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Pain Management

Degenerative Disc Disorder | Common Cause for Neck and Back Pain

Degenerative Disc Disease - treatingpain.com

A degenerative disc disorder is a common cause of neck or back pain and arm or leg numbness. Disc degeneration is a gradual wear-and-tear that causes the discs in your spine to lose water content. This makes the discs inflexible and likely to tear or shift out of place even after a minor strain. The problem starts when a disc starts pressing on a nearby nerve, causing pain, numbness, or weakness.

Degenerative disc disorders are the main cause of chronic low back pain, accounting for 39% of complaints. Although a degenerative disc disorder is a common condition in the elderly, it can also affect younger people. Disc injuries can start in young people after whiplash injuries, fall accidents, and improper lifting.

A conservative (non-surgical) approach is recommended in the first stages of treatment for a degenerative disc disorder. Pain can improve with rest, physical therapy and proper pain control. A pain specialist can offer you treatments such as epidural injections, nerve blocks, and regenerative therapy. An advanced procedure, spinal cord stimulation, can help in cases of resistant pain. These treatments can help decrease your pain while you heal.

The disc’s role in the spine

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

Discs are 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 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.

Disc degeneration can occur at all levels of your spine: neck, mid-back, and the lower back. However, disc problems are most common in the lower back. This area receives the most strain. It is repeatedly used for twisting and bending required with your everyday activities.

Cervical (neck) disc problems

The neck receives rotational strain, during head movements. Herniated neck discs cause pain in a certain pattern, along the path of a pinched spinal nerve. It may cause pain in your neck, arm, or shoulder.

Symptoms include:

  • A deep ache in your neck or numbness and tingling down your arm and fingers (radiating pain)
  • Pain that is triggered by sudden neck movement
  • Radiating (shooting) pain that gets worse when you look over your shoulder
  • Arm muscle weakness (difficulty holding and lifting things)

Thoracic (mid-back) disc problems

Disc problems are least likely in the thoracic area. However, when they do occur, they can have severe consequences. Depending on the size and location of the disc herniation, the disc material may press on the spinal cord.

Symptoms include:

  • Pain in the upper or mid-back that increases when you cough or sneeze
  • Pain in the chest or belly (this pain pattern can be confused with more serious heart, lung, kidney disorders and may require an extensive medical workup)
  • Numbness or paralysis below the level of the disc problem (example: paralysis below the waist)
  • Difficulty walking, leg weakness, bowel or bladder dysfunction (these severe symptoms start when a disc presses into the spinal cord)

Lumbar (low back) disc problems

A herniated disc in the low back area is the most common cause of sciatica, nerve pain that runs down the back of your leg. Sciatica, as well as other patterns of shooting pain in the legs, are common signs of degenerative disc disease in the low back.

Symptoms include:

  • Leg pain and numbness, often accompanied by low back pain (the leg pain is usually worse than the back pain)
  • Pain in the low back, buttock, thigh, calf, foot and/or toes (usually on just one side)
  • Neurological symptoms such as numbness, tingling, weakness in the leg, foot, and/or toes
  • Foot drop
  • Throbbing low-back pain (this is not always present in lumbar disc herniation)
  • Pain that increases with movement or prolonged sitting, laughing, or sneezing

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, back, chest, arms, legs or digits. Imaging tests will be used to confirm the exam findings.

Useful tests for disc-related 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.
  • Computerized tomography (CT) – X-rays from different angles create 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 – 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. These treatments work by reducing the inflammation around the disc and injured nerves and by decreasing pain.

Initial treatment for disc-related pain will likely include:

  1. Oral medications
  2. Epidural injections
  3. Regenerative therapy
  4. Physical therapy and other conservative measures

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, 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 and improve sleep.
  • Anticonvulsants – drugs that control seizures also treat nerve pain due to a herniated disc.
  • Opioids – are prescribed for the appropriate patients for a limited period, to reduce severe pain from a herniated disc.

Injections

  • Epidural Steroid Injection – this is an injection with a steroid into the epidural space (space next to discs). It decreases inflammation around the affected nerve roots and behind the discs.
  • Selective Nerve Root Block – this is an injection that pinpoints the location of the irritated nerve and offers brief pain relief.

Regenerative Therapy

  • This uses the patient’s own natural growth factors or stem cells to treat pain from herniated discs, and other neck/back conditions.

Click here for more information on Regenerative Therapy offered at NSPC’s affiliated StemCellArts Clinic.

Physical therapy and other conservative techniques

  • Physical therapy – offers exercises designed to stretch your neck/back muscles.
  • Rest – over-head reaching, neck/body rotation or lifting increases pain immediately after a disc herniation.
  • Neck braces – a collar or brace may provide some rest for the spine.

Spinal Cord Stimulation (SCS)

  • This treatment involves implanting an SCS device close to the pain source in your spine.
  • The SCS device delivers low-intensity bursts of current that block pain signals.
  • Often used for pain due to failed back surgery syndrome (back pain that continues after back surgery), nerve pain in the arms or legs.

For an evaluation of neck and arm pain from one of our NSPC doctors:

CLICK HERE TO REQUEST AN APPOINTMENT