A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner part of an intervertebral disc pushes out through a weak spot in the tougher exterior. This can cause pain, numbness, or weakness if it presses on nearby nerves. Herniated discs are very common, especially among adults ages 30-50. Many people experience acute pain from a herniated disc that goes away with rest and pain medication. But some continue to have chronic pain long-term. This article examines whether herniated disc pain is permanent.
What causes a herniated disc?
The discs between the vertebrae in your spine act as cushions or shock absorbers. Each disc has a tougher exterior called the annulus fibrosus and a soft jelly-like interior called the nucleus pulposus.
As we age, discs lose flexibility and shock absorbing abilities
As we get older, these discs start to lose their flexibility and shock absorbing abilities. The discs become thinner and more prone to cracks and tears in the exterior. This natural age-related degeneration is called spondylosis. It can cause small tears or cracks in the annulus that allow the inner nucleus to push out.
Injuries can lead to acute disc herniation
Disc herniations can also occur suddenly due to injury. Lifting heavy objects, a sudden stressful twist, or an impact injury like a car accident may cause part of the disc to protrude out through a weak spot in the annulus. When this pressed on nerves, it causes sudden severe back pain and other symptoms.
Common symptoms of a herniated disc
Symptoms of a herniated disc depend on its location and which nerves are affected:
Lumbar herniated discs
– Sciatica – Sharp pain starting in the lower back and radiating down one leg
– Numbness or tingling in the leg or foot
– Muscle weakness in the leg or foot
– Cauda equina syndrome – Bowel or bladder changes (rare)
Cervical herniated discs
– Neck pain
– Shoulder or arm pain
– Numbness/tingling in the arm or hand
– Muscle weakness in the arm or hand
Are herniated discs always painful?
Not always. Research indicates that around 30% of people over 60 who have no back pain still show evidence of a disc herniation on imaging tests.
Asymptomatic disc herniations
Many herniated discs cause no symptoms at all when they occur. They may be found incidentally when getting imaging for some other reason. These “asymptomatic disc herniations” generally do not require any treatment.
Painful herniated discs
Symptomatic herniated discs cause pain and other neurological symptoms when they press on spinal nerves. These almost always require some form of treatment, at least at first.
Is the pain from a herniated disc permanent?
For most people, the pain caused by a herniated disc is not permanent. Here is an overview of the typical course:
Initial intense pain
When a disc first herniates, it can press strongly on nerve roots and cause very intense pain. This may last anywhere from a few days to a few months.
Gradual natural improvement
Over time, the protruding disc fragment will usually retract back in towards the center and stop pressing so strongly on the nerves. This reduces inflammation and allows pain and other symptoms to gradually improve over weeks to months.
Long-term outlook
Within 6-12 months, most patients see significant improvement and are able to resume normal activities with little or no pain. Only about 5-15% have pain that lasts more than a year.
Here is a table summarizing the typical course of a symptomatic herniated disc:
| Time Frame | Typical Symptoms |
|---|---|
| First days to weeks | Severe sciatica or arm/neck pain |
| 2-8 weeks | Gradual improvement, moderate pain |
| 3-6 months | Mild, intermittent pain |
| 6-12 months | Little or no pain most days |
| 1+ years | Generally no pain unless re-injury |
What makes pain last longer?
There are certain factors that contribute to a small percentage of herniated disc cases following a more chronic, long-lasting course:
Older age
Discs lose strength and resiliency as we get older. Herniated disc pain takes longer to resolve in patients over 45.
Smoking
Smoking prevents oxygen from getting to discs and slows the body’s natural healing.
Obesity
Excess weight puts more strain on the spine and discs.
Physically demanding jobs
Jobs requiring heavy lifting, twisting, bending increase risk of re-injury.
Pre-existing back problems
People with prior history of recurring back pain have longer recovery.
Multiple herniations
When multiple discs are involved, symptoms take longer to improve.
Extremely large disc protrusions
Larger herniations that press harder on nerves are slower to resolve.
Chronic discogenic pain syndrome
In a very small percentage of patients, estimated around 5%, herniated disc pain can become a chronic condition called discogenic pain syndrome. Researchers believe this occurs when a disc is severely damaged and becomes a constant source of irritation and inflammation to nearby nerves. These damaged discs generate pain signals long after the original injury should have healed.
Chronic disc pain typically involves symptoms like:
– Constant dull ache with occasional sharp exacerbations
– Pain while sitting or bending that is relieved by lying down
– Stiffness and trouble moving the back
– Recurring episodes of sciatica
This pain may fluctuate but often becomes a lifelong condition requiring ongoing pain management.
Treatment options for lingering disc pain
For those whose pain persists longer than normal, there are both conservative and interventional treatment options that can help alleviate symptoms:
Medications
Anti-inflammatory drugs, muscle relaxants, and pain pills can relieve pain and inflammation.
Physical therapy
Stretching, strengthening exercises, and modalities like heat/ice can improve back mobility.
Epidural steroid injections
Corticosteroid injections around irritated nerves can reduce inflammation.
Spinal decompression therapy
Gentle traction devices can take pressure off discs and nerves.
Surgery
For severe sciatica that fails more conservative measures, surgery like microdiscectomy may be considered. This removes just the protruding portion of a disc to take pressure off compressed nerves.
Behavioral approaches
Cognitive behavioral therapy, mindfulness meditation, yoga, and acupuncture may help with chronic pain.
Prevention of recurrent disc herniations
Many back experts feel that proper self-care and avoiding re-injury are key to preventing recurrent disc problems after the initial herniation recovers:
Core strengthening exercises
Building core muscle strength protects the back from strain and poor mechanics.
Weight management
Maintaining ideal weight reduces load and compression on spinal discs.
Proper lifting mechanics
Techniques like lifting with the legs and keeping the load close to your body can prevent injury.
Good posture
Sitting and standing with proper posture avoids extra stress on discs.
Flexibility exercises
Stretching the back, hips and hamstrings preserves range of motion as we age.
Quitting smoking
Smoking accelerates disc degeneration. Quitting can help discs heal.
Supportive mattress
Sleeping on a medium-firm mattress minimizes nighttime strain on the back.
Stress management
Finding healthy ways to reduce emotional stress may prevent muscle tension and spasms.
Conclusion
For the vast majority of patients, the pain and other symptoms caused by a herniated disc improve significantly within 6-12 months without the need for surgery. Only about 5-15% experience pain that lasts more than one year. In rare cases, a severely damaged disc can become a source of chronic pain. Proper self-care, avoiding re-injury to the back, and making lifestyle modifications can help prevent recurrent or permanent disc pain after a herniation heals.
