Analgesics

1. Naproxen (Naprosyn) 500 mg followed by 250 mg PO tid-qid prn [250, 375,500 mg].

2. Naproxen sodium (Aleve) 200 mg PO tid prn.

3. Naproxen sodium (Anaprox) 550 mg, followed by 275 mg PO tid-qid prn.

4. Ibuprofen (Motrin, Advil) 800 mg, then 400 mg PO q4-6h prn.

D. Aerobic exercise may strengthen the abdominal and back muscles, relieve symptoms, reduce weight and alleviate depression and anxiety.

E. Trigger point injections can provide extended relief for localized pain sources. An injection of 1 to 2 mL of 1 percent lidocaine (Xylocaine) without epinephrine is usually administered. Ultrasound (phonophoresis) or electricity (iontophoresis) over the injected area may provide additional relief. Epidural steroid injection therapy has been reported to be effective in patients with lumbar disc herniation with radiculopathy.

F. Indications for herniated disc surgery. While most patients with a herniated disc may be effectively treated conservatively. Indications for referral include the following: (1) cauda equina syndrome, (2) progressive neurologic deficit, (3) profound neurologic deficit and (4) severe and disabling pain refractory to four to six weeks of conservative treatment.

References: See page 195.

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