A herniated disc causes severe pain. It occurs when the soft tissue inside the disc, which acts as a shock absorber between the vertebrae, comes out of its seat. Not everyone who has a herniated disc feels pain, but if the protruding material irritates the nerves in the back, the pain can be excruciating. Although it takes some time, many people return to normal life without having surgery.
Steps
Part 1 of 3: Identifying the Herniated Disc
Step 1. Recognize the symptoms
The areas of the spine most prone to this disorder are the lumbar and cervical areas. If the protruding disc is at the bottom, you will likely experience pain in your legs; if instead it is in the neck, then the shoulders could be very painful. Symptoms include:
- Pain in the limbs which may be worse with coughing, sneezing or certain movements.
- Numbness of touch or tingling and stinging. This phenomenon is caused by the pressure of the hernia on the nerve that runs the limb.
- Weakness. If the problem is in the lower back, you run a greater risk of tripping and falling. If the hernia is located near the cervical vertebrae, then you may have trouble grasping and carrying heavy objects.
Step 2. If you think you have a herniated disc, see your doctor
He will carry out tests to find out exactly the origin of the pain. He will most likely ask you questions about your medical history and recent injuries. In addition, it will test you to check:
- The reflexes;
- Muscle strength;
- Coordination, balance and the ability to walk;
- The sense of touch. The doctor will want to understand if you can feel light touches or vibrations in various areas of the body;
- The ability to lift the leg or move the head. These movements stretch the spinal nerves; if you experience worsening pain, numbness, or stinging, then you may have a herniated disc.
Step 3. If your doctor prescribes them, do some imaging tests
These are done to rule out other possible causes of the pain and allow the doctor to understand exactly what happened to the spinal discs. Tell your doctor if you are pregnant or suspect that you are pregnant, as this condition affects your choice of tests.
- X-ray. Your doctor may request an x-ray of the spine to make sure the pain is not caused by an infection, tumor, fracture, or misalignment of the vertebrae. The doctor may also consider a myelography useful: in this case a dye is injected into the spinal fluid so that it is visible on X-rays. In this way it is possible to understand if the hernia is compressing the nerves.
- Computed tomography (CT scan). During this exam you will need to lie down on a table that moves inside a scanner. The instrument performs sequential radiographs of the area to be checked. The technician performing the test may ask you to hold your breath briefly to make sure the images are in focus. You will not feel any pain, but you may have to fast for a few hours before the exam or you will be injected with contrast fluid. Computed tomography takes twenty minutes or less as a whole; thanks to this test the doctor is able to understand exactly which discs are affected by the hernia.
- Magnetic resonance imaging (MRI). An MRI scanner uses radio waves and the magnetic field to recreate a digital image of the body. This is a very useful test especially for understanding which spinal disc is problematic and which nerves are compressed. The MRI is painless, but you will need to lie down on a table that fits into the scanner. This makes loud noises and your doctor will provide you with earplugs or headphones to protect your hearing. The whole procedure takes about an hour and a half.
- This is the most sensitive imaging test, but also the most expensive.
Step 4. Perform a nerve exam
If your doctor is concerned that you may be suffering from nerve damage, they may ask you to undergo a nerve conduction test and electromyography.
- During the nerve conduction test, the doctor will apply a small electrical charge to the body to see if it is being properly transmitted to specific muscles.
- In electromyography, instead, thin needles are inserted into the muscle to measure the electrical impulse that arrives there.
- Both procedures can cause some discomfort.
Part 2 of 3: Using Home Remedies and Making Lifestyle Changes
Step 1. Apply ice or heat as needed
The Mayo Clinic recommends these home solutions to manage pain related to a herniated disc. The choice depends on the stage of your injury.
- In the first few days, cold packs reduce inflammation and swelling. You can use the ice pack or a pack of frozen vegetables wrapped in a cloth. Apply ice for 10 minutes and then let the skin return to body temperature. Never place ice directly on the skin.
- After the first few days, you can use heat to relax muscle tension. Wrap the hot water bottle or a warmer in a cloth; never place the heat source directly on the skin to avoid burns.
Step 2. If possible, stay active
You may need to rest a few days immediately after the hernia forms, but after this time you need to resume movement to avoid stiffening and to heal faster. Talk to your doctor or physical therapist to find exercises that fit your situation.
- Avoid any activities that can make the discomfort worse. These include carrying and lifting heavy loads or stretching.
- Your doctor may advise you to swim, as the water partially supports your body weight by relieving pressure on your spine. Other possible activities could be cycling or walking.
- If there are no contraindications, try hip lifts. Lie on your back with your knees bent and place your hands under your lower back. Tilt your pelvis until your hands are pressed to the floor with your back. Hold the position for ten seconds and then do 10 repetitions. If this exercise causes or worsens the pain, stop it immediately and see your doctor.
- Try the contractions of the buttocks. While lying on the ground with your knees bent, contract your glutes while holding the position for 10 seconds. You shouldn't feel pain; however, if this happens, do not continue and discuss with your physiotherapist or doctor.
Step 3. Change your sleeping position
You may find some relief by taking postures during the night that take some pressure off your spine and nerves. Your doctor or physical therapist may suggest that you:
- Sleeping with a pillow under your belly to gently arch your back in this way you reduce the pressure on the nerves.
