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Treatments and drugs
By Mayo Clinic staffConservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in nine out of 10 people with a herniated disk. Many people get better in a month or two with conservative treatment. Imaging studies show that the protruding or displaced portion of the disk shrinks over time, corresponding to the improvement in symptoms.
Medications
- Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen (Aleve, others). Many of these drugs carry a risk of gastrointestinal bleeding, and large doses of acetaminophen may damage the liver.
- Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or a hydrocodone-acetaminophen combination (Vicodin, Lortab, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs. Decrease or eliminate your Tylenol use if these combination medications are prescribed.
- Nerve pain medications. Drugs such as gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram, Ryzolt) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they're increasingly being used as first-line prescription medications for people who have herniated disks.
- Muscle relaxers. Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Flexeril, Amrix) also may be prescribed if you have back or limb spasms. Sedation and dizziness are common side effects of these medications.
- Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves, using spinal imaging to more safely guide the needle.
Therapy
Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. As the pain improves, physical therapy can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury.
A physical therapist may also recommend:
- Heat or ice
- Traction
- Ultrasound
- Electrical stimulation
- Short-term bracing for the neck or lower back
Surgery
A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if:
- Conservative treatment fails to improve your symptoms after six weeks
- A disk fragment lodges in your spinal canal, pressing on a nerve and resulting in progressive weakness
- You're having significant trouble performing basic activities such as standing or walking
In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Or your surgeon may suggest the implantation of an artificial disk.
- Chad DA. Disorders of nerve roots and plexuses. In: Bradley WG, et al. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa.: Butterworth Heinemann Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-7506-7525-3..50117-5&isbn=978-0-7506-7525-3&sid=1063623544&type=bookPage§ionEid=4-u1.0-B978-0-7506-7525-3..50117-5--cesec12&uniqId=221226396-3#4-u1.0-B978-0-7506-7525-3..50117-5--cesec12. Accessed Oct. 5, 2010.
- Herniated disk. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00334. Accessed Oct. 5, 2010.
- Herniated disc. American Association of Neurological Surgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Herniated%20Disc.aspx. Accessed Oct. 5, 2010.
- Herniated lumbar disc. North American Spine Society. http://www.spine.org/Documents/herniated_lumbar_disc_2006.pdf. Accessed Oct. 6, 2010.
- Herniated cervical disc. North American Spine Society. http://www.spine.org/Documents/herniated_cervical_disc_2006.pdf. Accessed Oct. 6, 2010.
- JAMA patient page: Herniated lumbar disks. Journal of the American Medical Association. 2006;296:2512.
- Cauda equina syndrome. American Association of Neurological Surgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Cauda%20Equina%20Syndrome.aspx. Accessed Oct. 6, 2010.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Oct. 6, 2010.
- Chou R, et al. Diagnosis ad treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147:478.
- Robinson J, et al. Treatment of cervical radiculopathy. http://www.uptodate.com/home/index.html. Accessed Oct. 7, 2010.
- Levin K, et al. Lumbosacral radiculopathy: Prognosis and treatment. http://www.uptodate.com/home/index.html. Accessed Oct. 7, 2010.
- Dworkin RH, et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain. 2007;132:237.
- Shelerud RA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 13, 2010.
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