Conservative Treatment of Low back Pain in Lumbar Disc Herniation: Comparison of Three Therapeutic Regimens

Abstract

Alireza Manafi Rasi, Ahmadreza Mirbolook, Reza Tavakoli Darestani, Shahram Sayadi, Mojtaba Baroutkoub, Mohammad Mahdi Omidian, Hasan Barati, Seyed Shayan Ebadi, Farzad Amouzadeh Omrani.

Purpose: This study aimed to compare three conservative therapeutic regimens among cases with acute lumbar disc herniation (LDH).
Methods: This is a cross-sectional study which was done among patients with previous definitive diagnosis of LDH who received at least one-year conservative treatment and aged 20-75 years. Based on the type of medication consumption which documented in medical records, the participants were divided into three groups including GA, GN and GNP. The GA group was subjected to physical therapy (ten sessions per month), as well as gabapentin (100 mg/daily); the GN group had received naproxen (500 mg, twice daily), along with gabapentin and physical therapy; and the GNP group received prednisolone (5 mg, twice daily) and naproxen, alongside gabapentin and physical therapy. The Oswestry Disability Index (ODI) was applied for evaluating functional improvement of participants, before and after treatments.
Results: among 547 participants, 202 (36.9%), 171 (31.2%) and 174 (31.9%) belonged to GA, GN and GNP groups, respectively. Overall, 374 (68.4%) participants were female. The average age of the study groups was 57.8 (10.5), 55.7 (11.8), and 57.3 (11.2) years in the GA, GN, and GNP groups, respectively. The between-group analysis showed a significant decrease in the ODI score in the GNP group, compared to GA (P<0.001) and GN (P=0.04) groups. No significant difference was observed in the overall ODI score between the GA and GN groups. Nevertheless, comparison of these two groups showed significant differences in two sections of ODI, that is, pain intensity (P<0.001) and social life (P=0.005).
Conclusion: Long-term use of low-dose oral corticosteroids alongside other medications, could produce satisfactory clinical outcomes in the conservative management of acute low back pain.