Most patients will improve with non-surgical (medical) treatment or conservative care.
Your doctor may recommend various treatments, such as a short period of bed rest, short-term use of a cervical collar, anti-inflammatory drugs to decrease nerve irritation, analgesics for pain control, physical therapy, exercise or epidural steroid injections. The aim of nonsurgical treatments is to decrease nerve irritation caused by the herniated disc, relieve the pain, and to improve the general condition of the patient. These results can be attained in most patients with disc hernia using a well-organized treatment program that integrates numerous treatment methods. Ask your doctor if you will be able to continue to work during treatment.
Following the onset of pain due to cervical disc hernia, a brief (1-2 days) period of rest may be useful. Returning to activities after this brief period of rest is crucial to prevent joint stiffness and muscle weakness. With the assistance of a nurse or physiotherapist, your doctor may teach you the specific exercises that will strengthen your neck. These exercises may be practiced at home, however you may need to visit a physiotherapist for a more special program that suits your abilities. The exercises must be performed exactly as your doctor or physiotherapist has shown. Your doctor or physiotherapist may decrease the pain, inflammation, and muscle spasm by applying treatments such as traction, heat or cold application, and manual (massage) therapy.
Drugs and Pain Treatment
Drugs that are used to control pain are called painkillers (analgesics). In most situations, the pain responds to commonly used over-the-counter medications like aspirin, ibuprophen, naproxen, and acetaminophen. If you have severe or persistent pain, your doctor may prescribe narcotic analgesics for a short time. Muscle relaxants may be added in some cases. A higher dose will not accelerate your healing. Possible side effects include: nausea, constipation, dizziness, and vertigo, with a chance of addiction. All drugs must be used exactly in the manner prescribed. Inform your doctor of all the drugs you are using (including over-the-counter drugs) and whether they have worked. Also, inform your doctor of any allergic reactions to drugs.
A group of analgesics named non-steroidal anti-inflammatory drugs (NSAIDs) may be added to control the inflammation in the nerves and the neighboring tissues. These include prescription drugs such as ibuprophen, naproxen, and diclofenac. If your doctor has given you analgesics or anti-inflammatory drugs, you have to be careful of side effects such as gastric irritation or bleeding. You should follow up with your doctor regarding possible long-term negative consequences of prescribed or non-prescribed analgesics and NSAIDs. In intense arm and neck pain, corticosteroid drugs (tablets or injections) are also prescribed occasionally for their strong anti-inflammatory effects. Corticosteroids may have side effects similar to NSAIDs. You should talk with your doctors about the benefits and risks of these drugs.
Epidural injections or "blocks" may be used to relieve intense arm pain. These are corticosteroid (cortizone) injections into the epidural space (the space around the nerves) by a doctor trained on this technique. The first injection may be supplemented with one or two subsequent injections. These are often done in an interactive rehabilitation and treatment program to decrease the inflammation of the disc and nerve.
Trigger point injections are local anesthetic (corticosteroids may be added in some cases) injections made directly into the painful soft tissues and muscles along the spine. Although they are helpful for pain control in some cases, they do not correct the herniated disc.