Author: Jasmeet Singh

TRIGEMINAL NEURALGIA

Trigeminal Neuralgia (TN) is defined by the International Association for the Study of Pain (IASP) as sudden, usually unilateral, severe, brief stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve (Merskey et al.). Less often patients may have a constant, aching or burning sensation. A tingling sensation or aching may also precede the pain episodes. Vibration or contact with the face may trigger the intense flashes of pain. The attacks usually last several seconds to a couple of minutes, and repeat over hours to weeks. The episodes then disappear for months to years before recurring. It can be bilateral, but does not involve both sides simultaneously. Rarely does the pain occur at night when the patient is sleeping. It tends to affect females slightly more than males at a ratio of 1.5:1, and increases slightly with age. Attacks can worsen over time, and the latent periods become more infrequent and shorter.

Pathology

The cause of trigeminal neuralgia is the compression of the trigeminal nerve root. Causes of compression are tumors (vestibular schwannoma or meningioma), epidermoid cyst, or aneurysm (out pouching of a blood vessel). The compression then leads to damage of the protective covering of the nerve, called myelin. As a result, the nerve acts in an erratic manner, causing pain signals to be sent sporadically at the trigger of light touch, chewing, or brushing the teeth. Rarely, traumatic injuries of the trigeminal nerve, such as a car accident, can lead to similar damage. Multiple sclerosis is a condition where the loss of myelin in one or more of the trigeminal nerve nuclei can also cause trigeminal neuralgia.

Diagnosis

Diagnostic criteria for classic trigeminal neuralgia have been developed and published by the International Headache Society (IHS),

Attacks of pain lasting from a fraction of a second to two minutes, affecting one or more of the subdivisions of the trigeminal nerve
Pain has at least one of the following characteristics:
- Intense, sharp, superficial, or stabbing
- Precipitated from trigger areas or by trigger factors
Attacks are stereotyped in the individual patient
There are no clinically evident neurologic deficit
Not attributed to another disorder

It can be difficult to diagnose TN and the Pain Physicians at Arkansas Pain have received extra training to examine and diagnose your painful condition. The physician may be able to demonstrate the trigger zones, while the neurological examination is normal. Most neurologic deficits indicate an alternative cause of pain. The physician may also order radiological imaging depending on his clinical suspicion and the history obtained. Other causes of facial pain can be differentiated by these factors:

Post herpetic pain – has persistent, typical rash that tends to involve the ophthalmic branch.
Migraine – pain is more prolonged and often throbbing.

Treatments Options

The standard medical approaches are anti-inflammatory, anticonvulsant, and antidepressant medications. If these fail, local anesthetic blocks are attempted. Lastly, percutaneous or open procedures may be done. Peripheral nerve stimulation may be a viable option earlier in the treatment of chronic facial pain. In patients not responded to medical treatment, there are several options for surgical procedures (Jannetta and Nurmikko et al).

These surgeries include:

Microvascular decompression – an invasive procedure involving removal or separation of vasculature, which is often the superior cerebellar artery, away from the trigeminal nerve.
Balloon compression – a balloon catheter is inflated and used to compress the gasserian ganglion.
Gamma knife radiosurgery – a noninvasive treatment that creates lesions by using focused gamma radiation. The radiation is targeted at the proximal trigeminal root with the aid of stereotactic frame and MRI.
Electrolytic rhizotomy – a percutaneous procedure that creates a lesion in the gasserian ganglion of the trigeminal nerve by using the heat of radiofrequency.
Linear accelerator radiosurgery – a noninvasive approach similar to gamma knife, but uses a different form of radiation, linear acceleration.
Peripheral neurectomy – an incision, radiofrequency lesioning, alcohol injection, or cryotherapy is used on a peripheral branch of the trigeminal nerve.
Chemical rhizotomy – an injection of glycerol into the trigeminal cistern. Tingling or burning is felt in the face, and pain relief is usually immediate, but may take up to a week.

All of the above mentioned treatments have a high recurrence of pain.

