Your doctor may offer you treatments such as:
- a brief period of rest
- anti-inflammatory drugs to decrease the irritation (called inflammation) caused by nerve compression
- physical therapy
- exercise and
- epidural steroid injections.
If rest is recommended, ask your doctor how long you need bed rest. Bed rest longer than necessary will cause joint stiffness and muscle weakness, making it difficult for you to perform activities that may decrease your pain. Therefore bed rest often does not exceed two days for lumbar pain, and one week for lumbar disc hernia. Besides, lying on a hard surface has no proven efficacy in the management of hernia and pain. Ask your doctor if you can continue to work during the treatment.
In addition, patient education with the help of a nurse or physiotherapist on how you can perform your daily activities without overloading your back may be helpful.
The aim of nonsurgical treatment is to decrease irritation caused by the herniated disc, protect the spine by correcting the general status of the patient, and to increase overall functionality. These goals can be successfully accomplished in most patients with disc hernia, using an organized treatment program that combines numerous treatment methods.
Ultrasonic heat, electric impulses, heat application, cold application, and manual (massage) therapy are among the initial treatments that your doctor may recommend. These treatments may decrease pain, inflammation, and muscle spasm. They will also facilitate an exercise program. Traction (pulling, stretching) may provide slight pain relief in some patients. However, this treatment must be performed only by a physical therapy specialist or a physiotherapist. People who are not licensed to do this may cause irreversible harm. In some cases, your doctor may recommend you to use a lumbar brace (a soft and flexible back support) at the beginning of your treatment. However, these braces do not heal the herniated disc. Treatment applied with the hands (manipulation) may provide short-term relief in vague lower back pain.
A physical therapy program often begins with stretching and postural change programs for decreasing the pain. When your pain decreases, more intense exercises directed toward flexibility, power, augmentation of endurance, and a normal life style can be initiated. Exercises must be started as early as possible, as the treatment progresses the exercise schedule must be adapted to it. Learning and keeping up with an exercise and stretching program that can be applied at home is a significant part of the treatment.
Drug Therapy
Drugs used to control pain are called painkillers (analgesics). In most conditions, lower back and leg pain respond to common over-the-counter drugs such as aspirin or acetaminophen. Analgesic-anti-inflammatory drugs, named nonsteroidal antiinflammatory drugs (NSAIDS), may be added in conditions where pain is not controlled with the aforementioned drugs and to control the irritation and inflammation (which is the actual cause of pain) due to disc hernia. These include: ibuprophen, naproxen, diclophenac, and various drugs sold with a prescription. If you have severe and persistent pain, your doctor may give you a short course of narcotic analgesics. In some cases, muscle relaxants are added to the treatment. A higher dose will not give you a faster recovery. Side effects include: nausea, constipation, dizziness, and vertigo—and may lead to addiction. All drugs should be consumed howordered by your doctor. Inform your doctor on all the drugs that you are using. If you previously tried the drugs prescribed to you (including the over-the-counter medicine), tell your doctor whether they worked for you or not.
If your doctor gives you painkillers or anti-inflammatory drugs, watch for side effects such as an upset stomach or stomach bleeding. For problems associated with long-term use of over-the-counter (nonprescribed) or prescribed painkillers and NSAIDs, you’ll need to follow up with your doctor.
There are other drugs with anti-inflammatory effects. Corticosteroids (cortisone) drugs (tablet or injection) are sometimes prescribed for intense lower back and leg pain because of their anti-inflammatory properties. Corticosteroids may have side effects like NSAIDs. You should talk with your physicians about the benefits and risks of these drugs.
Epidural injections or "blocks", may be used to relieve intense leg pain. These are corticosteroid injections made into the epidural space (space around the spinal nerves), and by a doctor trained on this technique. The first injection may be later supplemented with one or two more injections. These are most commonly performed as a part of a comprehensive rehabilitation and treatment program.
Trigger point (where pain is elicited upon pressing) injections of local anesthetic solutions (occasionally corticosteroids may be added) directly onto the painful tissues and muscles along the spine or at the back of the hip bone. Although they are useful for pain control in some conditions, they do not provide correction of the herniated disc.