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Gulf Coast Pain Management

Herniated discs can occur in any part of the spine. They are most common in the lower back (95% occur in the lower back 1), but can also occur in the neck (cervical spine) and mid-back (thoracic spine).

Often, a herniated disc does not cause any pain. Pain occurs when there is pressure from the herniated disc on the nerve roots or spinal cord. This pain or numbness may occur in the area of the body to which the nerve goes. For example, a herniated disc that presses on the nerve roots of the sciatic nerve (a large nerve that extends from the lower back down the back of the leg) may cause pain and numbness in the leg. This condition is called sciatica. Sciatica is the most common symptom of a herniated disc in the lower back. Symptoms of sciatica include shooting pain down the back of the leg, or weakness, tingling, or numbness in the leg.

Most herniated discs heal on their own over time (1 to 6 months) and surgery is usually not needed. Herniated discs are treated first with conservative (nonsurgical) treatment. Conservative treatment may include a short period of rest, medication for pain relief, and an exercise program prescribed by a doctor or physical therapist.

Who is affected

For people with low back pain, only 1 to 2 people out of 100 (1% to 2%) have low back pain that is caused by a herniated disc. Many people who have herniated discs do not have symptoms (no leg pain or back pain). Herniated discs can occur in people of all ages. They are most common in people between 35 and 45 years old . Herniated discs are common in people who perform heavy manual labor and those who drive motor vehicles for long periods of time.

Steps for comfort and pain relief

You can do the following steps to make yourself more comfortable and to relieve pain:

Limit your activities and rest your back for 2 to 4 days if your pain is severe. Try taking short walks and doing light activities that do not cause pain. Then begin your regular activities gradually. Even for people with severe pain, prolonged bed rest (more than 4 days) may cause the muscles in your back (and whole body) to become weaker and harm your overall health. Therefore, prolonged bed rest is not recommended. In the acute stage, use ice or heat to relieve pain. Apply ice 3 times a day. Do not use ice for longer than 15 to 20 minutes at a time. Heat relieves pain for some people, but should not be used too soon after an injury. Ask your doctor about using ice and heat to reduce your pain. Pain relievers that are available without a prescription can help reduce pain. Examples include aspirin (Bayer), acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen sodium (Aleve). Remember to follow the directions on the bottle, over the counter medications can have bad side effects, such as stomach ulcers, liver and kidney disease. Be sure to tell your doctor that you are taking over the counter medications because they can interact with the other medications and have devastating effects.

Steps to strengthen your back

Aerobic and isometric exercise will strengthen the muscles in your stomach and back and help prevent further injury. Other steps that will keep your back strong and healthy include getting regular exercise to maintain good health, using good posture, losing weight if you are overweight, and quitting smoking if you smoke.

Aerobic exercise (exercise that trains the heart and other muscles to use oxygen more efficiently) is one of the most effective means of speeding your recovery and preventing reinjures to your back.

Walking, swimming, and bicycling are all good choices. Non-weight-bearing exercises (such as swimming and cycling) tend to be better if you still have pain. Aerobic exercises can usually be started within 1 or 2 weeks after symptoms start. Increase your aerobic exercise regimen gradually. Start with 5 to 10 minutes a day and gradually work up to 20 to 30 minutes of continuous activity per day. Isometric exercises strengthen the muscles of the stomach and back and may include some weight training exercises.


Drug treatment is often used to treat pain caused by a herniated disc. Drug treatment does not cure a herniated disc, but reduces inflammation and pain and allows a person to begin an exercise program that will strengthen the stomach and back muscles.

Drug treatment includes the following:

  • Pain relievers such as acetaminophen, and nonsteroidal
  • anti-inflammatory drugs (NSAIDs), including aspirin
  • Narcotic pain relievers
  • Muscle relaxants
  • Tricyclic antidepressants
  • Epidural
  • Corticosteroid injections

What to Think About

The use of pain relievers or corticosteroid injections alone will not cure a herniated disc. It is important to take care of your back and do specific exercises to strengthen it, in addition to drug treatment, to control your symptoms. Some of the drug treatments used, such as narcotic pain relievers and corticosteroid injections, may have serious side effects. Talk to Lynne Carr Columbus, D.O. for her/his recommendations for you.

