NON – SURGICAL INTERVENTION IN BACK PAIN Dr. SANDEEP KUMAR KESHARWANI MS (ORTHO), FNB SPINE FELLOW
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- 1. NON SURGICAL INTERVENTION IN BACK PAIN Dr. SANDEEP KUMAR KESHARWANI MS (ORTHO), FNB SPINE FELLOW
- 2. NON-PHARMACOLOGIC o Patient education (back school) o Physical therapy (stretching, strengthening exercise, massage, traction) o Heat/Cold therapy o TENS o Chiropractic manipulation o Orthotic devices
- 3. MEDICATIONS o Acetaminophen o NSAIDs o Narcotics o Steroids o Adjuvants (Antidepressants, anticonvulsants, muscle relaxants)
- 4. MODES OF INTERVENTION Transduction NSAIDs, Local Anesthetics & Anticonvulsants Transmission Opioids, NMDA Antagonists Modulation Tricyclic Antidepressants, Opioids, GABA Agonists
- 5. Pain Step 1 Nonopioid Adjuvant Pain persisting or increasing Step 2 Opioid for mild to moderate pain Nonopioid Adjuvant Pain persisting or increasing Pain persisting or increasing Step 3 Opioid for moderate to severe pain Nonopioid Adjuvant Invasive treatments Opioid Delivery Quality of Life MODIFIED WHO 3- STEP ANALGESIC LADDER Proposed 4th Step The WHO Ladder Deer, et al., 1999 8 -10 4 - 7 1 - 3 Pain Severity
- 6. INVASIVE PROCEDURES o Selective injection o Intradiscal electrothermal therapy o Radiofrequency denervation
- 7. EARLY INTERVENTION 1. Medicines NSAIDS Acetaminophen Muscle Relaxants Narcotics (short duration) 2. Short term bed rest (2days maximum) 3. Physical therapy 4. Chiropractics
- 8. LATER ALTERNATIVES 1.Medicines- Antidepressants 2.Orthotic devices 3. Physical therapy 4. Therapeutic injections Epidural Nerve Root Medical Branch 5. Radiofrequency denervation 6. IDET 7. Acupuncture
- 9. THANKYOU
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