As part of the overall therapeutic protocol in the management of patients suffering from low back pain certain pharmacological and physical modalities have been found to be of value as adjuncts to VAX-D therapy.

The routine use of anti-inflammatory medications during the course of VAX-D treatment has been found to enhance the success of the procedure. In addition, patients should be encouraged to wear a pelvic support belt immediately after a VAX-D session. This precaution adds to the patient’s comfort level, and acts as a postural reminder to restrict bending and flexion.

NSAID's  (Recommended)

Generic Name

Daily Dosage

Rofecoxib (VIOXX)

Celecoxib (Celebrex)

Naproxen Sodium (Aleve)

Diclofenac

Methylprednisolone- Medrol DosePak

For VAX-D patients in moderate to severe pain, where chronic inflammation is a large component, oral steroids may be utilized for their anti-inflammatory properties, if there are no contraindications to their use. The initial dosage of methylprednisolone may vary from 4 mg to 48 mg per day 

depending on the specific disease entity being treated. It should be noted that dosage requirements are variable and must be individualized on the basis of the disease entity and the response of the patient.

Mucosal Protective Agents

Adequate gastrointestinal prophylaxis (using mucosal protective agents) such as histamine H2 antagonists or misoprostol (Cytotec 100-200 µg tablets), should be prescribed for patients who are at risk for peptic ulcer disease. We recommend NSAID’s (especially COX-I/COX-II meds) be taken with food or taken concomitantly with such agents in

Analgesics

Occasionally, some analgesia may be desirable to permit application of effective tensions during treatment.

Patients with low-back pain usually experience relief of pain on the table and do not require concomitant analgesia. However, some disc herniations have an associated inflammatory or soft tissueirritation and may need analgesia to

Muscle Relaxants

Muscle relaxants are not routinely required during VAX-D treatment. The use of such agents may be indicated in cases that tend to develop paravertebral muscle spasms following a treatment session.

Adjunct Therapy with VAX-D

Many patients experience relief of pain and muscle spasm while receiving VAX-D treatment. However, the stretching of soft tissues and muscles during a treatment session may elicit some transient discomfort immediately following the session. For this reason patients are advised to rise from the table slowly and carefully with the help of the technician, and should avoid postural strain or rapid and/or rotational movements in the immediate post treatment period. Stressful

Exercise During VAX-D

During the period that the patient is on a daily course of VAX-D, all exercises that result in flexion or rotation of the lumbar spine should be avoided as well as activities that require running or jogging. Any exercise or physical treatments that may

increase intradiscal pressures are contraindicated during the treatment period. Walking is permitted and should be encouraged as long as it does not cause discomfort or muscle spasm.

Exercise Post VAX-D

Experience has shown that patients treated with VAX-D may resume an active lifestyle including sporting activities and many exercises and/or exercise programs.

However, those who have achieved remission from serious lumbar dysfunctions that involve intervertebral discs such as herniation and/or degenerative disc disease should realize that their lumbar structures and tissues need time to heal. This resolution period requires approximately one to two months, depending on the severity of the underlying lesions, before individuals can safely engage in body contact sports or strenuous work and recreational activities.

In the immediate post treatment period, patients who are in remission and now able to enjoy pain free daily living and return to work, sometimes tend to engage in strenuous activities too soon and can experience a relapse. It is especially important to advise patients to allow time for resolution and healing of lumbar structures and tissues.

Following a course of treatment, patients in remission should be cautioned to gradually increase their exercise programs. If their low back pain has caused them to restrict their activities beforehand their muscle strength may have suffered and in fact some have demonstrable muscle debilitation and/or atrophy as a result of a neurological deficit.

For at least one-month post treatment exercises that require flexion, extension and/or rotation of the lumbar spine should be engaged in cautiously. For example abdominal strengthening sit-ups should only be carried out with the aid of support apparatus designed for this purpose.