Saeed Taj Din, Muhammad Asif, Muhammad Shoaib, Tahir Nazeer, Muhammad Arsalan Aftab, Junaid Mustafa.
Comparison of outcomes of caudal epidural injection, physical therapy alone and combination of both in treating low back pain due to prolapsed intervertebral disc.
Pak J Med Health Sci Jan ;13(4):820-3.

Background: The study is based on conservative management of low back pain in prolapsed intervertebral disc (PIVD )patients to whom surgery was advised but they refused to surgery . To increase the awareness about the conservative management of PIVD and its outcomes we compare caudal epidural injection, physical therapy alone and combination of both. This study helpful for those who want to go with conservative management with better understanding of treatment strategies. Aim : To compare the effectiveness of caudal epidural injection, physiotherapy and combination of both in treating low back pain due to PIVD among patients who refused to surgical interventions. Methodology : A Quasi experimental study conducted among PIVD patients who refused to surgery from orthopedic , neurosurgeons or spine surgeons of Lahore by convenient sampling method. Duration of data collection was 6 months A sample size of 50 patient was selected. The back pain Functional Scale questionnaire is used to measure 12 kind of activities of daily living and will rate in 5 categories. McGill pain questionnaire was used to measures the pain in mild, moderate and severe category . Patients were equally divided in groups A, B and C physiotherapy alone , steroid injection and combination of both respectively. Before treatment patients activity of daily livings ( ADLs ) and pain score was measured by BPFS and McGill score. Results : The improvement in the physiotherapy group was 13.93 ±4.74, in epidural group was 15.4± 4.91, and in combination group was 21.8 ±5.72. The improvement in functional score in the physiotherapy group was 26.87 ±15.06 in epidural group was 27.13 ±8.63, and in combination group was 32.67 ±8.79,P value calculated by ANOVA test (0.001) show that there is significant difference in the improvement level among all three groups. Conclusion : Although all there three treatments were effective in improving low back pain and function but the most effective treatment was combination of physiotherapy and epidural injection.

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