- Assume a fetal position with a pillow between the knees; the side affected by the hernia should face up.
- Lie on your back with some pillows under your knees, so that your hips and knees are bent and your lower back is parallel to the bed. During the day, you can lie on the floor with your legs propped up against a chair.
Step 4. Find support from the people around you
Living with chronic pain is very stressful and can cause you to fall into a state of anxiety and depression. If you maintain a social network, you can deal with all of this and feel less alone. Here's how you can find help:
- Talk about your problem with friends and family. If there are any activities that you are unable to do on your own, let them help you.
- Go to a psychotherapist. This professional will help you develop techniques for dealing with pain and accepting the truth, in case you have unrealistic expectations about recovery. Your doctor may recommend a psychologist who is experienced in pain management.
- Join a support group. In this way you will feel less alone and you will learn to manage the situation.
Step 5. Reduce Stress
Emotional and psychological tension make you more sensitive to pain. If you can develop techniques to keep it at bay, you will be able to control physical suffering as well. Some people find some benefit from practicing:
- Meditation;
- Deep breathing;
- Music- or art-therapy;
- Viewing calming images;
- The contraction and progressive relaxation of the various muscle groups.
Step 6. Discuss alternative treatments with your physical therapist
Sometimes, changing the way you move or sit can help keep things from getting worse. You may find alternative methods of pain management benefit, but always ask your doctor for advice to be sure that these techniques do not harm your health. Here are some ideas:
- A collar or back brace to wear for a short time to protect the area and provide stability;
- Traction exercises;
- Ultrasound treatments;
- Electrostimulation.
Part 3 of 3: Taking the Medications
Step 1. Treat moderate pain with over-the-counter pain relievers
In all likelihood this will be the first solution proposed by the doctor in case the pain is not disabling.
- The drugs he can recommend are ibuprofen (Brufen, Oki) or naproxen (Aleve).
- Although non-steroidal anti-inflammatory drugs (NSAIDs) are very helpful, they may not be suitable for you if you have high blood pressure, asthma, kidney or heart problems. Ask your doctor if you can take these medicines, as they may interfere with other drug therapies, including herbal treatments and dietary supplements. NSAIDs mainly create gastric disturbances, such as ulcers. Return to the doctor who is not benefiting after 7 days of treatment with anti-inflammatories.
Step 2. Fight the pain with prescription medications
Based on your symptoms and medical history, your doctor may recommend:
- Neuropathic pain medications. These medicines are becoming more and more popular because they have fewer side effects than narcotics. The most used are gabapentin (Neurotin), pregabalin (Lyrica), duloxetine (Cymbalta) and tramadol (Tralodie).
- Narcotics. They are typically prescribed when over-the-counter medications have proved too weak and those for neuropathic pain have not helped. They involve various side effects such as sedation, nausea, confusion and constipation. These medicines most often contain codeine or a mixture of oxycodone and acetaminophen.
- Muscle relaxants. Some people experience very painful muscle spasms and benefit from this class of medicines. One of the most common is diazepam. Some can cause sedation and dizziness, so they should be taken in the evening before bedtime. Always read the instructions on the leaflet to know if you should avoid driving or operating heavy machinery after taking the drug.
Step 3. Get cortisone injections for pain relief
Cortisone suppresses swelling and inflammation. If necessary, your doctor may inject the medicine directly into the site that is causing the pain.
- Alternatively, you will be prescribed corticosteroids to take by mouth to help control swelling.
- Corticosteroids are used to delay or avoid surgery. It is generally hoped that by reducing inflammation, the body will be able to heal on its own in the long term.
- When given for a long time, cortisone causes weight gain, depression, diabetes, hypertension, osteoporosis, bruising, acne, and vulnerability to infection.
Step 4. Discuss the possibility of surgery with your doctor
Your doctor may recommend it if the other solutions have not led to any results or if the nerves are very compressed. There are several surgical procedures for a herniated disc:
- Open discectomy. The surgeon makes an incision in the spine by removing the damaged portion of the disc. If the lesion is very extensive, he may decide to remove the entire disc. In this case it will be necessary to stabilize the vertebrae adjacent to the extracted disc. This is called a merger.
- Prosthetic replacement of the intervertebral disc. During the procedure, the surgeon removes the damaged disc and replaces it with a prosthetic material.
- Endoscopic laser discectomy. The surgeon makes a small incision in the spine to insert a thin tube with a light and camera (the endoscope). The damaged disc is then removed with the laser.
Step 5. Follow the surgeon's instructions during post-surgery recovery
Surgery proves useful for most patients, but it takes several weeks of recovery. You will be able to return to work 2-6 weeks after the procedure.
- If you notice any signs of complication after surgery, contact your doctor immediately. Although rare, some of the negative effects of surgery are infections, nerve damage, paralysis, bleeding, or temporary loss of touch.
- Spinal surgery leads to results for some time. However, if the patient has undergone a vertebral fusion, the load is transferred to the adjacent vertebra, resulting in the need for a second surgery. This is a very important issue to address with your doctor as it could mean more surgical procedures in the future.
