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Pain Management

Non-surgical treatment for a herniated cervical disc

Herniated Cervical disc - National Spine & Pain Centers

A herniated (ruptured) cervical disc is a common cause of neck pain and pain that travels to the arm. The problem starts when your disc shifts and starts pressing on a nearby nerve causing pain, numbness, tingling sensations, and possibly weakness.

Herniated discs are a common cause of pain and disability. A conservative (non-surgical) treatment is preferred since pain often improves without surgery.

A pain specialist can offer you several conservative treatments such as epidural injections or nerve blocks, that ease neck and arm pain, while allowing you to heal.

Role of a disc

Disks are cartilage cushions packed between the back bones (vertebrae) that make up your spinal column. They are made of a gel-like, water-rich center protected by a tough fibrous outer ring. While vertebrae hold you upright and protect the spinal cord, discs absorb shocks to the spinal column as your body moves.

Discs lie close to large spinal nerves as the nerves exit the spinal cord like branches from a tree. Since nerves are extremely sensitive, a disc herniation (rupture), can put pressure on a nerve and cause a lot of pain. In some cases, disc material itself can act as a chemical irritant toward the nerves. In more serious situations, the disc can press on your spinal cord, causing weakness and requiring immediate surgery.

An explanation for pain in the neck/arm areas

There are seven discs in your cervical (neck) area. The neck receives more rotational strain than other areas, such as the thoracic (mid-back) area, in order to enable head movements. Therefore, your cervical spine is more likely to suffer disc injuries.

Trauma or simple wear and tear seen with aging can cause a number of common disk problems. Pain from a disc injury starts with a combination of the following:

  1. Nerve injury – the injured disc presses on a nerve, causing pain in a specific pattern down the arm.
  2. Inflammation – caused when the gel-like center of disc leaks and irritates nearby nerves. This can happen after a disc rupture (break in the outer ring) or after a disc bulge (a leak without a break in the outer ring).
  3. Muscle spasm – pain starts as a result of tight muscles over the area of injury.

Symptoms

Herniated discs cause pain symptoms in a pattern, along the path of a pinched spinal nerve. Also, irritation of the annulus, the tough ring around the disc, may cause mechanical neck pain

Signs and symptoms of a herniated cervical disc:

  • Deep ache in your neck and/or numbness and tingling down your arm and fingers (radiating pain)
  • Pain may be triggered by sudden neck movement or jerking of the neck
  • Pain gets worse with movement
  • Radiating pain may get worse by looking up and away, toward the painful side
  • Pain improves with rest
  • Muscle weakness (difficulty holding/lifting things)

Diagnosis

After a thorough history and neurologic exam, a pain specialist can trace your pain to a specific level in the spine. Your doctor will look for weakness, changes in reflexes, and a loss of feeling in the skin of your neck, arms, and fingers. Imaging tests will be used to confirm the findings on exam.

Tests for neck/arm pain:

  • X-rays – basic imaging to evaluate bony areas of your spine.
  • Magnetic resonance imaging (MRI) – uses a strong magnetic field to create a detailed picture of your spinal column including the spinal cord and nerve roots.
  • Computerized tomography (CT) – X-rays from different angles create cross-section (slice) images of your spinal column.
  • CT Myelogram – an advanced test where a doctor injects dye into your spinal fluid during a CT scan. Shows where pressure exists on the spinal cord or nerves.
  • Nerve tests – electromyograms and nerve conduction studies measure how well electrical signals move along your nerves, in order to find the injury.

Treatment

Unless there is an emergency, such as a disc pressing on the spinal cord or increasing weakness, surgery is not the first option. Recovery often occurs over the course of several weeks to months with conservative (non-surgical) treatments. Conservative treatments work by reducing the inflammation around the disc and injured nerves and by decreasing pain.

For more information on situations when surgery is necessary for cervical disc herniation, click here:

It is important to consult your pain specialist since a disc may appear herniated on an MRI or CT, yet not be the main cause of your pain. Similarly, a disc herniation may look minimal on MRI/CT but cause you great pain. Therefore, your doctor must carefully compare your findings on physical exam with the imaging tests before starting treatment.

Treatment for neck and radiating arm pain will likely include injections, oral medications, physical therapy and other similar conservative and minimally invasive options.

Injections

  • Epidural Steroid Injection – this is an injection with an anti-inflammatory steroid into the epidural space (space next to discs). An epidural steroid injection can treat pain at several levels in the spine. It is intended to decrease inflammation directly around the affected nerve roots and behind the discs.
  • Selective Nerve Root Block – this is primarily a diagnostic injection to pinpoint the location of the irritated nerve.

Medications

Your doctor will prescribe over-the-counter medications, then advance to prescription medications if needed.

Medications used for disc herniation:

  • Anti-inflammatory medications – (NSAIDs) such as ibuprofen (e.g. Advil, Motrin) or COX-2 inhibitors (e.g. Celebrex) help reduce inflammation-related pain.
  • Steroids – like methylprednisolone (Depo-Medrol) can be given in pill form, over the course of a week, to reduce inflammation. 
  • Muscle relaxants – reduce muscle spasm that starts over the area of disc herniation.
  • Anti-depressants – help reduce tingling, shooting nerve-type pain (neuropathic pain) and improve sleep.
  • Anticonvulsants – drugs that control seizures also treat nerve pain due to a herniated disc.
  • Opioids – are prescribed for severe pain and for the appropriate patients for a limited period, to reduce severe pain from a herniated disc.

Physical therapy and other conservative techniques

  • Physical therapy – offers exercises designed to stretch your neck muscles and minimize the pain of a herniated disc.
  • Decreased activity – over-head reaching, neck rotation or lifting may increase pain in the period immediately following a disc herniation.
  • Neck braces – a cervical collar or brace may provide some rest for the cervical spine.

Advantages of non-surgical treatment for herniated cervical discs

  1. Avoid post-surgical pain syndrome – long-term pain starts after failed surgeries that involves a lot of scar tissue – which can be a new source of pain and restricted neck motion.
  2. Short recovery time – surgery will require a recovery period of several weeks to months. Conservative treatment allows you to recover faster.
  3. Lower risk – typically minimally invasive procedures carry a much lower risk.
  4. No incision scars – conservative treatments are minimally invasive, involving a needle, at most. You will not have painful scars that require healing.

For an evaluation of neck and arm pain from one of our NSPC doctors, click here