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Integrated Pain Management


Herniated discs or disc herniation…

also called slipped discs refers to a medical condition that affects the spine and involves the tearing of intervertebral disc’s outer covering called the annulus fibrosus.

Herniated Discs

This tear allows the bulging of the nucleus pulposus, which is the central portion. While herniated discs are mostly brought by the aging process degeneration, the condition can also be as a result of lifting injuries, straining and trauma.

Due to the posterior longitudinal ligament present in the spinal canal, the tears are in most cases postero-lateral.

The tear might lead to release of some inflammatory chemical mediators which result in severe pain even in cases where the nerve root is not compressed.

The herniated discs are further developments of protrusions, which is a condition involving the bulging of the disc though the annulus fibrosus is intact.

Albeit the disc is under pressure causing the bulge, the nucleus pulposus has not escaped out of the layers of the disc. Most minor herniated discs will heal in a few weeks and the use of anti-inflammatory drugs will effectively deal with the pain resulting from the herniation, bulge, tear or the protrusion.

There are several cases of herniated discs that will not heal on their own and thus will require surgery.

This condition is widely referred to as slipped discs though experts have termed it as medically inaccurate since the discs are firmly attached and cannot slip.

Signs and Symptoms

There are different symptoms of herniated discs and this depends on the location of the problem and the type of soft tissues involved in the condition.

The symptoms can range from no or just little pain if the disc is the only tissue injured to unrelenting lower back or neck pain which is severe in cases where nerve roots are compressed or irritated by the herniated material.

The main reason why most herniated disc cases are not diagnosed fast is the fact that the patients will have undefined pains involving the feet, knees or thighs. Other symptoms may include sensory changes such as paresthesia, paralysis, muscular weakness, tingling and numbness.

If the condition is affecting the lumbar area, the patient might experience sciatica because the herniation might be affecting the sciatic nerve.

The pain involved in herniated disc does not come and go and is not pulsating; it is a continuous pain especially when the individual is in a certain position.

Depending on the location of the condition, there are patients who have reported having herniated discs without any pain or noticeable symptoms. In this case, the extruded nucleus pulposus materials are not compressing any nerves and thus there will be no symptoms.

A study revealed that about 50% of the volunteers had focal disc protrusions and this indicates that a good number of people might have herniated discs that do not show any noticeable symptoms.

Prolapsed discs in the lumbar region will cause radiating nerve pain which is experienced in the groin area or lower extremities. This pain can also be associated with bladder and bowel incontinence.


Most medical experts have placed degeneration as the main cause of herniated discs and trauma as a minor cause. The degeneration of discs occurs with aging and degenerative disc disease.

Degeneration involves the anulus fibrosus and the nucleus pulposus being exposed to altered loads. The nucleus becomes unable to bear the load because it becomes stiff and fibrous.


When the load is transferred from the nucleus to the anulus, the anulus might fail and this will lead to fissures. When the nucleus substance reaches the periphery of the anulus, this is what is referred as disc herniation.

General wear and tear such as jobs that require sitting, driving, and squatting for a long period of time can lead to disc herniation. The condition can also result from jobs that require lifting.

Professional athletes involved in contact sports are at a higher risk of developing herniated discs. Chronic back tiredness and minor back pain are signs of wear and tear and they make an individual susceptible to disc herniation in traumatic events or an action as simple as bending to pick something up.

There is also a genetic part of the condition. Gene coding mutation for protein associated with extracellular matrix regulation such as THBS2 and MMP2 has been identified as a contributing factor to herniated lumbar discs.


There are a number of causes behind back injuries which means that prevention needs to be comprehensive.

Since most back injuries are experienced in manual labor the prevention methods are associated with biomechanics. For the prevention to be successful it needs to be from a combination of proper body mechanics, physical fitness, and education.



X-rays might not be effective in the revelation of problems involving the muscles, nerves, discs and other soft tissues but can be used in confirming other causes such as infections, tumors and fractures.


Magnetic resonance imaging will provide 3-dimensional images which will show the nerve roots, spinal cord, degeneration and tumors. This diagnostic method is highly useful in disc herniation problems.

Other diagnosis methods can include computed tomography or CT scan, myelogram, electromyogram and nerve conduction studies.

Differential diagnosis will include discogenic pain, mechanical pain, myofascial pain, Spondylosis or Spondylolisthesis, spinal stenosis, hematoma, abscess, mass lesion/ malignancy, discitis/osteomyelitis, myocardial infraction and aortic dissection.



If the patient is experiencing mild-moderate pain, then the doctor will most probably prescribe over the counter medication like ibuprofen, or naproxen.

If the pain does not improve with over the counter medication over a certain period of time, narcotics might be used. These are drugs such as a combination of oxycodone and acetaminophen and the possible side effects are nausea, constipation, confusion, and sedation.

Nerve pain medications such as pregabalin, gabapentin, or amitriptyline are now being prescribed over narcotics based on their effectiveness and reduced side effects.

Muscle relaxers may be prescribed in cases where the patient is experiencing muscle spasm. Cortisone injections can also be administered in the affected area to get rid of the inflammation.


Physical therapists can guide the patients on exercising using positions that will reduce the pain associated with herniated discs. Some of the other treatment methods used in therapy include ultrasound, electrical stimulation, traction, heat or ice and lower back or neck bracing (short-term).


There is only a small number of patients suffering from herniated discs that will need surgery. When conservative treatments fail, the doctor will most probably recommend surgery.

During surgery, only a small part of the protruding disc will be removed. In rare cases, the entire disk will be removed and this will require the fusing of the vertebrae using metal for spinal stability purposes and in some advanced cases, the surgery might involve artificial disc implantation.

It is important that any individual experiencing back pain or the symptom associated with herniated discs seeks medical attention for the condition to be dealt with before more damage is done.