Herniated or bulging discs are a leading cause of leg or back pain. In the United States, a herniated spine can cause pain for up to 2%. It is more common among men than in women. Men between the ages 55 and 35 are most affected. It can affect the neck or mid-back area, or the lower part of the spine depending on where it is located. This article will address the major symptoms, medication, treatment and at-home options to manage or prevent pain.
What is the difference between a herniated disc or a ruptured disc?
Your spine contains 33 bones, also known as vertebrae. These bones are connected by soft discs which act as shock absorbers and allow the spine to bend and stretch. Lumbar disc Disease is the term for damage to these discs. It includes two types: a bulging and herniated disc.
A bulging Disc is often due to age. Sometimes it’s called disc degradation. The fluid at the nucleus of the disc, also known as nucleus pulposus, evaporates, and the disc begins to flatten. This can cause the outer band to weaken. As it does, the nucleus-pulposus in the center of the disc dries out and the disc becomes bulged. This can often lead to people’s declining height.
A disc herniation is when the inner disc part ruptures and the pieces of disc material press onto the nerve roots in the spinal canal. “The nucleus has the inner part of the disc. The annulus fibrosus surrounds it.
A herniated disc happens when the nucleus pushes the annulus through and causes both disc ends to push inward. A herniated sphere generally pushes to the side at one point.
Although herniated spines usually occur in the lower part of the spine, it can also occur elsewhere on the spine. This condition can be referred to as a herniated disc, a slipped Disc or a ruptured disc. It can cause severe pain. It can lead to lumbar radiculopathy. This is also known by sciatica. Radiating pain down your arms may occur when the problem is located in the neck. It is uncommon to feel it in the middle-back or thoracic areas of the spine.
“Many people are unaware that they have a Disc herniation. This is because they don’t experience any symptoms.”
“This is because the herniation isn’t the problem. Disc herniation happens when the injured disc pushes up enough to cause irritation to the nerves close to the spine. The principal complaint is radiating discomfort. It is felt in the arm and leg in the neck, as well as the back in the lumbar.
According to a study on disc herniation, people between the ages 20 and 40 are more likely to experience acute disc rupture. “These people usually have short-term symptoms that could be tied to a particular event, such as lifting heavy things.”
“Chronic spinal disc herniations happen over time. They are more frequent in people aged between 50 and 70. Symptoms gradually develop. As people age, they are more at risk of injury. Risk factors include:
- Being overweight
- Inactive lifestyle
- Long hours can be spent in the same place, whether you are sitting or standing.
- Smoking
Research has shown that symptoms from a herniated spine can vary depending on where the disc is located: in the low or upper back, mid-back, or upper back.
Lumbar herniated disc
A low back injury can cause pain in the legs, hips, buttocks, back, or soles of the feet. Sciatica, or pain radiating down one of your legs, can occur.
Cervical herniated disc
Neck pain can be caused by damage to the spine. It’s possible that you feel pain when you move your neck. Also, you might feel pain when moving your neck.
Thoracic herniated disc
Although it is rare for damage to occur in the mid back, it is possible. It is possible for the pain to travel from the ribcage to your upper abdomen and chest. Your legs may feel numb or stiff. Pain is often worse when sitting or standing. Depending upon the location, you might notice muscle weakness and difficulty lifting a limb or arm. The pain is usually located on one side. The pain, numbness or weakness typically disappears or gets better over a few weeks or more.
How is a herniated Disc diagnosed?
Your healthcare provider will complete a physical exam. They may also assess your posture, muscle strength and muscle reflexes during the physical exam. They may ask you to:
- Bend forward, rearward, and sideways
- Your neck can be moved in three directions: forward, backward and sideways.
- While you’re walking, take your heels off and step on your toes.
- Lift your shoulders, elbows and wrists. During this task, check your strength.
Based on the results, your doctor could order additional tests such as:
- Magnetic resonance imaging, (MRI) and CT scans can be used for the diagnosis of the herniated hard Disc.
