Chronic low back pain

Patient

Q: Was in a car accident in 10 2009 have been having back pain ever since. went to dr had a mri done on 6 2010 revealed compression fracture on L1 and mild disc disease in T12 to L1 L1 to L2 and L3 to L4. mild protrusion of L1. Had my 2nd epideral and after a few days to a week im back to the pain ive been having, what is the next step and how can i relieve this pain.

Doctor

A:   Chronic low back pain (LBP) is the most expensive benign condition in industrialized countries and the most common cause of activity limitation in persons younger than 45 years. It is defined as pain that persists longer than 12 weeks and is often attributed to degenerative or traumatic conditions of the spine. Mechanical or activity-related spinal pain is most often aggravated by static loading of the spine (prolonged sitting or standing), long-lever activities (vacuuming or working with the arms elevated and away from the body), and levered postures (forward bending of the lumbar spine). Pain is reduced when walking or constantly changing positions, and when the spine is unloaded (reclining). However, a persistent, relenting pain requires further investigation, as follows: evaluation by a physician, imaging studies (MRI, CT scan) and sometimes even functional studies as electromyography. Your case may be managed as chronic low back pain (LBP), you might benefit of a longer course of Physical Therapy and anti-inflammatory medication (“Aleve”, “Motrin”). Some antidepressants are useful in chronic LBP to alleviate insomnia, and pain In addition, these medications may improve the patient's ability to cope, and they may reduce depression, anxiety, or fatigue associated with chronic LBP. Local anesthetics, corticosteroids, or other substances may be directly injected into painful soft tissues, facet joints, nerve roots, or epidural spaces.

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