Herniated Disc: Do You Have a Pinched Nerve or Disc Pain? What Next?

Two Causes of Pain: Pinched Nerve vs. Disc Pain

In identifying the cause of the patient’s pain, there are two general types of spinal disc problems physicians classify as the cause of the pain:

• Pinched nerve – When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain or radiculopathy (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain stemming from a pinched nerve in the lower spine is usually described as sciatica. On Spine-health, this type of condition where there is nerve root pain is referred to as a herniated disc. Other causes of a pinched nerve may include spinal stenosis and bone spurs from spinal arthritis.
• Disc pain – When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain. On Spine-health, this type of condition where there is actual disc space pain is referred to as degenerative disc disease.

Either of the above two conditions can occur in the neck, upper back or lower back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day to day basis.

It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.– refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful as the patient's specific symptoms and the doctor's physical exam results are in determining the source of the back pain and then evaluating potential back care and pain treatments.

My Take: It's a known fact that most of us have bulging or herniated discs and don't even know it. Most of the people that have herniated disc will live and die with them and never have problems.

Then, there is the group of patients that we know have herniated discs...and it's a big big number. But just because they have a lumbar disc herniation or a herniated disc in the neck, it does not mean they need surgery. Chiropractic, physical therapy, exercise, and sometimes just time will help most.

The problem lies with the sub-set of herniated disc patients that become chronic (back pain that lasts over 3 months) and do not respond to conventional conservative therapies. I estimate this to be 10-15% based on my 18 years clinical experience working with herniated disc patients in San Francisco.

Chronic back pain secondary to disc herniations, whether it be a pinched nerve (radicular pain) or axial pain (degenerated disc) is a major problem in the US, and conventional medical treatment options are limited primarily to epidural injections or surgery.