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Overview

Cyclobenzaprine

Prescription vs.OTC: Prescription by Doctor required

Cyclobenzaprine is a drug that is used as muscle relaxant. It is known to interfere and inhibit the nerve impulses sent from the brain to the muscles, thereby creating a numbing sensation in the muscles that subsides pain. The drug is usually administered along with other kinds of physical therapy and nutritional supplement to promote the repair of any skeletal or muscle injury.

The dosage depends upon the medical history of the patient, health conditions and the response to the therapy.

The drug is contraindicated in patients who have suffered or are suffering from glaucoma, cardiac disorders, lungs or liver disorders or renal malfunctioning. Take proper medical help in case you are pregnant, planning a pregnancy any time soon or breastfeeding. You must also inform the doctor of any other prescription drugs that you may be taking, such as hormonal pills as oral contraceptives, or any dietary supplements as Cyclobenzaprine may interact with the other drugs and cause a number of health complications. Some side effects include persistent headaches, dizziness, problems in sleeping, fatigue. You must avoid alcohol consumption, smoking, tobacco or caffeine during the course of the treatment to avoid any further health complications. Even the slightest discomfort should be reported to the doctor immediately, in order to avoid complications.

In addition to its intended effect, Cyclobenzaprine may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.
Balance disorder (loss of balance)
Altered heart rate
Hypersensitivity reaction
Skin irritation
Apnea (absence of breathing)
Nystagmus (involuntary eye movement)
Is It safe with alcohol?
No interaction found
Are there any pregnancy warnings?
Flexabenz gel is unsafe to use during pregnancy.
There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk, for example in life-threatening situations. Please consult your doctor.
Are there any breast-feeding warnings?
Flexabenz gel is probably unsafe to use during breastfeeding. Please consult your doctor.
Is it safe to drive while on this medicine?
Patients should not drive or operate machinery if they get affected symptoms like dizziness, drowsiness, fatigue, visual disturbances.
Does this affect kidney function?
There is no data available. Please consult doctor before consuming the drug.
Does this affect liver function?
There is no data available. Please consult doctor before consuming the drug.
Whenever you take more than one medicine, or mix it with certain foods or beverages, you're at risk of a drug interaction.

Popular Questions & Answers

I have back problem 2 years ago. It's ok but now I am suffered by cervical spondylosis so help me for better cure. Homeopathy & ayurved treatment I preferred first.

MBBS, PG-Diploma In Clinical Pathology
Orthopedist, Sri Ganganagar
I have back problem 2 years ago. It's ok but now I am suffered by cervical spondylosis so help me for better cure. Ho...
If your pain is severe, your doctor might suggest steroid injections. Muscle relaxants. Certain drugs, such as cyclobenzaprine (Amrix, Fexmid) and methocarbamol (Robaxin), can help relieve muscle spasms in the neck. Anti-seizure medications. The focus of Ayurvedic treatment in cases of Cervical Spondylosis is on pacification of the aggravated Vata by improving digestion and enhancing the digestive fire. This treatment is followed by administration of herbal medicines that foster rejuvenation of body tissues. RHUS TOX 30-Rhus tox is another effective remedy for cervical spondylitis. Rhus tox is the best Homeopathic medicines for cervical spondylosis when there is marked stiffness and pain in the neck on waking up in the morning.

It all happened on a morning when I woke up. I felt heavy striking pain in my left shoulder near to the neck. I applied some medicine's but they were near to any use. The pain still prevails and it's usually in the morning.

MPT - Orthopedic Physiotherapy, Fellowship in Orthopaedic Rehabilitation (FOR)
Physiotherapist, Kolkata
It all happened on a morning when I woke up. I felt heavy striking pain in my left shoulder near to the neck. I appli...
It could be a possible Scalene muscle spasm or Trapezius if neck movement causes pain. If shoulder Movements are painful then it may be Shoulder Pathology alone. Apply Flexabenz gel thrice daily followed by 15 minutes of Hot compression each time for three days, preferably at night time then at morning. If it doesn't help, then consult with your nearest GP or Orthopedician. Good luck!