Here at Arkansas Pain, your physician may talk to you about peripheral nerve stimulation (PNS) or spinal cord stimulation (SCS) of the nucleus caudalis for severe facial pain. These treatments may offer the potential for long-term management of the pain and may offer obvious benefit and less risk than neuro-destructive procedures. Because there is a trial period for SCS or PNS the procedure is often less invasive, reversible, adjustable, and testable for patients in pain.

Articles

Adam Sewell MD

TESTICULAR PAIN

Testicular pain, or orchialgia, is typically caused by some kind of trauma. Some other causes of testicular pain include infection, and inflammation. Testicular torsion is a traumatic condition in which the testicle twists inside of the scrotum, cutting off the blood supply. This is a medical emergency, and typically requires surgical intervention. Trauma can also cause testicular rupture. Some symptoms of testicular torsion or testicular rupture include sudden, severe pain as well as redness and swelling of the scrotum.

A common infection of the testicles is called epididymitits, an infection or inflammation of the epididymis. This condition is frequently caused by sexually transmitted disease, including chlamydia or gonorrhea. Epididymitis in older men may be related to an enlarged prostate. This condition usually results in a gradual onset of pain, including redness and swelling of the scrotum. Some other symptoms associated with epididymitis are nausea, vomiting, fever, painful urination, and painful intercourse. The typical treatment for this condition is antibiotics.

Orchitis is an inflammation of the testicle. Orchitis may be caused by epididymitis that has gone untreated. Symptoms of orchitis are similar to epididymitis, and are typically treated with pain medications, antibiotics, and ice. Occasionally orchitis needs to be surgically drained.

Another type of inflammation in the testicular region is an inguinal hernia. An inguinal hernia occurs when a loop of bowel protrudes into the scrotum through a weakened part of the abdominal muscles, and is typically treated by surgical intervention. Symptoms include pain and bulging in the groin and scrotum especially during heavy lifting activities. If the intestine becomes trapped, or strangulated it will require immediate medical attention.

Treatment

When testicular pain has been present for three or more months, it is considered chronic orchialgia. Chronic orchialgia may be treated with medications, acupuncture, biofeedback, physical therapy and muscle relaxation techniques, nerve blocks, and spinal cord stimulation. Common types of medications used to treat pelvic pain include anti-inflammatories, anti-depressants, neuropathic medications, and occasionally opioids.

For male pelvic pain that does not respond to more conservative treatment modalities, a spinal cord stimulator (typically with sacral leads) may be beneficial. Spinal Cord Stimulation (SCS) is when a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.

If you suffer from chronic pelvic pain, Arkansas Pain can help. We offer advanced and comprehensive treatment options that encompass all of your pain management needs. Call us today to schedule an appointment!

References

Adam Sewell MD

TENSION HEADACHES

Tension Headaches are generally a sharp, steady, throbbing or tight, lingering headache pain. Tension headaches occur often by untraceable triggers. Approximately 45 million Americans suffer from chronic headaches. Tension headaches are the most common form of headaches. While it was believed tension headaches were the result of neck or scalp muscles becoming tense and contracting, researchers have only found this to be true in some tension headaches. A new theory describes interference in nerve pathways to the brain as a more likely commonality of tension headaches.

Tension headaches can be set off in response to some sort of habitual trigger. Staring at a screen for too long or working under great stress are some of the simple common triggers of tension headaches. Certain foods and beverages can also trigger pain. Alcohol, caffeine and nicotine are indigestible products that can cause tension headaches upon consumption or withdrawal.

Symptoms are pain which is usually dull and all over the head. A tight, band-like feeling in the forehead can also accompany the pain. Other reports are irritability, disrupted concentration, and sensitivity to noise or light. Tension headaches are chronic if they occur in sufferers more than 15 times per month. Over 90% of women report suffering from tension headaches at some point in lives versus 70% of men. These headaches are most common for middle-aged people, presumably because of the connection to stress.

Over-the-counter pain medication such as ibuprofen and aspirin can temporarily relieve pain and sometimes outlast the headache. Additionally, doctors can prescribe antidepressants and muscle relaxants as preventative medications for chronic headaches. Some lifestyle changes may also help alleviate the frequency and severity of the headaches.

