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 Bulging/Herniated Disc

Overview

People often confuse a bulging disc with a herniated disc, as it is common to hear the two names being interchanged synonymously. Although these two issues are similar, one is actually different than the other. A bulging disc, (contained) is when one of the soft, jelly-like discs separating each individual vertebra in your spine is damaged and bulges, causing pressure on one of the tangent vertebra. This causes pressure on spinal nerves, sometimes causing severe pain or numbness throughout different parts of the body. A herniated disc (non-contained) is the result of a bulge that breaks through the thin layer of cartilage protecting the jelly-like disc, much like a water balloon. Bulging and herniated discs can happen anywhere in the spine, but most often occur in the lower back.

What Causes a Bulging Disc or Herniated Disc?

Bulging and herniated discs are caused by the deterioration or drying out of the disc over time. As we age, our discs wear down, causing them to allow less shock absorption and flexibility. This causes the thin layer of cartilage to weaken, enhancing the probability of a bulging or herniated disc.

What are the Symptoms of a Bulging Disc or Herniated Disc?

Depending on how the disc is pressing against, bulging and herniated discs can cause severe pain to no pain at all. Along with pain, a bulging and herniated disc can cause numbness. If the pain or numbness is in the buttocks or legs, then the damage is most likely in the lower spine. This is, more often than not, Sciatica, which is the most common symptom a bulging or herniated disc. If the symptoms are in the arms, shoulders, or neck, the bulging or herniated discs are more than likely in the upper spine and neck area. Although both bulging and herniated discs are likely to cause pain and numbness, many people that have had these disc disorders have experienced no symptoms at all.

How is a Bulging Disc or Herniated Disc Diagnosed?

Diagnosis of a bulging or herniated disc is typically done through a simple examination. However, if necessary, doctors may require a CT scan or MRI to determine the problem in the spine.

How is a Bulging Disc or Herniated Disc Treated?

Bulging and herniated discs rarely require invasive surgery. Typically, rest and relaxation is the best way to recover from severe cases of these disc disorders. Doctors usually recommend heating and cooling pads to reduce swelling and pain, and also a number of different daily exercises to help with flexibility and recovery. Also, there are a number of different medicines to help with the pain and swelling, so be sure to ask your doctor what is available and safe for you to take.

Terminology

Normal situation and spinal disc herniation in cervical vertebrae.

Some of the terms commonly used to describe the condition include herniated discprolapsed discruptured disc and slipped disc. Other phenomena that are closely related include disc protrusion, pinched nerves, sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc.

The popular term slipped disc is a misnomer, as the intervertebral discs are tightly sandwiched between two vertebrae to which they are attached, and cannot actually "slip", or even get out of place. The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched and twisted, all in small degrees. It can also be torn, ripped, herniated, and degenerated, but it cannot "slip". Some authors consider that the term "slipped disc" is harmful, as it leads to an incorrect idea of what has occurred and thus of the likely outcome. However, one vertebral body can slip relative to an adjacent vertebral body. This is called spondylolisthesis and can damage the disc between the two vertebrae.

Signs and symptoms

Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting neck or low back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. If the herniated disc is in the lumbar region the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Patients with L3 or L5 herniated disc (usually affecting the knee and leg) also have a high chance of experiencing decreased sexual performance ( erectile dysfunction ) due to the tissue involved with the penile muscle tissue. If the extruded nucleus pulposus material doesn't press on the p tissues or muscles, patients may not experience any reduced sexual function symptoms. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body.

It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location. If the extruded nucleus pulposus material doesn't press on soft tissues or nerves, it may not cause any symptoms. A small-sample study examining the cervical spine in symptom-free volunteers has found focal disc protrusions in 50% of participants, which suggests that a considerable part of the population can have focal herniated discs in their cervical region that do not cause noticeable symptoms.

Typically, symptoms are experienced only on one side of the body. If the prolapse is very large and presses on the spinal cord or the cauda equina in the lumbar region, affection of both sides of the body may occur, often with serious consequences. Compression of the cauda equina can cause permanent nerve damage or paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction. This disorder is called cauda equina syndrome.

