A herniated disc is a common cause of numbness and pain, particularly lower back pain. It may also cause general weakness in a leg or arm. Depending on location, a herniated disc may affect other parts of the body too.
For most people with a herniated disc, surgery is not necessary to correct the problem. However, many doctors do recommend cortisone injections to treat the back pain and swelling.
What is a Herniated Disc?
A herniated disc is a problem with one of the rubbery discs located between the spinal vertebrae, the stack of individual bones along the spine. The Mayo Clinic compares a spinal disc to a jelly donut, something with a soft center and a tough exterior.
Also called a slipped or ruptured disc, a herniated disc occurs when the soft “jelly” material in a disc pushes through a crack in the hard exterior part. The rupture may irritate the spinal nerves and cause back pain, numbness, tingling and weakness.
A herniated disc in the neck usually causes pain in the shoulder and arm. If a herniation occurs in the lower back, it may cause intense pain in the buttocks, thigh and leg; this is a common condition called sciatica. Many people experience herniated disc pain as “shooting pain” that is aggravated by coughing, sneezing and movement.
Causes and Risk Factors
Most people, including doctors, cannot pinpoint the exact cause of a herniated disc. The condition often results from disc degeneration, a gradual wear-and-tear that occurs with age and use. As a person ages, even minor twists and strains can cause a spinal disc to rupture.
Sometimes injury contributes to disc herniation. Many people use their back muscles instead of their leg or thigh muscles to lift and move heavy objects. Improper lifting, as well as traumatic injuries like accidental falls and back blows, can lead to a herniated disc.
Age, weight and occupation are three factors that increase the risk of disc herniation. Age plays a significant role in spinal disc degeneration. Excess weight stresses the lower back and may cause a disc to rupture. Jobs that require repetitive lifting, bending, pulling and pushing also contribute to back problems.
Cortisone Treatments for Back Pain
Conservative treatment generally relieves back pain in people with a herniated disc. Such treatment includes avoiding further back stress, taking appropriate pain medication, and following a suitable exercise plan.
Many doctors also recommend cortisone injections for patients with back pain. Sometimes called steroid shots, cortisone injections are not pain-relievers but anti-inflammatory medications. These hormone chemicals suppress the spinal swelling that causes back pain.
Cortisone injections typically contain a corticosteroid medication as well as a local anesthetic. Most shots are administered right in the doctor’s office. They are injected directly into the affected area of the back, near the nerves. Spinal imaging enables a doctor to safely guide the needle to the right area of the spine.
Cortisone injections are an effective treatment for herniated disc pain. However, most patients can receive only a limited amount of shots because of potential side effects. Too many cortisone shots carry a risk of complications: joint infection, bone deterioration, nerve damage, tissue thinning, tendon rupture and additional swelling and pain.
Preparing for a Cortisone Injection
People who take blood thinners may need to forgo this treatment for a few days prior to a cortisone shot. Certain nutritional supplements also have a blood thinning effect, so they must be halted too. Patients about to receive a cortisone injection should talk to their doctor about the medications and supplements to avoid before the shot.
Before receiving a shot, patients may have to change out of their clothes and into a hospital gown. They will then be moved into a position that makes it easy for the doctor to insert a needle into the affected area of the spine.
The area will be cleaned before the shot is given, and the doctor may also apply an anesthetic spray to numb the area and reduce pain. Some patients feel pressure as the doctor inserts the needle. If the procedure is uncomfortable, they should tell the doctor.
After the needle is inserted, the doctor will release the medication into the injection site. The corticosteroid will relieve inflammation and pain over time, but the anesthetic portion provides immediate pain relief.
Some people experience a warm, flushed face or chest after a cortisone injection. Diabetics may experience elevated blood sugar levels. These side effects are temporary. An ice pack applied to the injection site may relieve redness and pain.
Doctors generally advise patients to rest and avoid heavy lifting for a few days after a shot. Patients should consult their doctor immediately if they experience pain, redness, swelling or an infection that lasts for more than 48 hours.
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