I started avoiding anti-inflammatories back in the early 90's as the studies I saw didn't really show anything positive and just masked symptoms. You can add Stenosis, Spondylolisthesis to my spine issues as well. I have never used pain meds of any sort on a regular basis. I take 1 cyclobenzaprine 3-4 times a year and that does about all I need. Some great info you have posted for all to read!In general when its so many levels you certainly want to try conservative measures first. Ive seen so many train wreck spines where people are fused L1-S1 with lamis and anterior fusion as well and you still get post op issues such a scarring cause issues and osteophytes projecting into neural foramen... and its just a wreck.
For situations like you mentioned with multilevel disc issues id try epidurals and anti inflam meds and if surgery is needed try to pinpoint which level is causing you the most issues.
ohhhh and something i didnt mention! One of the reasons i use selective cox2 inhib is becuase of muscle growth. Many studies point to cox1 as being the primary muscle inflammatory mediator needed for post exercise muscle growth. Early studies were done looking at muscle trauma ( like cutting it) and it showed cox2 and we thought it was cox2...but turns out in physiologic muscle growth post exercise its mostly cox1.
So wtf does that mean....that means if you were to take large doses of say advil before working out...your muscle protein synthesis is probably gonna be blunted to the degree of over 80-90%. ( sorry no studies of guys on AAS). There seems to be less effect if advil or other cox1 inhibs are taken like the next day but if its in your system prior to exercise its mostly likely going to decrease your gains.
If you look at some studies on older people it showed that they made better muscle growth when taking advil...but you have to read the study to see that advil increased there functionality due to decreased pain so they were more active then there counterparts.
So thats one of the reasons i take a selective cox2 inhib when im in pain.