Herniated Disc Treatments and Medications

Herniated discs are one of the most common causes of back and leg pain. Up to 2% of the adult population in the United States experiences pain from a herniated disc in any given year. It affects men more than women—it is most common in men between the ages of 35 and 55 years old. It can affect the lower, mid-back, or neck area depending on the location of the damaged disc. In this article, we discuss significant symptoms, treatment, medications, and at-home strategies to manage and prevent pain.

What is a herniated disc?

Your spine has 33 bones, called vertebrae. There are soft discs between them that act as shock absorbers and allow you to bend and stretch. Damage to these discs is called lumbar disc disease, which encompasses two conditions: a herniated disc and a bulging disc.

A bulging disc often occurs with age and is sometimes referred to as disc degeneration. The fluid in the center of the disc, called nucleus pulposus, dries, and the disc flattens, which can cause the outer ring to weaken. As it does, the nucleus pulposus leaks out, creating a bulge in the disc, which is often the cause of decreasing height as people age.

A disc herniation occurs when the inner part of the disc ruptures and the fragments of disc material press on the nerve roots located in the spinal canal. “The inner part of the disc is the nucleus pulposus, and the outer part that surrounds the nucleus is the annulus fibrosus," explains Alex Taubert, DC, a chiropractor at Tauberg Chiropractic & Rehabilitation in Pittsburgh. "A herniated disc occurs when the nucleus pushes through the annulus and causes both parts of the disc to push outward. A herniated disc generally pushes outward at one point.”

Although it usually occurs in the lower back, herniated discs can occur anywhere on the spine. Some people refer to this condition as a slipped disc or a ruptured disc. It is a painful condition. In the lower back, it can cause lumbar radiculopathy, which is also known as sciatica. When it is in the neck area, sometimes referred to as cervical radiculopathy, you might have radiating pain down your arms. It rarely occurs in the mid-back or thoracic section of the spine.

“Many people have a disc herniation without knowing it because they don’t experience any symptoms," says Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. "This is because the herniation itself isn’t the problem. Disc herniation results in symptoms when the damaged disc pushes out enough to irritate the nerves near the spine. The chief complaint is the radiating pain—in the arm when it is in the neck area and the leg when it is in the lumbar region.”

Acute disc herniation is more common in people between the ages of 20 and 40, according to Justin Park, MD, a board-certified orthopedic spine surgeon with The Maryland Spine Center at Mercy Medical Center. “These people usually have short-lived symptoms that might be tied to a specific event, such as lifting something heavy," he says. "Chronic disc herniations occur over time, and are more prevalent in those between the ages of 50 and 70, where symptoms gradually develop.” Herniated discs can occur during the early stages of disc degeneration or after an injury. People are more susceptible to injury as they age after degeneration has started. Risk factors include:

• Being overweight

• Inactive lifestyle

• Sitting or standing in the same position for long hours

• Smoking

According to Mount Sinai Medical Center, symptoms of a herniated disc vary depending on where the injured disc is: in the low back, upper back, or mid-back.

Lumbar herniated disc

When damage occurs in the low back, you can experience sharp pain in one part of the leg, hip, buttocks, pain, or numbness on the back of the calf or sole of the foot. It can cause sciatica, which is pain radiating down one leg.

Cervical herniated disc

If you have damage in the upper spine, you can experience neck pain. You might notice pain when moving your neck. You can also experience deep pain near or over the shoulder blade, pain in the upper arm, forearm and fingers, and numbness along your shoulder, elbow, forearm, and fingers.

Thoracic herniated disc

Damage to discs in the mid-back is rare but can occur. When it does happen, the pain can travel around the rib cage, including in your chest and upper abdomen. You might have numbness, stiffness, and muscle weakness in your legs.

Pain often increases after standing or sitting, at night, when sneezing, coughing or laughing, walking, bending backward, straining, or holding your breath. Depending on the location, you might notice muscle weakness, difficulty lifting a leg or arm, standing on your toes, or squeezing tightly with one hand. The pain is often on one side of the body. Usually, the pain, numbness, and weakness disappear or improve over weeks or months.

How is a herniated disc diagnosed?

When seeking medical advice for your back pain, your healthcare provider completes a physical exam and asks for a description of your symptoms and how long you have been experiencing pain. During the physical exam, they check for numbness, muscle reflexes, muscle strength, and posture. They might also ask you to:

• Bend forward, backward, and sideways

• Move your neck forward, backward, and sideways

• Step on your toes and heels as you walk

• Raise your shoulders, elbow, wrist, and hand, and check your strength during these tasks

Based on the results of the physical exam, your medical provider could request additional tests, such as:

• Magnetic resonance imaging (MRI) or CT scan to determine the location of the herniated disk

• Electromyography (EMG) to determine the exact nerve root involved.