Acupuncture, massage therapy and biofeedback have also become viable treatment options for chronic headaches.

Those with headaches may wish to download the Arkansas Pain Headache Journal to document what you are experiencing. Use our journal to document the details of your headaches, possible causes, what treatment you attempted (medication, herbal remedies, dark room, etc.) and the effects of that treatment. This record can be extremely useful during your next visit.

References

Adam Sewell MD

SPINAL STENOSIS

Spinal Stenosis is a disorder due to the narrowing of the spinal canal causing nerve and spinal cord impingement. Often this results in persistent pain in the lower back and extremities. Difficulty walking, decreased sensation in the lower extremities, and decreased physical activity may also be seen. Spinal stenosis most commonly affects people over the age of 65. Scoliosis and hypertension are considered to be risk factors. Interestingly increasing age alone increases the risk for spinal stenosis without pre-existing pathology (Coronado 2007).

Pathology

Symptoms develop due to complications from the narrowing of the spinal canal where the spinal cord is located. This constriction produces symptoms of impingement on the spinal cord, spinal vasculature, and surrounding peripheral nerves. Disc bulging and herniation as well as arthritic changes of the vertebrae can cause narrowing of the canal. The pain and decreased mobility that is produced by this condition may cause a disability that can significantly impair a patient’s lifestyle (Boswell 2007). Another common complication of chronic pain due to spinal stenosis is Central Sensitization. Central sensitization occurs when there is an increase in the excitability of neurons within the central nervous system at the level of the spinal cord and higher. Symptoms of progressive and severe spinal stenosis include bladder or bowel incontinence, lower extremity weakness, or loss of sensation. These symptoms can be a medical emergency and require immediate evaluation.

Diagnosis

A physician most likely will order radiological imaging such as CT scan or MRI to confirm the level of stenosis.

Treatment

Medications such as NSAID’s, membrane stabilizing drugs and other analgesics

Epidural Steroid Injections involves injecting a medication into the epidural space, which includes both a long-lasting steroid.

Percutaneous Adhesiolysis also known as the Racz catheter uses a needle inserted into the caudal epidural space (by the tailbone). A catheter is advanced into the epidural space under fluoroscopy guidance where corticosteroid, local anesthetic, Wydase, and Hypertonic Saline are injected to aid in breaking up scar tissue.

Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.
Surgical Treatments al laminectomy or foraminotomy may be necessary to take pressure off the spinal cord and surrounding nerves. Often surgical decompression is recommended in acute spinal stenosis and especially in patients who rapidly develop loss of bladder/bowel function, weakness, and decreased sensation.

Journal Articles

Adam Sewell MD

SHINGLES

Shingles is a rash caused from the varicella-zoster virus, which is also the cause of chickenpox. The virus remains inactive after chickenpox, but can reactivate in the nerves in adulthood, causing the painful rash. It is not understood why some people develop shingles. Typically there is just one attack and Shingles is not infectious, but the virus can be passed to others who have never had chickenpox.

Symptoms of shingles include tingling and burning prior to the appearance of a rash. A rash will develop and will intensify to small blisters. The blisters can burst and create small ulcers. Within two to three weeks, the ulcers will heal. The rash is often seen on the spine, stomach and chest, although it may also be found on the face and mouth. Other symptoms include abdominal pain, chills, facial distortion due to muscle cramping, fever, headaches, joint pain, swollen glands and impaired vision.

Signs and tests

Tests are rarely needed, but if required it may include taking a skin sample to see if the skin is infected with the virus that causes shingles. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus but is not conclusive for diagnosis.

Shingles Treatment

Your doctor may prescribe an antiviral. The drug helps reduce pain and complications and shorten the course of the disease.

The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. Some people may need to receive the medicine intravenously.

Strong anti-inflammatory medicines or corticosteroids, may be used to reduce swelling and the risk of continued pain.

Other medicines may include:

Antihistamines to reduce itching
Pain medications
Creams containing capsaicin (an extract of pepper)

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, and calamine lotion, may help to relieve itching and discomfort and plenty of bed rest is recommended.

The skin should be kept clean, and contaminated items should not be reused. Non-disposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infecting other people who have never had chickenpox and especially pregnant women.

