot pack, TENS, Ultrasound,Traction• ESWT
(Extracorporeal shockwave therapy)• Pain Scrambler
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ESWT
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ESWT (Biological Effects)
• Relieving Pain • Increased blood flow • Induce an inflammatory-mediated
healing process• Release healing factors;
TGF-β1,IGF-1 Signs of inflammation and repair after 4 weeks
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ESWT (Target Tissues)
• Tendon• Tendon sheath• Bone• Muscle• Ligament• Connective tissue, synovium
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ESWT (protocol)
• Dependent upon the energy categoryHigh energy : 1,000 to 1,500 pulsesLow energy : 2,000 to 3,000
• Treatment area : greatest discomfort areapathologic tissuefunctional abnormal tissue
• Additional treatments may be benefi-cial
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Pain Scrambler
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What is Scrambler therapy?
• Patient‐specific cutaneous electro‐stimulation simi-lar to spinal cord stimulation, but non‐ invasive.
• Creates "non‐pain" information in packets of rapidly varying impulses, given non‐invasively using the patient’s own nerves.
• 30‐45 minute long sessions using EKG‐like pads. Above and below pain. Stinging, then tingling, then intermittent pulse; adjust to tolerance.
• No side effects reported in over 4000 patients; over 3000 in use in Italy. US FDA Cleared Feb 09.
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Epidural Steroid Injection
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Epidural Steroid Injection
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Facet Joint Injection
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Med Branch Block
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Exercise with Medex
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Back School
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Back School
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Spontaneous regression of HIVD 3Yrs later
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Spontaneous regression of HIVD 3Yrs later
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Arthroscopic Lumbar Discectomy
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Arthroscopic Lumbar Discectomy
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Arthroscopic Lumbar Discectomy
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Epidural Neurolysis
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Intradiscal Electrothermal Annuloplasty
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Nucleoplasty
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Vertebroplasty, Kyphoplasty
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Principle of Tx of LBP
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If possible, conservative
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• Thank You