From the Guidelines
Treatment for neuropathy due to a lumbar bulging disc should prioritize a combination of pain management, physical therapy, and lifestyle modifications, with a focus on reducing inflammation, improving spinal stability, and enhancing quality of life. The most recent and highest quality study, 1, recommends first-line treatments for neuropathic pain, including antidepressants, α2-δ calcium channel ligand anticonvulsants, and topical lidocaine.
Key Components of Treatment
- Over-the-counter pain relievers like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) can help reduce inflammation and pain.
- Prescription medications such as gabapentin (starting at 300mg daily, gradually increasing to 300-600mg three times daily) or pregabalin (starting at 75mg twice daily, up to 300mg daily) specifically target nerve pain.
- Muscle relaxants like cyclobenzaprine (5-10mg three times daily) may be prescribed for associated muscle spasms.
- Physical therapy focusing on core strengthening, proper posture, and specific stretching exercises is crucial for long-term improvement.
- Heat and cold therapy can provide temporary relief, with heat improving blood flow and cold reducing inflammation.
- Activity modification to avoid movements that worsen symptoms is important, but complete bed rest is not recommended as it can lead to muscle weakness.
Additional Considerations
- For persistent symptoms, epidural steroid injections may provide temporary relief by reducing inflammation around the affected nerves.
- Surgery is typically reserved for cases with severe or progressive neurological symptoms or when conservative treatments fail after 6-12 weeks.
- The British Pain Society's spinal care pathway, as described in 1, emphasizes the importance of self-management, early assessment, and a stepped care approach, empowering patients to make informed choices regarding available treatment options.
By prioritizing these treatment components and considering the individual patient's needs and preferences, clinicians can develop an effective treatment plan that improves outcomes and enhances quality of life for patients with neuropathy due to a lumbar bulging disc.
From the Research
Treatment Options for Neuropathy due to Lumbar Bulging Disc
- Medications such as pregabalin and gabapentin have been shown to be effective in managing neuropathic pain in patients with spinal cord injuries or lumbar disc herniation 2, 3.
- Pregabalin is a novel GABA analog that binds to the α2-δ subunit of voltage-sensitive calcium channels, with efficacy noted within the first several days of administration 2.
- Gabapentin and pregabalin can decrease perioperative central sensitization and early post-surgical neuropathic pain, and can effectively relieve neuropathic pain and prevent the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy 3.
- A comprehensive algorithm for the management of neuropathic pain recommends multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy 4.
- Lumbar disc herniations can be diagnosed with a thorough history and physical examination along with advanced imaging, and treatment plans are dictated by corresponding patient symptoms and examination findings with their imaging 5.
- Both pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 6.
Non-Surgical Measures
- Most patients can experience relief with nonsurgical measures, such as physical therapy, chiropractic care, and pain management medications 5.
- Transforaminal epidural steroid injection (TFESI) has been used to treat radicular pain, and additional medications such as gabapentinoids can be administered to relieve remnant pain 6.