Complications

Sometimes, the pain in the area where the shingles occurred may last for months or years. This pain is called post herpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe pain. It is more likely to occur in people over 60 years.

Other complications may include:

Another attack of shingles
Blindness (if shingles occurs in the eye)
Deafness
Infection, including encephalitis or sepsis (blood infection) in persons with weakened immune systems
Bacterial skin infections
Ramsay Hunt syndrome if shingles affected the nerves in the face

Prevention

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive immediate medical attention.

References

Adam Sewell MD

SCOLIOSIS

Scoliosis is a condition involving abnormal curvature of the spine and affects 5-7 million people in the US.

Scoliosis can begin at any age is more prominent among females and can be genetic, occurring in about 1-2% of adolescents and more than 50% in persons over age 60.

Scoliosis may be idiopathic, congenital, or occur as a consequence of another condition. It is called idiopathic when no underlying cause can be identified. Most cases of scoliosis are considered idiopathic. Congenital scoliosis is present at birth. Scoliosis as a secondary symptom of another condition may occur in concert with neuromuscular diseases such as spina bifida and cerebral palsy, and hereditary musculoskeletal disorders including osteogenesis imperfecta, Marfan syndrome, Stickler syndrome, Ehlers-Danlos syndrome, and muscular dystrophies. In other cases, scoliosis may arise from physical trauma, spinal stenosis, and bone collapse from osteoporosis.

Scoliosis may produce specific, progressive signs and symptoms. The main diagnostic criterion for scoliosis is spinal curvature exceeding 10 degrees in a single plane. The spine may appear to bend in a “C” or “S” shape. Other signs of scoliosis may include uneven musculature on one side of the spine, uneven hips, uneven leg lengths, imbalance, anxiety, and a prominent rib or shoulder blade caused by rotation of the ribcage. In severe cases, which involve angles of greater than 25 degrees, patients may experience difficulty breathing, pain, and reduced functionality, and infections that can cause damage to the heart and lungs.

If scoliosis is neglected, spinal deformity may progress dramatically. In general, treatment is based upon severity and location of the curvature, as well as the age of the individual. Recommended treatment programs include physical therapy, occupational therapy, and chiropractic care. Surgery is usually reserved for patients whose curves are greater than 45 degrees or have a high likelihood of progression, and impaired physiological functions such as breathing. Fortunately, most curves can be treated non-operatively if they are detected before they become too severe.

References

Adam Sewell MD

SCIATICA

Sciatica

Sciatica is a condition that refers to a group of pain symptoms or unusual sensations, typically manifesting on one side of the body, lasting for a period of weeks to months.

The pain and other sensations result from an irritation or compression of one or more nerve roots in the lumbar spine, or lower back. Pain often starts in the lower back or in the buttocks, down the leg, the ankle, and into the foot.

The symptoms range from pain, cramping, weakness, tingling, or numbness. Sometimes the pain is described as a having a “pins and needles” sensation. The discomfort follows the same pathway as the sciatic nerve—down the leg.

Most patients fully recover from sciatica; and in most cases, the nerve is not permanently damaged. Although not typically considered an emergency, medical attention is needed if the symptoms are severe and don’t improve. If more serious symptoms arise, consult your physician, or go to the emergency room immediately.

Serious symptoms may include:

Severe pain
High body temperature
Bladder or bowel incontinence
Lower extremity weakness
Profound loss of sensation
Inability or difficulty in walking

The sciatic nerve is the longest and largest nerve in the body. It controls motor and sensory functions for the lower extremities (legs, ankles and feet). As such, the sciatic nerve can be compromised by a variety of conditions and diseases. Many of these conditions can ultimately lead the nerve to become inflamed, pinched, stretched or damaged.

Conditions that cause lower back pain and sciatica include:

Herniated or bulging disc
Degenerative disc disease
Spinal stenosis
Piriformis syndrome
Facet hypertrophy

Additionally, sciatica and lower-back pain may also result from pregnancy, tumor, pelvic infections, and other causes.

