What initial treatment is advised for patients with a suspected acute lumbar disc herniation

Initial treatment options include a short period of bedrest (not to exceed 3 days), oral medications (nonsteroidal antiinflammatory drugs [NSAIDs], aspirin, mild opioids), progressive ambulation, return to activity, and patient reassurance. Epidural injections can be considered. As acute pain subsides, physical therapy and aerobic conditioning are advised. If a patient fails to improve with 4 to 6 weeks of nonsurgical care, further evaluation is indicated. The optimal time for nonsurgical treatment ranges from a minimum of 4 weeks to a maximum of 6 months.

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