Other Treatment Choices The goals of treatment are to: Exercise, including aerobic and isometric exercise, is an important and effective part of treatment for a herniated disc. There are a variety of exercises you can do to help relieve pain, strengthen the muscles that support your back, and prevent reinjury. Lynne Carr Columbus, D.O. or your physical therapist can recommend exercises for your specific condition. Also, there are rehabilitation programs that are designed to teach people how to care for their backs and prevent reinjury. There are other treatments that people use for leg and back pain caused by a herniated disc. Although scientific studies have not been done to test the effectiveness or safety of these treatments, they may help some people. Some examples include:

  • Massage (may help relieve pain)
  • Manipulation (may not be recommended in some cases)
  • Corsets or braces
  • Transcutaneous electrical nerve stimulation (TENS)


Most people with a herniated disc do not need surgery, because their symptoms tend to improve over time. See making the decision about surgery for a herniated disc. Surgery may be considered if a herniated disc is causing nerve root compression and there is:

  • Progressive nerve damage in the leg such as weakness, loss of coordination, or loss of feeling
  • Sciatica that becomes severe and disabling
  • Large fragments of disc material lodged in the spinal canal that are clearly causing nerve-related problems
  • Impaired bladder, bowel, and sexual function (a rare condition called cauda equina syndrome)

Unless emergent surgery is indicated surgery is considered as a last resort, after other treatments fail. It is appropriate for certain people with certain conditions. Further considerations for surgery include your age, your overall health, the severity of your symptoms, and the impact of the symptoms on your life, such as the inability to work or the onset of emotional problems. For example, surgery may be considered if a person's job requires a quick recovery, and there is no time to wait for the herniated disc to heal itself. Surgery may also be considered for older adults if the herniated disc is less likely to improve without surgery because of other spinal diseases.

Surgery Choices

Surgical treatment for a herniated disc may include the following. Discectomy is used for bulging discs or ruptured discs, or to remove disc fragments from the spinal canal. A laminotomy or laminectomy may be done at the same time as a discectomy, or separately. A laminotomy or laminectomy alone may also relieve pressure on nerve roots in the spine. Percutaneous discectomy involves using a special tool that is inserted through a small cut in the back. This tool is used to cut out or drain a herniated disc, thereby reducing the size of the disc. This procedure is used for bulging discs and discs that have ruptured into the spinal canal. This procedure is considered less effective than open discectomy.

Discectomy may be the most effective type of surgery for people who have tried conservative (nonsurgical) treatment without success and who have severe, disabling pain.

What to Think About

Studies show that people who have surgery to treat herniated discs usually have faster relief of symptoms compared with people who don't have surgery. However, studies show that these early benefits may decrease over time. The majority of patients do well with conservative therapy consisting of anti-inflammatories, physical therapy and epidural steroid injections After several years, most people have less pain and improved muscle strength, whether or not they had surgery. Surgery may be considered in cases where a quick recovery is necessary.

Other things to consider about surgery include:

  • How severe your symptoms are and whether your leg and/or back pain are preventing you from doing your normal daily activities or your job.

  • Whether there are medications that you are willing or able to take that can relieve your leg and/or back pain.

  • Whether you would follow a rehabilitation program that would be necessary after surgery.

  • Whether you are able or willing to have surgery.

If surgery is considered, it is the most successful when done within 2 to 6 months after symptoms begin. People who have had symptoms (pain, weakness, or numbness caused by a herniated disc) for a long time may not benefit as much from surgery. After surgery, a rehabilitation program can speed recovery. If a person is not able or willing to complete a rehabilitation program, he or she may not be a good candidate for surgery.

The goals of treatment are to:

  • Relieve pain in the leg and lower back
  • Relieve pressure on spinal nerve roots
  • Strengthen the muscles that support the spine to prevent reinjures
  • Teach people with long-term (chronic) pain how to cope with symptoms on a daily basis
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Lynne Carr Columbus, D.O.

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