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Radicular manifestations
Nerve root
Acute back pain
Less than 4 weeks
Subacute back pain
4-12 weeks
Chronic back pain
>12 weeks
Radicular LBP
Lower-extremity pain
Paresthesias
Weakness
Result of nerve root impingement or compression
Electromyography
Measures electrical impulse within muscle tissue, nerve conduction testing, and evoked potentials
Myelogram
Dye injected into spinal column
Can show PRESSURE ON CORD/NERVE
1st line tx for acute/subacute
Nonpharm
Heat and massage
Acute/subacute unresponsive to nonpharm
NSAIDs
1st line tx for chronic LBP
Nonpharm
exercise
rehab
acupuncture
mindfulness
Chronic LBP unresponsive to nonpharm 1st line
NSAIDS
Meds that block sodium channels
Lidocaine, anticonvulsants, TCAs
Opiods
reserve for severe break through pain
Interventional therapy
Nerve Blocks with lidocaine
TENS
Electrical impulses
When is back surgery indicated?
Radicular or spinal cord compression (herniated nucleus pulposus)