Free Conquer Back and Neck Pain - Walk It Off! by Mark Brown

relief in order to sleep and function, I recommend a series of one to three epidural steroid injections (I will explain what epidurals are in a moment). Epidurals are very effective in relieving pain from a herniated disc. Pain relief allows you to walk off the symptoms and keeps you from taking narcotics and muscle relaxants (commonly prescribed pain relievers), which are habit-forming, make you drowsy, and cause depression (more about this in Chapter 8 on chronic back pain). If the pain from a herniated disc is still significantly impairing their quality of life after three months of waiting for it to go away, then I recommend the third option, surgery.
    Here is a further explanation for the three options in treating a painful herniated disc: walk it off, epidural steroid injection, and surgery.
What does it mean to “walk it off?”
    We know from several classic studies that the natural history of symptoms from disc herniation is spontaneous resolution, if given enough time. As long as the disc has not caused progressive or severe nerve damage, it is better to try to walk the symptoms off. The secret is not to allow the pain to make you physically debilitated or mentally ill.
    First you should consult a spinal specialist (see Chapter 4 ) who is familiar with disc problems and who should determine that your symptoms are really the result of a herniated disc.
    Second, you should do only what is necessary to obtain enough pain relief so that you can get a night’s sleep and get around enough to take care of yourself. This means taking as few narcotic painkillers and anti-inflammatory medications as possible. Try not to take any muscle relaxants at all, which cause too many side effects, such as drowsiness and depression. Avoid traction, hanging upside down, manipulation, and especially passive stretching of the painful extremity. Remember how I made an enemy of a colleague by performing a straight-leg-raising test? Very light massage, heat and/or ice packs — well padded so as not to burn your skin — are good for pain relief. Most of these touch measures, as well as acupuncture, will relieve pain as long as you are not taking narcotic pain medications. I will explain the reason for this in the chapter on chronic pain. Try to remain as active as possible within the limits of your pain and stamina. Walking, aquatic exercises, stationary bicycle, and treadmill aerobics all help to keep you from becoming deconditioned (out of shape). Do
not
take pain medication so that you can exercise. Remember that the pain is a warning that something is wrong, and it is a normal defense mechanism. If, because of the pain, you cannot remain active despite these measures, then you should consider the following options for your disc herniation.
What is an epidural, how does it work, and is it painful?
    Epidural steroid injection (epidural) is a method of injecting a small amount of local anesthetic and steroid medication (the most powerful anti-inflammatory drug available) directly into the area of your spine where the nerve is being irritated by the herniated disc. The object is to place the potent steroid where it will do the most good. The local anesthetic is added to the injection to give you immediate pain relief and to confirm that the injection is at the correct location. Herniated discs can be a triple whammy to the nerve because they not only compress and stretch the nerve, but they leak irritants to the nerve. Epidural steroid injections are meant to block the irritants and reduce the pain. I prescribe them so that patients can get enough pain relief to avoid taking narcotic painkillers and so that they can get a good night’s sleep. One of the benefits of epidural injections is that only small doses of steroids are required to be effective.
    I am not an advocate of giving steroids by mouth, the so-called “dose-pacs,” because it requires very high doses to get enough steroids to the area of the irritated nerve to be effective.