Insights and advice about herniated discs

Pain from a herniated disc
Pain and other symptoms generated from a cervical or lumbar herniated disc can be misunderstood by medical and health professionals and patients alike. This confusion occurs partly because health professionals commonly do not agree on spinal disc pathology, and partly because disc problems such as a herniated disc are not always well explained to (or understood by) patients.

Some of the factors that make the identification and treatment of a herniated disc challenging include the following:

Terminology about a herniated disc can be confusing. There are many different terms to describe a herniated disc, such as a pinched nerve, bulging disc, ruptured disc or slipped disc. These terms tend to be used somewhat differently among health professionals because there are no generally agreed upon definitions for many disc problems. Interchangeable terminology can be confusing and frustrating for patients who hear their condition referred to in different terms by different practitioners, causing the patients to remain unclear as to the real diagnosis.
The extent of disc problem or disc herniation does not necessarily correlate to the patient’s level of pain. Although it may seem contrary to common sense, the severity of pain from a herniated disc does not always correlate to the amount of physical damage to the disc. Additionally, less serious back problems may cause more pain than a herniated disc. For example, a large herniated disc can be completely painless, while a muscle spasm from a simple back strain may cause excruciating pain. This means that the severity of pain is not a determining factor for identifying a herniated disc.
Many herniated discs do not cause any pain. Radiographic findings of a disc herniation are common (such as from an MRI), but oftentimes the herniated disc is not associated with any pain or symptoms. While there may be an association between trauma to the disc and the onset of the patient’s symptoms, a herniated disc also may occur without a specific, recalled event.
It is difficult to distinguish a herniated disc from other spinal problems. The nerves and anatomical structures—such as discs, muscles and ligaments in the spine—have a great deal of overlap. This makes it difficult for the brain to distinguish between problems with one structure in the back versus problems with another. For example, a herniated disc can feel similar to a bruised muscle or ligament damage. Please see What’s a herniated disc, pinched nerve, bulging disc, etc...? for explanation of the differences between a herniated disc and other common disc problems.
Pain from a herniated disc is a complex personal experience. Physical and psychological factors are constantly changing and can contribute to a patient’s experience of pain. A herniated disc may not be painful at all times, or it may become even more painful because of psychological and other factors in the patient’s life. For example, many studies have established a correlation between back pain and depression. While it is often not know which problem comes first—the pain or the depression—it is known that it’s important to treat both for the patient’s overall health. The pain from a disc herniation also may become more severe when compounded with other physical problems in the spine, or situational factors (such as poor posture, sitting for a long period, etc).
There is no single treatment that works best for all patients. Different treatment options are available for either a cervical or a lumbar herniated disc, as described later in this article. Some patients may find that a combination of conservative treatment options work best (such as medications, injections, and/or physical therapy), while other patients may find that early surgical intervention is necessary to find adequate relief from the pain and symptoms caused by a herniated disc. Working with a spine care professional, patients will need to develop an individualized treatment plan to relieve their pain and provide for long term rehabilitation.

Importance of a clinical diagnosis for a herniated disc
Because of the complexities of understanding pain from a herniated disc, patients should not attempt to make their own diagnosis. An inaccurate self-diagnosis may lead to further damage to spinal structures or to more severe episodes of back pain or leg pain if the condition is left untreated or treated incorrectly. Working with a spine specialist helps ensure that the correct location of a herniated disc, extent of the problem and source of pain are identified early on. The next section outlines the process of obtaining an accurate clinical diagnosis and explains in more detail how a herniated disc causes pain.