A disc herniation can be a very painful and disabling condition in which the patient often feels both back pain and radiating symptoms of various kinds down one or both legs. The pain in the leg is often described as electric shocks or tingling. In addition, you may experience numbness, pins and needles and reduced strength in the same area. In an acute herniation the condition can be so disabling that it is difficult to stand, sit or move around. Many are signed off sick and find it hard to carry out necessary everyday activities from the moment they get up in the morning until they go to bed. Sleep at night can also be poor, and the desperation for help becomes great when everyday life is this painful.
So what options are there? How can a disc herniation be treated?
Painkillers?
Painkillers are most often the first thing patients with a disc herniation in the back try as treatment. The frustration is seldom reduced when many experience that the pain is unchanged. Research on disc herniation and painkillers has shown that this type of treatment has little to no effect.
Placebo is in fact just as effective as NSAIDs (anti-inflammatory medication) in the treatment of long-term sciatica. Opinions are divided when it comes to the use of steroids as acute treatment of a disc herniation. There are a number of studies with varying results. There is also insufficient evidence of a positive effect of paracetamol, benzodiazepines, opioids and antidepressants, so the use of these drugs is not recommended. In addition, there is little evidence for the use of antiepileptics.
Fortunately, some patients still experience pain relief from using medication, but which medication and how much should be clarified in consultation with your GP.
Physical treatment?
Very many people see a physiotherapist, chiropractor or manual therapist for treatment of a disc herniation in the back. Nor do these professional groups have any evidence whatsoever that they can cure a disc herniation. They cannot crack, push, stretch or press a disc herniation back. Once the injury has occurred, it must be given time to heal. Most disc herniations get better on their own over time. A skilled practitioner will therefore spend the time finding out what gives pain relief and suggesting various measures that can help. This differs greatly from person to person. Some find relief from walks in the woods and fields, while others do best lying still, almost in the foetal position in bed. Patients with low back pain often experience relief from various types of physical treatment and rehabilitation, but the radiating pain in the leg needs time to settle. Our practitioners can contribute with advice, pain-relieving treatment and help you find the load that is right for you.
Disc herniation surgery?
Surgery is the only measure that will get patients with a disc herniation pain-free faster, although an operation is not guaranteed to bring improvement either. Why, then, are not all those with such severe pain operated on?
All operations naturally carry a risk of complications. An operation treats the current symptoms but probably has little preventive effect against new disc herniations in the same disc, or elsewhere in the back. It also does not have a markedly better effect with regard to pain and disability beyond 12 weeks. Therefore, early back surgery should preferably not be performed on the basis of pain.
As a general rule, acute disc herniation surgery should be performed in the case of:
- Weakness in one or both legs.
- Marked sensory changes/loss of sensation.
- Signs of clumsiness in fine motor skills, unsteady gait, spasticity in muscles, increased tendon reflexes, bladder disturbances and/or involvement of the anal sphincter.
- Loss of sensation in the perineum and thighs (saddle area), urinary retention and paralysis of the anal sphincter.
10-20% of those who have had disc herniation surgery unfortunately have to be operated on again. Repeat operations have a significantly higher complication rate and lower success rate, largely because of scar tissue.
Surgery vs treatment?
After 12 months there is no significant difference in pain and disability between patients who have had surgery and patients who have received treatment without surgery. Patients who are operated on early will regain function and relieve pain more quickly. Conservative treatments are not more cost-effective than surgical treatment. There are complications with both surgery and drug treatment.
What do you do about a disc herniation in the back?
Fortunately, the prognosis for disc herniation is generally good. 8 out of 10 will recover within 8-12 weeks. Even so, up to 12 weeks is a long time to wait for improvement when everyday life is largely affected by the pain. It is important to try to keep moving, and in some cases treatment, painkillers and exercises adapted to your symptoms can relieve pain. There is also no shame in staying still if it gives the best relief, but then the risk of getting pain elsewhere in the body naturally increases. Painkillers should be used for weeks, not months.
If you are reading this early in the course of a disc herniation, you unfortunately have to prepare for several weeks of moderate to severe pain. Try a few different things, and talk to professionals for assessment, advice and guidance. The vast majority find some form of pain relief.
Our physiotherapists, chiropractors and manual therapists are ready to help you if you have a disc herniation.
References:
- Diagnosis and treatment of sciatica Jensen et al. BMJ 2019
- Which pain medications are effective for sciatica (radicular leg pain)? Pinto et al. BMJ 2017;
- Fjeld et al. Bone and Joint Journal, 2019
- Hout et al. BMJ 2008
- Weinstein al. JAMA 2006
- Paul et al. NEJM 2007