Prolapsed intervertebral disc causes low back pain which is often severe and usually comes on suddenly. The pain is usually eased by lying still and is often made worse on sudden movements of the spine such as for cough or sneeze.
Medications:
- Tab. Dolokind MR (Aceclofenac 100 mg, Paracetamol 325 mg, Chlorzoxazone 250 mg) 1 tablet twice a day for 5 days AND
- Tab. Pantakind 40 (Pantoprazole 40 mg) one tablet a day on empty stomach for 7 days.
- If patient is not diabetic or hypertensive – 7 days course of steroid – Tab. Zempred 4 (Methylprednisolone 4 mg)
Day 1 – 2 tablets before breakfast, 1 tablet each after lunch, dinner and 2 tablets at bedtime (total dose 24 mg per day).
Day 2 – 1 tablet before breakfast, 1 tablet each after lunch and dinner, 2 tablets at bedtime (total dose 20 mg per day).
Day 3 – 1 tablet before breakfast, 1 tablet each after lunch, dinner and at bedtime (total dose 16 mg per day).
Day 4 – 1 tablet before breakfast, 1 tablet each after lunch and at bedtime (total dose 12 mg per day).
Day 5 – 1 tablet before breakfast and at bedtime (total dose 8 mg per day).
Day 6 – 1 tablet before breakfast (total dose 4 mg per day).
General advice:
- Bed rest for first 48 hours. Later advice gentle non weight bearing exercises.
- Advice hot fomentation to reduce muscle spasm.
- Avoid lifting or moving heavy weights whilst bending over.
- Suggest using lumbar corset or support belt for a few days till patient has improved mobility.
Investigations:
- MRI Spine- to evaluate intervertebral disc protrusion and pressure effects.
Referral:
- Refer patient for physiotherapy to improve mobility and reduce muscle spasm.
- Consider referral to spinal surgery in case of MRI evidence of nerve compression.