To diagnose this condition, a pain physician performs various muscle tests to note any limitations in movement in the lower extremities. The pain physician most likely will order one or more diagnostic tests, such as X-ray, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI) or bone scan. MRIs are considered the best procedure to detect causes of chronic lower-back pain and sciatica. Depending on medical history and other factors, additional tests may be required.

There are many treatment options available for pain relief, reduction and management.

Pharmacotherapy – over-the-counter non-steroidal anti-inflammatories (NSAIDs), acetaminophen and other analgesics. Prescription medications such as, membrane stabilizing drugs and muscle relaxants may be prescribed for pain relief or management associated with lower-back pain and sciatica.

Epidural steroid injections (ESI) – this procedure involves injecting a medication into the epidural space. The injection includes both a long-lasting corticosteroid and a local anesthetic. The corticosteroid is long-lasting and works to reduce inflammation and irritation. The anesthetic works immediately to interrupt the pain-spasm cycle.

Lysis of adhesions – also know as the “Racz Procedure.” Using an epidural needle, a catheter is placed into the injection site to administer fluids and medication, during the procedure, and to break-up scar tissue.

Trigger point injections (TPIs) – this involves injecting a local anesthetic and corticosteroid into one or more trigger points. TPI addresses areas of muscle containing trigger points, such as knots of muscle formed through muscles spasms.

Disc decompression – a needle is inserted through the skin into the herniated or bulging disc with a local anesthetic and possible sedative. The protruding material is suctioned out of the disc and pressure on the nerves or ligaments are eliminated.

Infusions techniques– a local anesthetic and other medicines are administered through the catheter for extended time periods.

Transcutaneous Electrical Stimulation (TENs) – TENs is the use of electric current produced by a device to stimulate the nerves for pain management.

Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.

Intrathecal Pump Implants – an intrathecal pump is a computerized device, which delivers concentrated amounts of medication(s) into the spinal cord area via a small catheter.

Botox injections – injections of small amounts of Botox ease pain through paralyzing nerves or muscles. They should only be administered by a licensed physician, with experience using Botox as a pain relief treatment.

Other alternative and supplemental therapies for sciatica pain relief include, massage, acupuncture, biofeedback, physical therapy and exercise.

Nutrition and healthy eating habits offer many benefits for pain and overall good health. A nutritionist may prescribe a specific nutritional program. This may include the addition of vitamins, minerals, or supplements.

References

Adam Sewell MD

ROTATOR CUFF TEAR

Rotator cuff tears can cause nagging, aching pain that limits daily activities. A rotator cuff becomes torn when one of the tendons is injured. The tendon no longer attaches properly to the top of the humerus, or upper arm bone. The most common tear is in the supraspinatus muscle and tendon. This can cause an inflammation of the acromion, which may cause additional pain. There are several types of tears: partial, full-thickness, acute and degenerative.

The causes of these tears are most often an injury resulting from lifting something too heavy over-head, or repetitive stress. A lack of blood supply to the area, caused with age, can also reduce the body’s natural ability to repair itself. If a tendon is already slightly injured and the blood supply is diminished, a tear can occur. Most rotator cuff tears are caused from a combination of repetitive and degenerative causes. People age 40 and older are most at risk.

Symptoms include: pain if lying on the shoulder at rest, or when lifting and lowering the arm; weakness in the limb, especially when rotating the arm; or a crackling noise when moving the arm. When a tear is caused from a sudden injury, such as falling off a ladder or a car accident, there may be a snapping noise, followed by intense pain and a weakness in the arm.

A pain physician will rule out arthritis and a pinched nerve during examination. An MRI and ultrasound will likely be ordered to confirm the tear diagnosis. The MRI should provide the size and location of the tear.

Non-surgical treatment for rotator cuff tears include: rest, avoiding activities that cause pain, nonsteroidal anti-inflammatory over the counter medications, physical therapy and steroid injections. Half of all rotator cuff tear patients report pain relief without surgery. If a patient’s pain doesn’t improve, the physician may recommend surgery to repair the tendon and tear.