My left knee paining I am 62 years old female diabetic .in x ray swelling indicated pl suggest some medicine.

MPT - Orthopedic Physiotherapy, Fellowship in Orthopaedic Rehabilitation (FOR)
Physiotherapist, Kolkata
My left knee paining I am 62 years old female diabetic .in x ray swelling indicated pl suggest some medicine.
Go for Proper Physiotherapy treatment for Symptomatic management and healthy lifestyle. For relief, you can apply Flexabenz gel thrice daily followed by 15 minutes of Hot compression twice daily.
1 person found this helpful

My wife is suffering from neck pain. Pain is from top back head to back neck and also covering some part of back. She suffering from 10 days.

MPT - Orthopedic Physiotherapy, Fellowship in Orthopaedic Rehabilitation (FOR)
Physiotherapist, Kolkata
My wife is suffering from neck pain. Pain is from top back head to back neck and also covering some part of back. She...
Pain from head to neck can be due to Postural fault which leads to eventually Derangement or unhealthy joint and disc orientation, as a result the surrounding soft tissues like Muscles and fascia, ligaments etc they get tight and weak or overworking. One of the most common cause us Forward Head Posture which can lead to neck and headache. Reduced Neck Curvature associated with neck muscles spasm can lead to the said complain. For immediate relief, do Ice Massage at the back of head and neck for 15mins - 15mins Rest- 15mins ice Massage repeat. Do it twice a day. Apply Flexabenz gel followed by Ice Massage. Take proper sleep. Adequate water intake is compulsory Take Banana regularly two in quantity. Almond and dates will also help. Consult after three days. Good luck !!!

Popular Health Tips

7 Non-Surgical Methods To Treat Spondylitis!

MD, FIPP
Pain Management Specialist, Kolkata
7 Non-Surgical Methods To Treat Spondylitis!

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows- 

  1. Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots. 
  2. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include: 
    • Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits 
    • Opiates, for example, hydrocodone, for pain relief 
    • Epileptic medications, for example, gabapentin, to ease pain created by nerve damage 
    • Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain 
  3. Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it: 
    • Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve. 
    • Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles. 
    • Exercise routinely to help you recover quickly. 
    • Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief. 
  4. Interventional Pain Management: It is a highly effective treatment for back and neck pain
  5. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest must be avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs). 
  6. Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles. 
  7. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.
1 person found this helpful

Cervical Spondylosis - Symptoms, Causes, Treatment

BPTh/BPT
Physiotherapist, Lucknow
Cervical Spondylosis - Symptoms, Causes, Treatment


Cervical spondylosis:

?Cervical spondylosis is a medical term for neck pain caused by age-related ‘wear and tear’ of bones and tissues. 

The degenerative process chiefly affects the vertebral bodies, the neural foramina, and the facet joints. If it may cause severe pressure on nerve roots with subsequent sensory or motor disturbances, which causes pain, paresthesia, and muscle weakness in the limbs.

Causes of cervical spondylosis

  • Spondylosis is caused from years of constant eccentric pressure, from joint subluxation or poor posture, being placed on the vertebrae, and the discs between them. The aberrant stress causes the body to compose new bone in order to compensate for the new weight distribution. This eccentric weight bearing from bone displacement will cause spondylosis to occur.
  • Poor postures and loss of the mundane spinal curves can lead to spondylosis as well. Spondylosis can affect a person at any age; however, older people are more affected.
  • Cervical spondylosis is a very prevalent condition. It's estimated that 8 out of 10 adults will have some degree of cervical spondylosis by the time they are 60 years old (but many will not have any conspicuous symptoms).
  • The most cases outlook of cervical spondylosis is generally good. Most cases respond well to treatment after a few weeks.