- Electromyography (EMG), to determine which nerve root is involved.
- A myelogram will provide information about the size and location of Disc herniation.
- For nerve damage assessment, use Nerve Conduction Velocity.
- As discs do not show up on Xrays of the spine, it is not possible to diagnose a herniation. But it can help rule other causes of pain in the neck or back.
The treatment options for herniated discs
A conservative therapy may be recommended by your doctor when a herniated disc is first diagnosed. He advises that the first step is to avoid painful positions and activities. You will not be asked to lie still, but you will be given exercises that can help lower pain and strengthen the spine. The medication can be either over-the-counter if the pain feels mild or moderate or cortisone injections when the pain becomes severe. These conservative options may be sufficient to relieve herniated-disc symptoms within a few short weeks. If the pain continues to persist, physical therapy offers guidance through positions and exercises to relieve it.
Physical therapy sessions can teach you exercises to strengthen and tone your back and stomach muscles. These exercises will reduce your pain. You might also learn to lift objects properly without straining your back. Physical therapy is usually started within the first few weeks following an injury. “A good prognosis will be possible if you see a physical therapist sooner than later.”
“Many of our patients can get physical therapy within 4 to 6 appointments. They can return to the activities they love and recover quickly.
If you do not get relief with physical therapy or rest, your doctor might suggest that you have steroid injections. Cortisone is injected directly to the spine to reduce swelling. One dose might be enough, but several may be needed over the course of several weeks. Steroid injections have the potential to cause long-term side effects, including nerve damage and cartilage loss. Your doctor should only prescribe steroids to treat symptoms that aren’t being relieved by physical therapy or rest.
Herniated discs typically heal in four to six months with rest and physical therapy. If you are not able to get relief with non-surgical methods, your doctor may suggest surgical treatment. This is usually only an option if the symptoms persist. There are many types.
These include:
- Lumbar surgery is used to repair a herniated or bulging disc in the lower spine. The surgeon will first remove the injured disc (discectomy) then fuse the vertebrae of each side together to stabilize your spine.
- Cervical surgery is done when the herniated spine is located in the neck. Discogy can be performed by a surgeon in the spine. The vertebrae then fuse to provide spinal stabilization if necessary. Fusion might not be needed if you use a posterior incision (back).
- Artificial disc surgery involves the removal and replacement of the disc. Only a small proportion of people can have this type of surgery. However, it is available for the cervical and lumbar regions.
The treatment of herniated discs
There are several medications for herniated Discs, including nonsteroidal anti-inflammatory drug, opioid pain medication and muscle relaxants.
Nonsteroidal anti inflammatory medicines (NSAIDs)
NSAIDs work to reduce swelling, pain, and inflammation. This group of medications includes:
- Aleve (naproxen)
- Celebrex (celecoxib).
- Indocin or indomethacin
- Daypro (oxaprozin)
Opioid pain relief medications
Narcotic pain relievers can only be prescribed. If they are not taken as directed, they can cause severe side effects and even addiction. They work by signaling your brain to stop you from experiencing pain.
These are just a few:
- OxyContin (oxycodone).
- Percocet (oxycodone/acetaminophen).
- Demerol (meperidine).
- Kadian MS Contin morphine
- Vicodin is a combination of hydrocodone (acetaminophen and hydrocodone)
- Zohydro ER (hydrocodone)
- Codeine is only available in generic forms
Muscle relaxants
Muscle relaxers decrease pain by relaxing the muscles around your spine and depressing you central nervous system. They may be prescribed when a herniated disc causes muscle spasms. Some examples of these are:
- Soma (carisoprodol)
- Fexmid (cyclobenzaprine)
- Valium (diazepam)
- Skelaxin (metaxalone).
Injecting epidurals with corticosteroids reduces swelling. The effect lasts for anywhere from a few short weeks to several months. They cannot heal herniated discs but can reduce pain so you can do physical therapy.
