Treating herniated disc pain

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Dr. Nocerini

Dr. Nocerini

Having a herniated disc can significantly impact ones ability to live life as they wish to. The pain can be quite severe and long-lasting without appropriate treatment.

At Texas Pain Relief Group, pain specialist Dr. Robert Nocerini regularly treats patients from across Dallas, TX who experience pain from herniated discs.

Dr. Nocerini was kind enough to answer a few of the more common questions people ask who have a herniated disc, or believe they might be experiencing pain from one.


Question: What are Intervertebral Discs?

Dr. Nocerini: “Intervertebral discs are the shock absorbers of the spine. They connect the spinal bones and allow spinal flexibility in multiple directions. They are made up of a thick outer ring of cartilage, which is called the annulus, and a more gel-like center called the nucleus. There is an intervertebral disc between each bone in the spine, except at the very top of the neck.”

Question: What is a Herniated Disc?

Dr. Nocerini: “Herniated discs occur when part of a disc has weakened and extends beyond its original margins.”

Q: What causes a Herniated Disc?

Dr. Nocerini: “With age, wear and tear, and also injury, the outer annulus of a disc may weaken and no longer be able to contain the gel-like nucleus.”

Q: What is the difference between a Herniated Disc and a Bulging Disc? What about a Slipped Disc?

Dr. Nocerini: “These terms all pretty much mean the same thing, although the term “slipped” disc is not used in medical terminology.  The common terms “bulge,” “herniation,” “protrusion,” or “extrusion” each describe a different shape or degree of movement of a disk outside of its original location. Disc sequestration refers to a piece of disc that has completely separated from the rest of the disc. Different providers often use these terms interchangeably, so it is important to remember that they all refer to the same general condition.”

Q: What is the difference between Disc Herniation and Disc Degeneration?

Dr. Nocerini: “Disc herniation refers specifically to the movement of part of the disc outside its original margins. Disc degeneration refers to the process of gradual dehydration, wear and tear, and weakening of the disc with age. Disc degeneration generally results in a flattening of the disc and a loss of its shock absorbing properties. This weakening may result in disc herniation, tears or fissures in the disc, or leakage of the disc proteins outside of the disc.”

Q: What is Degenerative Disc Disease?

Dr. Nocerini: “Not all bulging or herniated discs cause pain, and they are quite common in people who have no back pain. A herniated disc may cause pain when it touches or compresses spinal nerves, or it may cause pain through substances that are leaked from the disc nucleus. The nucleus of the disc contains inflammatory proteins that are irritating to the spinal nerves, so even though a herniated disc may not be touching a nerve, it can still cause pain. It remains unknown why herniated discs are painful in some individuals but not others.”

Q: What are the symptoms of a Herniated Disc?

Dr. Nocerini: “The symptoms are pain, numbness, or weakness. Pain may be in the low back and radiate through the buttock to the leg. Frequently, the leg pain is worse than the back pain. The pain is typically made worse by sitting or by motions that increase pressure at the disc, such as coughing, sneezing, or straining to have a bowel movement.”

Q: How is a Herniated Disc diagnosed?

Dr. Nocerini: “History and physical exam may suggest a disc herniation. MRI is used to confirm the presence of a herniated disc.”

Q: What is Sciatica?

Dr. Nocerini: Sciatica is a broad term used to describe pain that is experienced through the distribution of the sciatic nerve.  The sciatic nerve is a large nerve that runs through the buttock and leg and is made up of individual nerve roots that originate in the lower lumbar and upper sacral spine. Sciatica is typically experienced as pain in the buttock with radiation down the back of the leg. A herniated disc is one cause of sciatica, and it may produce pain, sometimes with numbness, and/or weakness, by affecting the lumbar and sacral nerve roots that make up the sciatic nerve.”

Q: What are the treatment options for Herniated Discs?

Dr. Nocerini: “In many cases, symptoms will improve and resolve in several weeks with conservative treatment. Initial options consist of over the counter anti-inflammatory medication and physical therapy. If these measures are ineffective, prescription medications may be used, and epidural steroid injections may provide relief in some patients. Surgery may be considered in cases of severe, incapacitating pain, if neurologic symptoms are present, or if there is failure to improve with nonsurgical treatment.”

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