Symptoms of cervical spondylosis

  • Cervical spondylosis includes neck pain and shoulder pain. The pain can be rigorous in some cases.
  • Infrequent headaches may occur, that customarily start at the back of the head, just above the neck, and peregrinate over top of the forehead.
  • Pain conventionally comes and goes, with flare-ups followed by symptom-free periods.
  • Around 1 in 10 people develop perennial (chronic) pain.
  • Other, more severe, symptoms customarily only occur if you develop:
  • Cervical radiculopathy – where a slipped disc or other bone pinches or irritates a nerve
  • The most common symptom of cervical radiculopathy is the sharp pain that" travels" down one of your arms (known as brachialgia).
  • You may experience some numbness or" pins and needles" in the affected arm, and stretching your neck and turning your head makes the pain worse.

Diagnosis of cervical spondylosis

  • The spurling test may be used to evaluate patients with cervical radiculopathy. The sign is elicited by extending, rotating, and laterally flexing the patient’s neck toward the symptomatic side. Then, the doctor applies axial pressure on the spine. Pressure applied on top of the head may increase symptoms.
  • The spurling test has a sensitivity of 30% to 60% and a specificity of 90% to 100%, quite similar to those of other provocative maneuvers (low sensitivity but high specificity). This test help confirms the diagnosis of cervical radiculopathy.
  • X-ray, and mri scans are helpful for diagnosis of pain but generally not definitive and must be considered together with history and physical examinations.

Cervical spondylosis treatment

Treatment for cervical spondylosis depends on the severity of signs of sickness. The goal of treatment relieves pain, help you maintain your normal activities as much as possible, and prevent permanent injury to the nerves and spinal cord.

Physical therapy management

  • There have been several trials and systematic reviews into the use of physical therapy program for treatment of cervical spondylosis and its consequences.
  • There are several types of manipulations and exercises your physiotherapist can utilize to relieve stiffness, strengthen the area, and restore the function of the neck. Treatments such as cold or heat application, deep tissue massage, neck stretching, ultrasound and electrical stimulation may be used prior to exercise.
  • During physiotherapy, you practice a range of exercises to stretch and strengthen the muscles that support the neck. You also learn how to improve your posture and range of movement exercises. You have to learn correct postures, the physiotherapist stand in front of a mirror while exercising, so you can see your mistakes and correct them.
  • ?one technique sometimes to provide pain relief and improve movement by cervical traction. Traction gently extends the neck opening the spaces between the cervical vertebrae and temporarily relieve pressure on the affected discs. Neck traction either done continuously or intermittently (short periods of pulling and resting).
  • It’s also possible at home to do cervical traction. There are pulley system devices that enable you to perform cervical traction in lying down. It’s important if you do cervical traction at home to see your physiotherapist first to make sure that you buy the right things and learn how to correctly set up.
  • ?cervical pillows (neck pillows) are designed to stabilize the neck while you sleep.
  • A cervical collar may also help you stabilize and realign your spine and relieve pain.

Medications

If over-the-counter pain medication doesn't help, your doctor might prescribe:

Non-steroidal anti-inflammatory drugs- prescribe-strength ibuprofen or naproxen sodium might be needed to relieve pain and inflammation. Muscle relaxants- certain drugs, such as cyclobenzaprine and methocarbamol can help relieve muscle spasms in the neck. Antidepressants- antidepressant medications have also been found to help ease neck pain from cervical spondylosis.

Surgery

Cervical spondylosis tends to be a chronic pain condition, but in most cases, it’s not progressive. Only rare cases surgery is required.

2 people found this helpful

Non-Surgical Treatments for Ankylosing Spondylitis!

MD, FIPP
Pain Management Specialist, Kolkata
Non-Surgical Treatments for Ankylosing Spondylitis!

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

  1. Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
  2. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
    1. Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
    2. Opiates, for example, hydrocodone, for pain relief
    3. Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
    4. Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  3. Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it:
    1. Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve.
    2. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
    3. Exercise routinely to help you recover quickly.
    4. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  4. Acupuncture: Acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  5. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs).
  6. Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  7. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age. Consult an expert & get answers to your questions!
5379 people found this helpful

Back Pain Management

BPTh/BPT
Physiotherapist, Pune
Back Pain Management

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

Exercise based recovery/physiotherapy: your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.

