Is it a slipped disc? Pinched nerve? Sciatica? Leg Pain May Stem from pinched nerve in the low back
Last updated Wednesday, March 05, 2008
Management and treatmentTreatment The options for treating lumbar radiculitis range from
managing pain with anti-inflammatory medication to reparative surgery
Symptoms
may be improved with relative rest and lifestyle modification, education, oral
medications, and physical therapy. Common oral medications comprise
anti-inflammatories such as ibuprofen and Naproxen, acetaminophen for
pain-management, and compounds such as Gabapentin, and Nortriptyline, which can also be used for pain and sleep.
Steroid injections may be indicated when other treatments fail, or used in conjunction with these other treatments.
Steroid
injections generally are performed under X-ray (fluoroscopic) guidance.
The steroid,
a very powerful anti-inflammatory, is directed into the epidural space
around
the specific nerve root that is being compressed or irritated. The goal
of the injection is to decrease inflammation in as direct manner as is
possible. This typically reduces the patient's pain and facilitates the
return of function.
This would improve the patient's ability to participate in other
treatments.
Patients who take prescribed blood thinners, have bleeding
disorders, have allergies to contrast dye, or have active infections
should contact their physician before considering this procedure.
Physical therapy also can help improve patients’
biomechanics and strengthen core muscles. Acupuncture and other complimentary
therapies may be considered, as well.
Intractable pain and neurologic degradation in the
wake of more conservative treatments are indications for surgery. A surgeon
would pinpoint the location and cause of the compressed nerve, and aim to
reduce or eliminate that pressure. (See video: Specific Indications for Spine Surgery.)
Self-management Patients can adjust daily work activities and/or
reduce participation in activities that cause or exacerbate discomfort of lumbar
radiculitis (inflammation of a nerve root in the lower spine, causing pain,
tingling, numbness or a burning sensation in the back and legs).
If specific postures are more painful, explore posture
changes that could provide relief. Physical therapy – to master a guided
program of stretching and exercising at home – can be very helpful to reduce
painful events; the programs are most effective if the patient diligently
maintains the program while he or she is at home, apart from the physical
therapist.Health care team A primary care
provider, nonsurgical sports and spine specialists, orthopaedic surgeons, and
physical therapists all can help treat lumbar radiculitis (inflammation of a nerve root in the lower
spine, causing pain, tingling, numbness or a burning sensation in the back and
legs).Pain and fatigue Acetaminophen,
aspirin, and other non-steroidal anti-inflammatory drugs may be used for relief
from pain due to lumbar radiculitis, but narcotics should usually be avoided.
Higher levels of pain can be alleviated by steroid injections, but the number
of injections per year is limited.
A TENS
(Transcutaneous Electrical Nerve Stimulator) unit or biofeedback may be
tried.
A TENS unit is a small, battery-operated device which relieves pain by
blocking nerve impulses. Biofeedback is a technique which can help
control pain, blood flow, and skin temperature.
Meditation,
hypnosis, and others may be learned from a psychologist who specialized in pain
management. Diet Radiculitis
(inflammation of a nerve root in the lower spine, causing pain, tingling,
numbness or a burning sensation in the back and legs) typically does not
correlate with a patient’s diet. Being overweight, however, can contribute to
back pain; for instance, being overweight could create pain in a person’s
knees, and a resulting change in gait could adversely affect the spine. In such
instances, or if excess weight causes back pain, a change in diet, in
conjunction with exercise, could benefit the patient.Exercise and therapy A physician’s exam and laboratory tests will help a
doctor determine the appropriate time for a patient to start an exercise
program.
Physical therapy can help improve patients’
biomechanics and strengthen core muscles that better support the spine and a
person’s upper-body control. Building a program of range-of-motion stretches
and strengthening exercises into one’s daily routine can be very helpful to reduce painful events; such
programs are most effective if the patient is diligent at home, apart from
visits to the physical therapist.
Patients can adjust daily work activities and/or reduce
participation in activities that cause or exacerbate pain. If specific postures
are more painful, explore other postures that could provide relief.
Acupuncture and other complimentary therapies may be
considered, as well. Medications If back
pain is not relieved using other forms of treatment, medication may be
prescribed. The medication chosen depends on the back pain. For example,
medications called analgesics can help relieve pain. If back pain is caused by arthritis,
medication to reduce inflammation as well as relieve back pain may be
prescribed. The most common medications prescribed are called nonsteroidal
anti-inflammatory drugs such as aspirin and ibuprofen.
People
taking medication for back pain should ask their doctor or pharmacist questions
such as those listed below:
- What will the medication do?
- How long will it take before I notice results?
- What is the name of the medication?
Is there a generic brand?
- Are there side effects I
should know about?
- How should I take the
medication (i.e. before or after meals, with or without food, etc.)?
- How often should I take
the medication?
- What should I do if I
forget to take a dose at the specified time?
People taking medication for back pain should
also let their doctors know if they are taking other medications. Sometimes
certain medications cannot be taken together.Surgery Often surgery
can effectively treat severe cases of lumbar radiculitis, when pain and
instability, or other symptoms such as loss of bowel or bladder control, are
sustained or worsening despite non-surgical treatments.
Joint aspiration Joint
aspiration is the process of removing some fluid from the sore joint(s). It is
not indicated to treat lumbar radiculitis. Injection of anti-inflammatory
steroids can be an effective pain reliever, though it will not change
physiological structures that are causing pain.Splints or braces Neither
splints nor braces are indicated to treat lumbar radiculitis.Alternative remedies Acupuncture
and other complimentary therapies may be
considered. Relaxation techniques, such
as meditation, visual imagery, progressive muscle relaxation, yoga, or
biofeedback may also be helpful for people with lumbar radiculitis
(inflammation of a nerve root in the lower spine, causing pain, tingling,
numbness or a burning sensation in the back and legs).Social impacts Any chronic
pain condition can have psychological impacts on patients. The frustration of
untimely bouts of pain can cause patients to choose not to participate in
social activities, and/or can bring anger and depression. Reduced participation
in physical activities can contribute to weight gain.
However, managing chronic pain with a program of
exercise, stretching and pain medication – as well as relaxation techniques –
can help the patient maintain a more active role in social opportunities. Detecting
this condition early on can give patients a better chance to manage their
symptoms in the long term.Long-term management Many
patients are able to adequately self-monitor their pain and other symptoms of
radiculitis, managing with medication, physical therapy and other treatments,
and visit a physician when their symptoms change markedly or degrade over a
span.Surgery for Lumbar Radiculitis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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