• A myelogram to provide information on the size and location of disk herniation.

• Nerve conduction velocity to help determine nerve damage.

A spine X-ray is not used to diagnose a herniation as the discs do not appear on X-rays, but it helps to rule out other causes of back or neck pain.

Herniated disc treatment options

When your doctor first diagnoses a herniated disc, he or she might suggest conservative therapy, according to Dr. Anand. “You’ll begin with simply avoiding the positions and activities that bring pain," he says. "This doesn’t mean lie still; rather, you will likely be given a set of exercises to perform that can help reduce pain while simultaneously strengthening the spine. Medication, if needed, can range from over-the-counter options if the pain is mild to moderate to cortisone injections if the pain is more severe. Often these conservative options are enough to relieve herniated disc symptoms within a few weeks. If the pain does not resolve, physical therapy guides you through positions and exercises designed to reduce pain.”

During physical therapy sessions, you might learn exercises to strengthen your back and stomach muscles, which lessen pain. You might also learn the proper way to lift objects without straining your back. Physical therapy usually starts a few weeks after your injury. “You can have a good prognosis if you reach out to a physical therapist sooner rather than later,” according to Adeeb Khalfe, DPT, a physical therapist at Movement Evolution in Houston. “Many of the patients who receive physical therapy can fully recover and get back to doing the activities they love within four to six appointments that include exercises and manual therapy.”

If you don’t receive relief from rest and physical therapy, your doctor might suggest steroid injections. For this treatment, cortisone is injected directly into your spine to reduce swelling and lessen the pain. You might need one dose, or several over a few weeks. Steroid injections do have potential long-term side effects, such as cartilage and nerve damage. Your doctor should use steroid injections only when rest and physical therapy do not relieve symptoms.

Most times, herniated discs heal in four to six weeks with rest and physical therapy. If the nonsurgical treatment does not improve symptoms, your physician might discuss surgical options, which is usually done only as a last resort. There are several types of surgery, according to the American Association of Neurological Surgeons.

These include:

• Lumbar spine surgery is for a herniated disc in the lower back. The surgeon removes the damaged disc (discectomy) and then fuses the vertebra on either side together to stabilize the spine.

• Cervical spine surgery is when the herniated disc is in the neck area. Surgeons can make an incision in the front or back of the neck, whichever provides the best access to the spinal canal, and perform a discectomy. Then, vertebrae are fused for spinal stabilization when necessary. When using a posterior (back) incision, fusion might not be required.

• Artificial disc surgery involves removing the affected disc and replacing it with an artificial one. Only a small percentage of people are eligible for this type of surgery, but it is available for the lumbar and cervical regions.

Herniated disc medications

Medications for herniated discs include nonsteroidal anti-inflammatory drugs, opioid pain medications, and muscle relaxants.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs help reduce swelling and pain. This class of medication includes:

• Aleve (naproxen)

• Celebrex (celecoxib)

• Indocin (indomethacin)

• Daypro (oxaprozin)

Opioid pain medications

Narcotic pain relievers are only available by prescription. They can have serious side effects and lead to addiction when not used properly. They work by sending signals to your brain to say you are not in pain.

Some of these include:

• OxyContin (oxycodone)

• Percocet (oxycodone and acetaminophen)

• Demerol (meperidine)

• Kadian MS Contin (morphine)

• Vicodin (hydrocodone and acetaminophen)

• Zohydro ER (hydrocodone)

• Codeine only available in generic form

Muscle relaxants

Muscle relaxers reduce pain by relaxing the muscles around the spine and depressing the central nervous system. They are sometimes prescribed if your herniated disk is causing muscle spasms. Some of these include:

• Soma (carisoprodol)

• Fexmid (cyclobenzaprine)

• Valium (diazepam)

• Skelaxin (metaxalone)

Epidural injections contain corticosteroids and work to reduce swelling. Their effect usually lasts anywhere from a few weeks to a few months. They do not cure your herniated disc but can lessen the pain so you can complete physical therapy.

What is the best medication for a herniated disc?

There is no “best” herniated disc medication. People react differently to drugs, and what is best for one person may not be the right choice for someone else. Choosing the best prescription for each person depends on several factors, including:

• Medical condition

• Medical history

• Other medications currently being used and potential interactions

• Other conditions (including pregnancy, breastfeeding or intending to get pregnant)

• Tolerance for drugs and response to treatment

Work with your doctor to determine the best medication for you.

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Best medications for a herniated disc