  • Medications: your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
  • Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
  • Opiates, for example, hydrocodone, for pain relief
  • Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
  • Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  • Home treatment: in case your condition is less severe, you can attempt a couple of things at home to treat it:
  • Take an over-the-ounter pain reliever, for example, acetaminophen or a calming medication, for example, advil or aleve.
  • Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
  • Exercise routinely to help you recover quickly.
  • Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  • Acupuncture: acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  • Bed rest: severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (dvt, blood clots in the legs).
  • Support/brace use: temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  • Lifestyle: losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.

Once the conservative treatment fails:

Early aggressive treatment plan of back leg pain has to be implemented to prevent peripherally induced cns changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total lbp patients would need surgery approx 20% of discal rupture or herniation with neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology response to treatment. Using precision diagnostic therapeutic blocks in chronic lbp, isolated facet joint pain in 40%, discogenic pain in 25% (95% in l4-5 l5-s1), segmental dural or nerve root pain in 14% sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of lbp after conservative treatment has failed.

Need for non-surgical options: outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “in case of surgery, the chance of recurrence of pain is nearly 15%. In fbss or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:

  • Dural fibrosis
  • Arachnoidal adhesions
  • Muscles and fascial fibrosis
  • Mechanical instability resulting from the partial removal of bony ligamentous structures required for surgical exposure decompression
  • Presence of neuropathy.
  • Multifactorial aetiologies of back leg pain, some left unaddressed surgically.

Epidural adenolysis or percutaneous decompressive neuroplasty is done for epidural fibrosis or adhesions in failed back surgery syndromes (fbss). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ l. A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope sciatica gets complicated by pivd with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location type of pivd causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or la was injected. A flexible guide wire is passed at selected location direction on which the inflatable balloon is threaded to the area of interest.

Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time location. We inflated the balloon with contrast agent to have visualization of adhesiolysis opening up of adhesions or root route. Here the balloon pressure time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure patient`s response. Once dilatation is done the drug mixture of steroid with la or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our balloon neuroplasty foraminoplasty as it is safe targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via s1 foramen. Now we are employing this technique for fresh cases coupling with intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The idd is done by coblation/ laser/ dekompressor or rf biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “balloon neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited relieved of previously interventionally unmanageable disco-radicular pain including fbss sufferers.

Intradiscal procedures:

Provocative discography: coupled with ct a diagnostic procedure prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain (even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options in assessing previously operated spines.

Percutaneous disc decompression (pdd): after diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.

Ozone-chemoneucleoplasty: ozone discectomy a least invasive safe effective alternative to spine surgery is the treatment of choice for prolapsed disc (pivd) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical and lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at european countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, percutaneous intradiscal decompression can be done via transforaminal route with drill discectomy/ laser or coblation nucleoplasty/ biacuplasty/ disc-fx / endoscopic discectomy are good alternatives before opting for open surgerical discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In biacuplasty radiofrequency energy is used in bipolar manner heating shrinking the disc  making it harder as well for weight bearing. It also seals the annular defect ablates annular nerves relievingback pain. In laser or coblation nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. 

Dekompressor: a mechanical percutaneous nucleotome cuts drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts drills out the disc material debulking the disc reducing nerve compression curing sciatica brachialgia. It comes in needle size of 17g for lumbar discs 19 g for cervical discs. In lumbar region postero-lateral approach is used  in cervical discs anterolateral approach is used. 

Disc-fx : endoscopic discectomy: in this novel technique a wide bore needle is inserted placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent decrease recurrences. Next higher procedure, endoscopic discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion extrusions causing spinal canal stenosis with root or cord compression with leg pain.

Laser discectomy done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. 

