By vgreene, 3 March, 2020 Not recommended Epidural injections not rec d for neurogenic claudication in central spinal canal stenosis 5
By vgreene, 3 March, 2020 Initiation of long term opioids rec d against by VA NICE 1 5 considered by ACP only as last resort if benefits risk after shared decision making 3
By vgreene, 3 March, 2020 Trials of not previously used neuropathic meds amitriptyline duloxetine gabapentin pregabalin rec d by NICE 6 nbsp nbsp Carefully evaluate pts for drug abuse hx before prescribing pregabalin or gabapentin watch for signs of abuse dependence 6 nbsp nbsp Pr
By vgreene, 3 March, 2020 Consider surg ref for sciatica when non surg tx not improving pain fxn and imaging consistent w pt sx 5
By vgreene, 3 March, 2020 Consider MRI if pain persists in spite of conservative tx 6wk per ACR 2 rec d against unless would affect tx per NICE5
By vgreene, 3 March, 2020 Not recommended acetaminophen PO corticosteroids BZD SSRI traction ultrasound TENS PENS acupuncture 1 3 5
By vgreene, 3 March, 2020 Tramadol recommended only short term if acute rescue tx needed in pt who failed initial tx or if initial tx contraindicated 3 6
By vgreene, 3 March, 2020 Epidural steroid may provide short term pain relief in sciatica 1 5 but rec d against for claudication 5