Lumbar disc disease is another frequently encountered problem in the pain clinic. Patients with prolapsed discs often recall a specific event precipitating the onset of the pain. The pain is exacerbated by standing and increases in abdominal pressure, whilst it may be relieved by lying flat. It may radiate into the leg in a der-matomal distribution and, if significant nerve root compression is present, this may well be the dominant complaint. Sensory, motor and reflex changes may also accompany the pain. Straight-leg raising may produce radicular pain when the leg is raised to greater than 40°. Positive crossed straight-leg raising produces pain in the affected side by raising the contralateral side. CT and/or MRI scanning will demonstrate disc prolapse, if present, and the presence or absence of nerve compression. The patients can be divided into two groups - those with symptoms, signs and radiological evidence of nerve compression at one (occasionally more) level, and those in whom the findings are inconsistent, e.g. symptoms referable to a different disc prolapse than seen radiologically; or those with no radiological lesion.
The management of "disc induced" sciatica follows the standard guidelines for back pain but more focused treatments are available for persistent or severe problems. Discectomy is discussed elsewhere. Epidural steroid injections are widely practiced. It is difficult to establish the number of these procedures performed but, in the UK, the figures will be measured in the
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.