Rotator Cuff Tear – PainDoctor.com

Adam Sewell MD

REFLEX SYMPATHETIC DYSTROPHY

Post author By Jasmeet Singh
Post date April 9, 2020
No Comments on REFLEX SYMPATHETIC DYSTROPHY

Reflex sympathetic dystrophy (RSD) is also referred to as Complex Regional Pain Syndrome (CRPS), and typically occurs in the upper or lower extremities. There are two types of CRPS, CRPS 1, and CRPS 2. CRP1 occurs when pain stems from an initial painful event that may or may not be traumatic. CRPS 2 occurs when pain stems from an identifiable painful event or nerve injury. Both CRPS 1 and CRPS 2 cause continuous, intense pain out of proportion to the severity of the injury. Some common symptoms include drastic changes in the temperature and color of the skin over the affected limb or body part. The pain can be accompanied by severe burning, skin sensitivity, sweating, and swelling. Some other key features of CRPS include hyperalgesia, which is an increased sensitivity to painful stimuli, and allodynia, a painful response to a typically non-painful stimulus.

Diagnosis

CRPS is a very complex pain disorder, which can be very difficult to treat. CRPS often begins in the hand or the foot, and spreads to the affected arm or leg. CRPS can also spread to the opposite arm or leg. The cause of CRPS is unclear. There are no specific tests to diagnose CRPS, but testing can be done to rule out other diagnoses that may explain the symptoms. Blood testing can be ordered to rule out other inflammatory or rheumatologic conditions. Nerve conduction studies can also be ordered to rule out peripheral neuropathy or nerve entrapment conditions. Finally, a magnetic resonance imaging (MRI) can be ordered to rule out any soft tissue causes for the patient’s neuropathic symptoms. The diagnosis of CRPS is made in the absence of these other possible causes for the patient’s pain.

Treatment

The typical treatment for CRPS includes nerve blocks for pain reduction, desensitization treatments with a physical therapist, and medications that help with neuropathic pain. Some nerve blocks for upper extremity pain include stellate ganglion blocks, cervical epidural steroid injections, and interscalene blocks, followed by physical therapy. Injections for lower extremity CRPS include lumbar sympathetic nerve blocks, lumbar epidural steroid injections, and femoral sciatic nerve blocks, followed by physical therapy. Some medications used for CRPS include gabapentin, pregabalin, duloxetine and amitriptyline. If a patient does not respond to the physical therapy or medications, spinal cord stimulation may also be considered.

References:

Adam Sewell MD

PROLAPSED DISC

Prolapsed discs is the condition of a vertebral disc pushing outside of its designated space, which typically puts pressure on nearby nerves.

A prolapsed disc, also known as herniated or bulging discs, can be caused from back trauma, or regular back strain from heavy lifting. Researchers report some 5% of lower back pain is due to prolapsed discs. While a small percentage, this condition is one of the leading causes for back surgery.

When a disc is prolapsed, the inner liquid layer of the spine presses against the outer thick tissue layer causing a bulge. This bulge presses on a spinal nerve root, causing pain, numbness or weakness. The most common prolapsed discs are found in the lumbar, or lower, spine. They can also occur in the neck. When a disc is prolapsed in the lumber spine, it can cause radiating nerve pain; the pain is actually felt in another area of the body, typically the lower extremities or groin. This can also cause bowel and bladder incontinence, however this is most likely seen in patients with a more advanced form of prolapsed disc called Cauda Equina.

To assist with diagnosis, an X-ray should be ordered to search for possible fractures which could be a cause of the pain. A CT or MRI scan can be ordered to produce images of the inter-vertebral discs to look for possible nerve root compression. Finally, a nerve conduction study could also be ordered.

Initial treatment for low back pain is physical therapy, in addition other treatments options are:

Lifestyle changes, including weight loss, a healthy diet and regular exercise
Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) for management of pain
Opioid medications or muscle relaxants for more severe pain
Epidural steroid injections

For the 10% of patients who do not respond to these conservative treatment options, surgery may be required to alleviate pressure on the nerve root and ease pain. The most common surgeries are open discectomy, micro-discectomy and endoscopic.

To prevent prolapsed discs, patients should practice good posture and use proper lifting techniques to avoid injuries and strains to the lower back.