Lumbosacral Discogenic Pain Syndrome Treatment & Management

Updated: Aug 19, 2016
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
  • Print
Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

An acute or subacute disc injury should initially be treated conservatively. Conservative care includes physical therapy, anti-inflammatory medication, analgesics, and non–habit-forming sleep aids as necessary.

The emphasis of physical therapy is to reduce muscular guarding, improve segmental motion, reverse or improve mechanical faults, and ultimately improve the function of the injured individual through a home exercise program.

Once muscle guarding and mechanical faults have been improved, the patient is generally started on a lumbar stabilization program, with a trunk and lower extremity stretching program and a graduated conditioning program. The conditioning program emphasizes walking and may, depending on the individual’s history and overall health, emphasize weight training in a lumbar-safe manner.

Next:

Recovery Phase

Rehabilitation Program

Physical Therapy

This phase of rehabilitation focuses on the functional biomechanical and soft tissue deficits. Strengthening exercises start in simple planes and progress to complex muscle patterns. A lumbar spine stabilization program is initiated, using coordinated co-contraction of the abdominal and extensor muscles in a neutral posture.

Other Treatment (Injection, manipulation, etc.)

Evidence for epidural injection, one of the most frequent interventions for chronic low back pain, has been highly variable. However, for those with persistent discogenic pain despite a conservative approach, epidural steroid injection may be warranted to provide pain relief to allow for more active participation in conservative treatment. A 2012 meta-analysis of lumbar interlaminar epidural injections in the treatment of radiculitis due to disc herniation, spinal stenosis, or axial pain for nonherniated discogenic pain showed good-to-fair evidence for local anesthetic plus steroid under fluoroscopy. Evidence was best for herniated discs with radicular pain; however, results from one randomized controlled trial and two nonrandomized control studies showed positive effects at 3-, 6-, and 12-month follow-up for this approach to lumbosacral discogenic pain without radiculopathy. [9]

A randomized clinical trial by Desai et al evaluated the effectiveness of intradiscal biacuplasty versus conventional medical management in the treatment of lumbar discogenic pain. The study concluded that intradiscal biacuplasty is more effective than conventional management alone. [10]

Previous
Next:

Maintenance Phase

Rehabilitation Program

Physical Therapy

The final phase of rehabilitation requires full nonpainful active and passive lumbar range of motion and an appropriate neutral posture during both static and dynamic activities. Sport-specific activities should be reviewed to ensure correct techniques.

Previous