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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, according to the American Academy of Orthopaedic Surgeons.
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. Depending on your symptoms, your doctor may recommend:
- Modified activity. Take it easy when you have severe back pain. Try to stay away from activities that aggravate your symptoms, such as improper reaching, bending and lifting, using a rowing machine, and prolonged sitting. Intermittent activity to maintain fitness and minimize stiffness is very important, so physical therapy and exercises to increase flexibility and strength may be prescribed. A herniated disk isn't a fragile spine problem, so don't avoid physical activity altogether. In fact, staying at work is best, even if you need to reduce your workload or assume lighter duties. Work with your doctor or a physical therapist to find the right combination of rest and activity. Eventually, your activity level can gradually increase until you're comfortable with everyday tasks.
- Physical therapy. A physical therapist can apply heat, ice, traction, ultrasound and electrical stimulation for pain relief. Physical therapists can also 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.
- Heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you may switch to gentle heat to give relief and comfort.
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Pain medication. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as aspirin, ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen (Aleve, others). NSAIDs carry a risk of gastrointestinal bleeding, and in large doses acetaminophen may damage the liver.
Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Flexeril) may also be prescribed if you have back or limb spasms. Sedation and dizziness are common side effects of these medications.
If your pain doesn't improve with these medications, your doctor may prescribe narcotics, such as codeine or a hydrocodone-acetaminophen combination (Lortab, Vicodin) for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.
Neuropathic pain medications or "nerve pain" pills, such as gabapentin (Neurontin, others) also have been prescribed for this type of pain. Alternatively, inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves.
- Bed rest. Constant, severe back pain from a herniated disk sometimes requires one or two days on bed rest. Strict bed rest for more than a day or two, however, can inhibit recovery by causing loss of muscle tone.
- Time. Herniated disk symptoms generally take four to six weeks to significantly improve.
Surgery
About 10 percent of people with herniated disks eventually need surgery. You may be a good candidate for surgery if conservative treatment fails to improve your symptoms after six weeks. Surgery also may be considered if a disk fragment lodges in your spinal canal, pressing on a nerve, or if you're having trouble standing or walking.
A common surgery for a herniated disk is a microdiskectomy. This surgery is related to standard or open diskectomy, a spinal surgery that involves cutting away some of the spinal bones (vertebrae) to access the herniated disks and compressed nerve roots. In microdiskectomy, surgeons use a surgical microscope or magnifying lens to allow smaller incisions in the skin, muscles and bone overlying a herniated disk. Smaller incisions and less disruption to surrounding tissue lessen pain and shorten recovery time. During a microdiskectomy:
- You're placed under general anesthesia, which means you won't be conscious during the surgery. In some cases, though, microdiskectomy is possible without general anesthesia, using injections that cause temporary numbness (local anesthesia) in the back.
- The surgeon makes a small incision over the herniation and moves the back muscles away from the spine as much as possible. Small amounts of bone and ligaments may be removed to gain access to the herniated disk and nerve root.
- Small instruments are used to remove the herniated portion of the disk and other disk tissue and fragments, relieving pressure on the nerve.
- The incision is closed with stitches or staples.
Some people go home the same day, while others stay in the hospital overnight. Most people make a full recovery and return to work within two to six weeks.
- 1. Herniated Disc. NeurosurgeryToday.org. http://www.neurosurgerytoday.org/what/patient_e/herniated.asp. Accessed Oct. 5, 2008.
- 2. Chou R. Patient Information: Low back pain. http://www.uptodate.com/home/index.html. Accessed Oct. 2, 2008.
- 3. Wheeler SG, et al. Approach to the diagnosis and evaluation of low back pain in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 2, 2008.
- 4. What is back pain? National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Back_Pain/back_pain_ff.pdf. Accessed Oct. 5, 2008
- 5. Hu SS, et al. Disorders, diseases and injuries of the spine. In: Skinner HD. Current Diagnosis and Treatment in Orthopedicas. 4th ed. New York, N.Y.: McGraw-Hill; 2006. http://www.accessmedicine.com/content.aspx?aID=2319599. Accessed Oct. 5, 2008.
- 6. Herniated disk. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00334&return_link=0. Accessed Oct. 5, 2008.
- 7. Chou R. Subacute and chronic low back pain: Pharmacologic and noninterventional treatment. http://www.uptodate.com/home/index.html. Accessed Oct. 2, 2008.
- 8. Knight CL, et al. Treatment of low acute back pain. http://www.uptodate.com/home/index.html. Accessed Oct. 2, 2008.
- 9. Health care guideline: Adult low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. http://www.icsi.org/low_back_pain/adult_low_back_pain__8.html. Accessed Oct. 15, 2008.
- 10. Shelerud RA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 12, 2008.
- 11. Heliovaara M. Body height, obesity, and risk of herniated lumbar intervertebral disc. Spine. 1987;12(5):469-472.
