Pain and inflammation in musculoskeletal disorders

Question 1

Low Back Pain

Answer 1

 Low back pain in the lumbosacral area of the back
 Non-Drug treatment: Physio Exercises / Manual therapy / Psychological therapy
 Drug treatment: Acute & Chronic Low back pain
o First Line: Oral NSAID (possibly with PPI)
o Last Line (ineffective / contra-indicated): Weak Opioid alone /+ Paracetamol

Question 2

Sciatica

Answer 2

 Sciatica (Radicular pain or Radiculopathy) is neuropathic leg pain secondary to compressive lumbosacral nerve root pathology
 Treat as for lower back pain (SEE ABOVE)
 If unresponsive: Possible treatment for neuropathic pain (Amitriptyline, Nortriptyline, Pregabalin, Gabapentin)
 Acute / severe sciatica: Possible Epidural injections of local anaesthetic and/or corticosteroids
 No improvement in pain & function with drug & exercises: Spinal decompression