Ancreatitischolecystitispenetrating ulcer   9. How many americans have lower back pain? 2/3 of americans have lbp: cardinal million10% of lbp is degenerative: 20 millionrecurrence is common: 40% within 6 months chronic lbp is a chronic problem with intermittent exacerbations, analogous to asthma, rather than an acute disease that can be cured.   10. buy cheap viagra How do you treat acute lbp? First two weeks:r/o cauda equina syndrome, hemodynamic instability, significant trauma, cancer, fever/infection, substance abuse, abdominal or pelvic pain, urinary retention, unexplained weight loss, unrelenting night pain, leg weakness, abdominal aortic aneurysm. If none: conservative therapy conservative therapy-first two weeks:limited bed rest-less than two daysaspirin/ibuprofenmuscle relaxants may be helpfulheat/coldearly ambulation and exercise (progressive)no lifting/bending70% improved in two weeks (reassurance) 2 - 6 weeks:reassessment in officeconsider medication changeorder x-rays if: change in symptoms, patient is over age 50, chronic steroid use, chronic lbp6 months without prior treatmentphysical therapy if: unable to work, chronic lbp for more than 6 months90% improve in six weeks (reassurance) 6 weeks:re-examine abdomen and pelvissedimentation rate and cbcmagnetic resonance image 6 weeks - 6 monthspain clinic therapies may include:physical therapy for more than 2 monthsconsider chiropracticacupuncture - not of proven valuemedications can include neurontin, amytriptilline, nsaidsepidural steroid injectionsback school   11. viagra coupon How do you localize and treat chronic lbp? buy generic viagra online Facet injections may provide relief and localize pain and facet rhizotomy may effectively treat pain in ~40% of patients (tzaan & tasker, can j neurol sci 27(2)125-130, 2000) si joint injections may effectively treat pain in ~40% of patients (ferrante, etal, regional anaes & pain med. xlpharmacy generic viagra , 26(2):137-42, 2001) discograms may help localize pain and idet may treat pain (controversial)   12. viagra viagra same day How do you treat patients with chronic lbp after conservative therapy fails? viagra for sale Consider spinal fusion surgery (several types) - depends on whether pain is due to disc disease, joint disease, number of levels involved, etc. buy viagra cheap :open post lumbar fusion with iliac crest bone graft open posterior spine fusion of pedicle screws (psf) posterior lumbar interbody fusion (plif) ant. viagra canada overnight delivery ingredients viagra manufacturing