Seld: epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This procedure is done under vision via an epiduroscope inserted via caudal canal or transforaminally employing front or side firing laser fibers /or fine instruments. If you wish to discuss about any specific problem, you can consult a pain management specialist.

2 people found this helpful

Non-surgical Treatment for Cervical Spondylosis - Tips!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Non-surgical Treatment for Cervical Spondylosis - Tips!

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

  1. Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
  2. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
    1. Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
    2. Opiates, for example, hydrocodone, for pain relief
    3. Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
    4. Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  3. Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it:
    1. Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve.
    2. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
    3. Exercise routinely to help you recover quickly.
    4. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  4. Acupuncture: Acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  5. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs).
  6. Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  7. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.

ONCE THE CONSERVATIVE TREATMENT FAILS:

Early aggressive treatment plan of back & leg pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total LBP patients would need surgery & approx 20% of discal rupture or herniation with Neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP , isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5-S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed. 

NEED FOR NON-SURGICAL OPTIONS: Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “In case of surgery, the chance of recurrence of pain is nearly 15%. In FBSS or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:

  1. Dural fibrosis
  2. Arachnoidal adhesions
  3. Muscles and fascial fibrosis
  4. Mechanical instability resulting from the partial removal of bony & ligamentous structures required for surgical exposure & decompression
  5. Presence of Neuropathy.
  6. Multifactorial aetiologies of back & leg pain, some left unaddressed surgically. 

EPIDURAL ADENOLYSIS OR PERCUTANEOUS DECOMPRESSIVE NEUROPLASTY is done for epidural fibrosis or adhesions in failed back surgery syndromes (FBSS). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with EPIDUROSCOPE Sciatica gets complicated by PIVD with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe & effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location & type of PIVD causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or LA was injected. A flexible guide wire is passed at selected location & direction on which the inflatable balloon is threaded to the area of interest.

Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time & location. We inflated the balloon with contrast agent to have visualization of adhesiolysis & opening up of adhesions or root route. Here the balloon pressure & time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure & patient`s response. Once dilatation is done the drug mixture of steroid with LA & or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our Balloon Neuroplasty & foraminoplasty as it is safe & targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via S1 foramen. Now we are employing this technique for fresh cases coupling with Intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The IDD is done by Coblation/ Laser/ DeKompressor or RF Biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “Balloon Neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited & relieved of previously interventionally unmanageable disco-radicular pain including FBSS sufferers. 

INTRADISCAL PROCEDURES:

PROVOCATIVE DISCOGRAPHY: coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines. 

PERCUTANEOUS DISC DECOMPRESSION (PDD): After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.

OZONE-CHEMONEUCLEOPLASTY: Ozone Discectomy a least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, Percutaneous intradiscal decompression can be done via Transforaminal route with Drill Discectomy/ Laser or Coblation Nucleoplasty/ Biacuplasty/ Disc-FX / Endoscopic Discectomy are good alternatives before opting for open surgerical Discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In Biacuplasty radiofrequency energy is used in bipolar manner heating & shrinking the disc & making it harder as well for weight bearing. It also seals the annular defect & ablates annular nerves relieving back pain. In Laser or Coblation Nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. 

DEKOMPRESSOR: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts & drills out the disc material debulking the disc reducing nerve compression curing Sciatica & Brachialgia. It comes in needle size of 17G for lumbar discs & 19 G for cervical discs. In lumbar region postero-lateral approach is used & in cervical discs anterolateral approach is used. 

DISC-FX & ENDOSCOPIC DISCECTOMY: In this novel technique A wide bore needle is inserted & placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful & sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent & decrease recurrences. Next Higher procedure, Endoscopic Discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion & extrusions causing spinal canal stenosis with root or cord compression with leg pain.

LASER DISCECTOMY done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. 

SELD: Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This Procedure is done under vision via an epiduroscope inserted via Caudal canal or Transforaminally employing front or side firing Laser fibers &/or fine instruments. If you wish to discuss about any specific problem, you can consult a Pain Management Specialist.

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