What is your best option for treating a herniated or bulging disc?
There is no “best herniated distal medication”. Different people react differently to medication. The best option for one person may not work well for another. There are several factors that influence the choice of the best prescription.
- Medical condition
- Medical history
- Possible interactions with other medications or medications currently in use
- Other conditions (including pregnancy.
- Tolerance of drugs and response
Your doctor will help you determine the best medication.
What are the common side effects of herniated disc medication?
NSAIDs could cause problems with digestion, including nausea, vomiting or diarrhea. The side effects of NSAIDs include headache, dizziness, and skin reactions such as rash. You may develop stomach ulcers, kidney and liver disease from prolonged use.
Opioids can have side effects such as dizziness/vomiting, sleepiness, nausea, and physical dependence. However, common side effects from muscle relaxants are drowsiness and dizziness. Side effects include insomnia, temporary high levels of blood sugar, increased appetite, and damage to cartilage and nerves if steroids are administered regularly. Chronic steroid usage can lead to adrenal deficiency and osteoporosis.
What are some home remedies for a herniated disc?
You don’t have to go to the hospital for pain relief. There are other options. The Neurological Hospital of New York advises using ice to reduce swelling during the initial few days. Then you can switch to heat, according to The Spine Hospital. But everyone reacts to heat and/or ice differently. Some may prefer heat to others.
Moderate exercise may be beneficial. Your physician or physical therapist should let you know when exercises are safe and how you can strengthen your back, stomach, and stomach muscles. Six weeks is the best time to avoid twisting or heavy lifting.
Some people find yoga beneficial, but you should gradually return to your regular activities. There are several things you can do that will help to prevent another injury.
- Learn the correct lifting techniques
- Maintain a healthy weight
- Keep your abdominal muscles strong and your back strong with exercises
Prescription Medications – Herniated Discs
- Prescription NSAIDs: Prescription-strength NSAIDs are available if the over-the-counter variety proves unsuccessful.
- Muscle relaxants: A herniated spine can often be accompanied by muscle spasms. The muscle relaxant may offer relief in these cases.
- Oral steroids: The use of oral steroids (also known as corticosteroids), may help reduce swelling. These medications are intended for short-term usage. Use of steroids for prolonged periods has been associated with multiple adverse reactions.
- Opioids: Narcotic pain medication (narcotics). These medications can be used to treat acute or intense pain. They are only prescribed for severe cases. Patients may become more sensitive to opioids over time and require higher doses to achieve relief. These pain medications may also be addictive.
- Antidepressants: These drugs prevent pain messages reaching your brain from reaching it. They also increase endorphins which are your body’s natural painkillers. Another added benefit–antidepressants help you sleep better.
Spinal Injections – Herniated Discs
The epidural injectable steroid: Corticosteroids (anti-inflammatory compounds) are used to quickly relieve pain caused from compressed nerves. The medication is administered intramuscularly and may provide significant pain relief. However it may take up to a few days for it to start working. It is not common to give more than three injections in one year.
Warning on Medications
Side effects of medication are not uncommon. There are other factors that you should consider when making your decision on which medicine you should try.Talk to your doctor before you start taking any medication, even if it’s over-the counter and poses no risk. It is also important to keep in mind that you cannot rely on only pain relievers and injections for pain from a herniated or bulging disc.
Acute Lumbar Prolapse: No need for Muscle Relaxants
Acute lumbar Disc Prolapse can be very severe. Sciatica is back pain that causes sciatica (or down the leg) and often leads to the patient visiting the doctor. Physical therapy and medication like anti inflammatory are used to manage the pain.
Another form is drug therapy using muscle relaxers/relaxants. The most frequently used muscle relaxants include benzodiazepines. (Librium, Valium) These drugs are used to alleviate anxiety as they have a sedative action. Side effects of benzodiazepines are causing concern.
