Bed rest, psychoactive drugs and epidural injections

Abstract

Acute backs can be the result of new disease entities (such as prolapsed intervertebral discs or muscle tears), or exacerbations of existing conditions (such as facet joint subluxations secondary to segmental instability or longstanding disc disease). The latter, acute on chronic syndromes, are the more common especially in those patients older than 45 years. Patients younger than this tend to get prolapsed discs (if they are male) or strained ligaments (if they are female). Acute prolapsed discs are accompanied by agonizing pain and intense muscle spasm. Straight leg raising is nearly always reduced. These patients should be put to bed to rest, a treatment that is often prescribed for other causes of acute backs but is seldom necessary. Macnab (1977) points out that theoretical treatment must be tempered by reason. What about tomorrow’s surgery for the dentist with an acute back pain? The experience of the lay world is that the majority of patients will get better just creeping around with their pain mollified by analgesics. Cyriax (1969) writes that getting out of bed will not increase the size of the disc protrusion, but merely cause additional pain. It is for the patient to decide which he dislikes more — not doing what he wants or getting increased pain if he does: ‘There is no point, therefore, in keeping a patient of this sort in bed any longer than he wishes’.