Health Tip: Managing Herniated Disk Pain

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I am in pain and have been for many years. It really is a horrible thing. sometimes hell on earth. I read alot of pain blogs and I just want to say that opioids are wonderful.
I have been on them of 3 years now. With proper nutrition, mild exercise and staying hydrated, side effects can be minimalized.

john of NM 4:46PM December 21, 2009

Thats fine for early problems, but seems to be VERY ineffective later on in the chronic stage. One of the problems I see the most is pain without any evidence for surgical intervention. These patients are usually of no further interest to the surgical mentality, and have had the usual series of "blocks" from the block jocks without any real reduction in pain or return of quality of life. They have been instructed to do the basic modalities described here, and are still quite miserable. The insurance companies won't cover the physical therapy or cognitive therapy needed to help these patients deal with the pain. I also find that certain disease states are missed by the other docs, such as bipolar disorder and diabetes, contribute to poor pain management skills or an increase in pain perception.
The bottom line is that pain is a quite complex problem that is associated with many inflammatory problems and mental issues. Why else would the literature show that 45% of female patients that come for pain management were sexually abused as children? I have a real problem with articles like this because the information is too simplistic, and is not applicable to real pain.

Pervis Milnor, III, MD of TN 2:27PM December 18, 2009

NSAIDs tend cause ulcers and general bleeding problems, and in chronic pain, they are easily over-used. Acetaminophen (Tylenol) in a too-high dose can destroy the liver. They are known to kill at least 19,000 people every year, and pain from herniated disks is very likely to be chronic.
Steroid injections in most cases that I've seen, myself included, hurt a lot when they're done, and when the local mixed with the steroid wears off, the pain is increased and the patient is often immobilized. Nonetheless, doctors get angry and refuse opioids when the patient calls in, frequently nearly hysterical from the pain. There's also a chance of arachnoiditis. From an abstract: “Studies have shown without fluoroscopic guidance there is evidence that even in experienced hands: 8-30% of interlaminar needles are misplaced outside the epidural space, over 50% of the time the wrong interspace is entered, and even if the needle is placed in the epidural space, 74% of the time the steroid fails to reach the target nerve root. Because of the overwhelming evidence against *SNIP* blind injections, most physicians utilizing evidence based medicine (including the 1,600 members of the International Spinal Injection Society) have abandoned this technique. *SNIP* (Guided) Transforaminal injections demonstrate long lasting effects and do offer a valid alternative to surgical intervention.
This abstract is over ten years old, but US doctors still prefer blind injections.
Ice is ineffective unless you cause frostbite in the skin and the top layer of muscle - disks are just too deep for it to be effective. As for heat, in an ongoing problem such as this is likely to be, I have seen patients literally cook the tissue. Exercises are likely to cause more damage even under the direction of physiatrists. Opioids are the "gold standard treatment" the world over, but the DEA and DOJ refuse to recognize this and attack doctors who have broken no laws, and doctors will not band together to defend themselves, so one by one, they are occupying prison cells, and the DOJ brooks no interference. An advocacy organization was just destroyed and it's founder reduced to beggary by a DOJ Bush appointee and a complicit judge.
Diskectomy is the best bet; as the patient becomes less mobile, the disks become desiccated due to lack of movement (which can be helped a lot by opiates, but almost never is), and pieces tend to compromise nerve roots, causing exquisite pain, which very often becomes chronic. A way to assure failure of a diskectomy is inadequate post-op pain control. Again, the pain, if it isn't already, becomes chronic due to hyperplasticity and central sensitization. Until the cops - the DEA - are removed from the pain management equation and doctors are once again in charge, I see no change coming.

Ian MacLeod of OR 4:20PM December 14, 2009