There’s Life after a Herniated Disc

What do you do when your doctor diagnoses you with a herniated disc in your lower back? Well, first off don’t panic! How you approach this new piece of information has a lot to do with your particular clinical situation. For starters, think closely about where you feel your pain. Is it mostly in your lower back, or do you feel the most intense symptoms going down one leg?

Experiencing pain primarily in the lower back is a common problem that will afflict two thirds of the population at some time. The causes of low back pain are often nondescript and difficult to define. In other words, it can be difficult to accurately pinpoint factors contributing to the ache in your back, and evidence dictates that ordering an MRI for back pain is not really cost-effective when it comes to adding value to the treatment process. But if your doctor went ahead and got the MRI for you anyway, don’t assume that just because the radiologist found a herniated disc that this finding is clinically relevant. In fact, past studies have shown that a large proportion of asymptomatic volunteers do have herniated discs in their lower spines even though they don’t have symptoms. When it comes to choosing management strategies for your back ache, it may not be all that helpful to approach it as a herniated disc problem.

On the other hand, if most of your pain is shooting down one leg or the other, a symptom often referred to as sciatica, then an MRI finding of a herniated disc may be much more relevant. Herniation means that disc material, including the outer cartilage annulus and inner gelatinous annular elements, has pushed out beyond the normal margins of the disc space. When this happens nerve roots can get irritated by the mechanical pressure exerted on them as well as by chemical inflammation created by the herniation.

The pain associated with a nerve root irritated by a herniated disc can be acutely intense, and it is often described as shooting, electrical, sharp, or like pins and needles. A pinched nerve root can also lead to annoying numbness down the leg, as well as muscle weakness when the motor nerves that communicate with specific muscles in the leg are affected. In some cases foot drop can occur, characterized by difficulty pointing the foot up, or conversely, weakness pointing the foot down to lift the heal off the ground. The end result of all of this is that sciatica from a herniated disc can in some cases become quite debilitating.

The good news is that the body is well-equipped to recover and heal from a herniated disc, meaning the odds are in your favor to get better over time! Consider these facts:

  • Research shows that in most cases (up to 87%) the pain subsides after an average of 3 months
  • Sciatica pain usually improves without surgery
  • Muscle weakness usually improves over time (81% recovery rate in the first year)
  • Leg and foot numbness may be more persistent but will resolve in the first year 50% of the time
  • Herniated discs shrink over time with an estimated 76% resolved after 1 year

So what do you do when faced with what appears to be a symptomatic herniated disc? Given that the odds are good for a meaningful recovery in the 3–12 month range after the problem starts, I usually recommend taking a conservative approach whenever possible while trying to give the body its best chance to heal. Unfortunately, finding relief can be hard to come by while waiting out the healing process. Studies have not found opioids to be more effective than nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen in treating back pain or sciatica. We also know that bed rest is not helpful, and excessive avoidance of activity can lead to delays in recovery. Moving the body when it is feeling intense pain can be tricky, though. (Click here for tips: http://www.painreliefrevolution.com/article/treatments-exercises/six-tips-how-exercise-chronic-pain.)

Alternative approaches that may help include acupuncture and chiropractic treatment, and if symptoms persist beyond the first month, epidural cortisone injections have been found to provide mostly short-term relief. While more immediate relief can be found after surgery, studies have not found any benefit to surgery over conservative care after the first year, although surgery may be considered when bad neurologic deficits are present.

The good news is that for most of us, there is a good chance the effects of a herniated disc will subside over time if we can hang in there and work through it.

References:

http://www.nejm.org/doi/full/10.1056/NEJMcp1512658

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