I have a patient with a 6 month history of LBP secondary
to a slight contained disc herniation at L5-S1 & posterior annular
tears to L5-S1 & L4--L5. She also has had some SI jt dysfunction and
facet dysfunction and a significant anatomical leg length
discrepancy, but the SI and facet problems have resolved due to PT,
orthotics, and jt injections. The current problem is pain and
tingling in the S1, some L5 dermatome Sxs, and in the buttocks all
on the left side, which tends to occur only during acute flare-ups
which the patient attributes to increased sitting (and standing) and
increased activity (job is primarily sitting all day with limited
intermittent activity). NSAIDS help decrease the pain, but the
patient has had four major flare-ups since the initial injury 6 mos
ago, and recently the NSAIDS seem to be less effective in relieving
Sxs. The patient is unable to change the sitting requirements of her
job or to quit her job, but is quite frustrated by the flare-ups
which seem to last longer with more severe Sxs each each time. The
MD has suggested an epidural if Sxs do not resolve after this most
recent flare-up. The Pt has been in PT from 2x/wk to once every
other week throughout the course of the injury. Ab bracing &
strengthening increase Sxs during flare-ups and ST work helps only
for a day or less. Is there something else I have missed or could
try? Has anyone had much long-term success with epidurals for
discogenic pain?
J Kison, SPT, ATC
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