What is the role for alternative treatments for discogenic low back pain?

• TENS (transcutaneous electrical nerve stimulation) and acupuncture can reduce pain although they do not address the primary mechanical problem.
• Injections into trigger points, motor points, and ligaments can reduce the secondary soft tissue component of the pain in selected individuals.
• Epidural steroid blockade may playa role in reducing inflammation of the nerve root.
• Chymopapain disc injections are rarely considered due to occasional serious neurological or medical complications.
• Percutaneous discectomy is a promising surgical technique that is in its infancy.

GUIDELINES FOR PATIENTS WITH A LUMBAR DISC SYNDROME

1. Strict bed rest for_______hrs. per day for ________days. (One shower per day. Out of bed for meals; preferably standing).
   
   It is often comfortable to lie face up with a pillow under both calves or in a side-lying position with the knees and hips bent slightly, or face down with a pillow under the abdomen.
   
2. Lie face down with pillow under head and chest 10-20 min. every 3-4 hrs. Discontinue this if you experience buttock or leg pain. Low back discomfort is acceptable.
   
3. Avoid sitting. When necessary, sit in a chair with a firm back with a lumbar support or cushion (at waist level.)
   
4. When standing, it is often comfortable to place one foot on a stool or step.
   
5. When driving is necessary, use a lumbar support cushion (pillow at waist level) and sit with rear at very back of seat. If possible, move seat forward and recline 30 degrees. Stop driving every 30-40 min. Get out of the car and stand upright arching your back slightly. Then continue driving.
   
6. Avoid bending. When necessary, bend at the knees and directly in front of you.
   
7. Avoid lifting. When necessary, lift the object close to your body and directly in front of you.
   
8. Avoid twisting.
   
9. Treat sneezing (colds and allergies), coughing, and constipation as fully as possible with medications.
   
10. When traveling:
    Whenever possible, interrupt sitting every 30-45 min. by standing up and
    arching your back with your hands on your hips. Recline as much as
    possible, bulkhead or aisle seat, two light suitcases instead of one heavy.
    
11. When exercising:
    Avoid: Raising weights in front of you, trunk twisting and bending (i.e. full sit-ups). straining. breath holding, bouncing (jumping, running on hard surface).
    Advise: When using machines or free weights, it is best to use small poundage lifted numerous times rather than lifting high poundage only a few times.