Pain Archive

Ask the doctors

Q. I have a herniated disc in my back. What does this mean, and will this heal on its own?

A. A herniated disc, also called a slipped or ruptured disc, is a common problem that can happen at any age, but becomes more common in middle age and beyond. It occurs when the jelly-like filling in a spinal disc — one of the pads between your vertebrae, or spinal bones — breaks through the disc's outer shell, called the annulus, and bulges through the tear. When this happens, the material may press on nearby nerves, which can cause a host of symptoms including inflammation, pain, and numbness. Where in your body you experience these symptoms depends on the location of the herniated disc. For example, if the disc is in your neck, you may feel pain down your shoulder and into your arm. If the disc is lower in your back, it may irritate your sciatic nerve, which can cause pain that radiates through your buttock and down your leg. The good news is that in most cases — 90% of the time — pain caused by a herniated disc will go away on its own within six months. Initially, your doctor will likely recommend that you take an over-the-counter pain reliever and limit activities that cause pain or discomfort. But in some cases, if you've been using these strategies and haven't noticed an improvement, your doctor may recommend further evaluation and possibly an additional treatment strategy, such as physical therapy. Surgery is typically not recommended unless the problem does not respond to therapy, if you are having an increasingly hard time moving, or if your doctor believes the spinal cord is being compressed.

Try conservative measures first to control pain, and know the limits and risks of cortisone  shots if you choose to try it.

Most people who suffer with back pain already know the drill: time heals this wound. Over weeks to months, the pain will calm down, and you will slowly return to your normal life. In the meantime, try to stay as active as possible and rely as much as possible on over-the-counter pain relievers to help avoid needing cortisone shots. Doctors call these shots corticosteroid injections.

But for some, these conservative measures may not relieve the agony soon enough—especially if the problem is back pain caused by irritated spinal nerves. After a few weeks, just getting to the bathroom may start to feel like Napoleon's winter march in Russia. At that point, you may be offered a cortisone injection to calm the war zone in your lower back.

A reasonable and well-intentioned effort to reduce and relieve pain can inadvertently lead to a potentially life-threatening addiction, but there are some surprisingly simple ways to avoid such scenarios.

Some ideas seem reasonable, but that doesn't mean they'll help.

People increasingly consult the Internet about medical problems. If you're looking for approaches to relieve joint pain and inflammation caused by wear and tear (osteoarthritis) or an immune system attack (such as occurs in rheumatoid arthritis), you may find methods that sound promising and even sensible. But will they work? Here's advice on five pain relief methods commonly touted on the Internet.

1. Music therapy

Listening to music can evoke powerful emotions that help people relax or heal, which is the basis of music therapy. Research has found that music therapy is associated with less anxiety before surgery or during chemotherapy, and better functioning during physical rehabilitation.

The stigma is fading, but learn the pros and cons before trying it.

Despite the hype and popularity of medical marijuana, you may not be sure if it's something to consider. You're right to be cautious; the use of marijuana to treat health problems is still being studied, and we don't have all the answers about its risks and benefits.

We do know that medical marijuana use among older adults is increasing. "Older adults tend to use it for physical ailments. No. 1 is chronic pain. Insomnia is another big one, too. Older people have a hard time sleeping, and there aren't a lot of other safe options," says Dr. Peter Grinspoon, a primary care physician with Harvard-affiliated Massachusetts General Hospital.

Some common painkillers may boost the odds of a heart problem. Use them wisely to lessen your risk.

In 2004, the drug maker Merck pulled rofecoxib (Vioxx) off the market, following revelations that the popular prescription painkiller increased the risk of heart attacks and strokes. That action triggered a closer look at drugs in the same class, known as nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs, which are widely used to ease pain, quell inflammation, and cool fevers, include over-the-counter drugs such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and the prescription drug celecoxib (Celebrex).

A high pain tolerance may account for some "silent" heart attacks. But failing to recognize atypical symptoms is a more likely explanation.

 Image: © digitalskillet/Getty Images

Nearly half of people who have a heart attack don't realize it at the time. These so-called silent heart attacks are only diagnosed after the event, when a recording of the heart's electrical activity (an electrocardiogram, or ECG) or another test reveals evidence of damage to the heart.

What's behind this surprising phenomenon? One explanation may be a higher-than-average tolerance for pain, as a recent study suggests (see "Does a high pain tolerance mask heart attack symptoms?"). Other people mistake their symptoms as indigestion or muscle pain. Still others may feel pain, but in parts of their upper body other than the center of the chest.

Tennis elbow is the common term for lateral epicondylitis, an inflammatory condition of the tendon that connects the extensor muscles of the lower arm to a bony prominence on the outside of the elbow called the lateral epicondyle. The condition causes pain at the point where the tendon attaches to the epicondyle. The pain may radiate to the forearm and wrist, and in severe cases, grip strength may lessen. It can become difficult to perform simple actions like lifting a cup, turning a key, or shaking hands.

As many as half of all people who play racket sports have the condition, but most people who have tennis elbow didn't acquire it by playing tennis, squash, or racquetball. It can result from any activity that involves twisting or gripping motions in which the forearm muscles are repeatedly contracted against resistance, such as pruning bushes or pulling weeds, using a screwdriver, or playing a violin. Tennis elbow is an occupational hazard for professional gardeners, dentists, and carpenters.