From the Research
The initial treatment for disk stenosis should focus on conservative, non-surgical approaches, prioritizing multimodal care with education, advice, and lifestyle changes, as well as home exercise and manual therapy, as recommended by the most recent guideline evidence 1. The treatment plan should be tailored to the individual patient, considering the type of treatment involved.
- Start with a combination of rest (1-2 days maximum to avoid deconditioning) and activity modification to avoid painful positions.
- Over-the-counter pain medications such as acetaminophen may be considered for pain relief, although the evidence for their effectiveness in disk stenosis is limited.
- Physical therapy should be initiated early, focusing on core strengthening, flexibility, and proper body mechanics.
- For more severe pain, prescription medications may include serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants, as suggested by the guideline evidence 1.
- Epidural steroid injections are not recommended as a first-line treatment, according to the guideline evidence 1, which suggests that they may not provide significant long-term benefits. The goal of these conservative treatments is to reduce inflammation, relieve pressure on affected nerves, and strengthen supporting structures to improve spinal stability, ultimately improving the patient's quality of life and reducing morbidity and mortality.
- Most patients experience significant improvement within 6-12 weeks of consistent conservative management, making surgery unnecessary in the majority of cases. It is essential to monitor the patient's progress and adjust the treatment plan as needed, considering the individual patient's response to the initial treatment approach.