<s>[INST] Hai Doctor I am uday  age 54 last 10 years iam suffering from back pain L4 L5 bulging and now I am also suffering from neck pain and shoulder pain radiating upto right fingers due to cervical spondylosis  . Already taken MRI, BMD is very low . Pl. advise  the treatment for me. Thank youregardsudhay YYYY@YYYY [/INST] Hi, thanks for writing to Chat Doctor. The initial management of cervical disc disease is always by conservative management (non-surgical methods) and includes the following -Soft Collar: Soft collar allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles. Medicines: Analgesic are needed in the acute phase. Muscle relaxants are essential for relieving muscle spasms once the acute pain subsides. Neurotrophic vitamins like METHYLCOBALAMINE (activated It B12) or PREGABALIN will help in alleviating the neuropathic pain. Cervical traction: may enlarge the disc space, permitting the prolapse to subside. Intermittent cervical traction for not more than 30 minutes at a time. Physiotherapy: Once the acute phase of pain has subsided, Isometric strengthening exercises of the paravertebral muscles are started. Improving neck strength and flexibility with simple exercises may lessen discomfort and pain. Moist heat can be usefulEpidural steroids: are useful for patients with severe articular pains in the limbs. Cortisone is a powerful anti-inflammatory preparation and so its injections in the "epidural space" can decrease swelling as well as pain. If your symptoms are not resolving with the above measures, consult an orthopedic surgeon for further management. Hope this information is helpful. Good day </s>