A short-term use of benzodiazepines is generally considered safe and effective. The problem comes down to long-term use. These drugs can cause negative psychological or physical side effects. It is possible to become physically and psychologically dependent on these medications. Patients may experience withdrawal symptoms when they try to stop using the drug.
This study examines one specific benzodiazepine – diazepam, also called valium – in the treatment and management of sciatica and low back pain. All 60 patients enrolled in this study were diagnosed with lumbar disc prolapse using imaging studies (CT scans or MRIs).
A disc prolapse occurs when there is disc herniation. The main types of disc herniation include disc prolapse; disc herniation; and disc sequestration. In the event of disc prolapse, the disc will bulge. The annulus covers the inner portion of a disc that is still intact. The disc material usually faces the spinal canal in the opposite direction. The protruding or bulging discs can become so large that they press against nearby spinal nerve roots, causing back and/or leg discomfort (sciatica).
The pain causes muscles to contract and to stay in that contracted state. This creates a protective muscles spasm that actually increases the pain. Muscle relaxants such diazepam work by relaxing muscles in spasm to interrupt the pain-spasm pattern. But do they work? This is the issue we’re trying to address.
Participants in the study were randomly divided into two groups. Everyone received physical therapy and either Valium or a placebo. It was a doubleblind study. That means that patients, physicians and physical therapists did not know which participant was being treated with diazepam. Patients were allowed to take a pain reliever/anti inflammatory (Voltaren) as prescribed by their physician.
Each patient received a unique type of physical treatment. The idea behind the approach is to identify the best direction of spinal movement for each patient. The patient is then shown how to move in that same direction repeatedly. The goal is for the patient to feel less pain in the legs and have the pain confined to the low back.
After seven days of treatment, the results were measured again after six weeks, then one year. The main outcome was the percent of total, centralized pain (moved up the leg to the back). Other outcomes included pain intensity, duration, muscle strength (moved from the lower leg to the lower back), ability to walk, mobility (touching fingers with toes), pain medication and ability to work.
Surprisingly though, patients who received a placebo (a sugar pill without active ingredients) had the best pain management and were admitted the quickest to the hospital. The placebo group returned to work faster than the others. Patients who were given the placebo were able to move farther than patients who took valium. Patients who were prescribed valium were also more likely than others to ask for more medication, and to need it more frequently.
The authors concluded, however, that benzodiazepines shouldn’t be used for pain control in patients suffering from sciatica (disc prolapse). The pain in the placebo group was less than that in the Valium group.
It has been suggested muscle relaxants might actually be detrimental to the goal of removing pressure from the spinal nerve. Tightness and muscle spasm may cause spinal nerve pressure to increase. This will allow the disc to protrude from its original position. The most effective treatment plan for this problem remains to be antiinflammatories (pain relievers), physical therapy, and analgesics (pain relievers).
Frequently asked queries about a herniated disc
Can a herniated spine heal on its own?
Michigan Medicine claims that a herniated distal can usually heal itself. Although symptoms typically improve in four to six months, some sufferers may have symptoms for up to a month. If you have not experienced pain or numbness for six weeks, it is a sign that you need to see your doctor.
Are herniated discs visible on an X Ray?
An X-ray does not show a herniated or bulging disc. However, doctors can use them during the diagnostic process to rule out other causes of back problems. An Xray can detect a narrowed space among vertebrae and could indicate a disc disorder.
How painful is a herniated spinal disc?
It all depends on the strength of the disc, and how it presses against a neuron. The pain is often worse when active, and it is better when you are asleep. According to an American family physician, pain can be worsened if you sneeze, cough, laugh, or bend.
What is best for herniated discs?
Most of the initial treatment consists in rest and moderate physical activity. You might also consider physical therapy, which can strengthen your muscles by doing specialized exercises. If the above treatment fails, your doctor may suggest steroids injections. Surgery is a last resort.
How long does a disc herniation heal?
A herniated spinal disc should heal in between four and six weeks.