Cause

Disc herniations can result from general wear and tear, such as when performing jobs that require constant sitting and squatting. However, herniations often result from jobs that require lifting. Traumatic injury to lumbar discs commonly occurs when lifting while bent at the waist, rather than lifting with the legs while the back is straight. Minor back pain and chronic back tiredness are indicators of general wear and tear that make one susceptible to herniation on the occurrence of a traumatic event, such as bending to pick up a pencil or falling. When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back).[citation needed]

Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the posterior side (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.[citation needed]

There is also a strong genetic component. Mutation in genes coding for proteins involved in the regulation of the extracellular matrix, such as MMP2 and THBS2, has been demonstrated to contribute to lumbar disc herniation.

Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc - a classic picture. MRI scan of cervical disc herniation between fifth and sixth cervical vertebral bodies. Note that herniation between sixth and seventh cervical vertebral bodies is most common. MRI scan of cervical disc herniation between sixth and seventh cervical vertebral bodies. MRI scan of large herniation (on the right) of the disc between the L4-L5 vertebrae. MRI Scan of lumbar disc herniation between fourth and fifth lumbar vertebral bodies.

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Pain Management

1. What Is Pain Management? Pain management is a quickly growing medical specialty that combines integrative therapies with traditional medical care. Ideally, this allows patients to have the best of both worlds. This type of care is typically customized for each person and should be created by the patient/healthcare provider treatment team. Following are some examples of this approach: Acupuncture: Developed in China, it has been practiced for thousands of years. The most commonly used and most scientifically studied acupuncture technique stimulates points on the body using thin, solid, metallic needles that are manipulated by hand or electrical stimulation. Massage: Used in numerous cultures. Usually, a therapist will press, rub, and otherwise manipulate the muscles and other soft tissues of the body with their hands, fingers and/or forearms to enhance function and promote relaxation. Physical therapy: Techniques include movement, exercises, water therapy, ultrasound, heat, and ice to help improve function, increase flexibility and strength, and decrease pain. Tai chi: This ancient Chinese discipline is sometimes thought of as a combination of yoga and meditation. Tai chi is rooted in self-control, and is a series of slow and soft movements. These exercises are thought to be calming and relaxing, providing both physical and emotional benefits. Medications: Often an important part of managing illness and relieving pain. Two common categories of medicines include: Over-the-counter medications: These are medications that you do not need a prescription from a healthcare provider to purchase. Follow the directions on the label and be sure to tell your loved one’s healthcare provider about them. Prescription medications: These medications require a prescription from a healthcare provider and must be purchased from a pharmacy. When using these medications, follow the directions on the label and call your healthcare provider with any questions. It is helpful to discuss all medications taken with the pharmacist. Social support: Identified as a significant way to help reduce pain. An individual’s support system includes friends, family members, and caregivers, including professionals. 2. Caring for a Person With Pain It is difficult to watch a loved one suffer from pain. Here are some important things to keep in mind: Believe your loved one’s report of pain. Pay attention to the signs that indicate your loved one might be in pain. These may include: Facial expressions, such as grimacing Breathing and sighing heavily Unusual body movements, such as limping Behavioral changes, such as not wanting to eat or sleep Emotional changes, such as crying or irritability Attend visits to the healthcare provider with your loved one. Prepare questions in advance and take notes. Keep a pain diary to use as a starting point for a discussion with the healthcare provider. For pain diaries and other assessment guides, Talk to the insurance company. You will likely need to communicate with your loved one’s insurance company to assist with claims. Before you pick up the phone to speak to a claims representative, it is necessary to gather some information: Your name and relationship to your loved one Your loved one’s birth date Insurance policy number Name and address of the organization that sent the bill Total amount of the bill Diagnosis code on the bill Insurance company’s explanation of benefits Remind and encourage your loved one to follow their treatment plan, such as doing their exercises or taking their pain medication. Take responsibility for all pain medications. There are many responsibilities that come with using medication to treat pain. Some things you should think about are: Keep a record of all medications being taken (prescription and over-the-counter medications). Tell the healthcare provider about all over-the-counter medications or herbal supplements your loved one is taking. If pain disrupts your loved one’s sleep, speak to their healthcare provider about treatment options. Lock up medications to avoid theft. Keep all medications out of the reach of children. Talk to a pharmacist about appropriate disposal after medications are no longer needed. 3. Caring for Yourself Seek support from other family caregivers. There is great strength in knowing you are not alone. Value yourself. When people offer to help, accept the offer and suggest specific things they can do to help you. Watch out for signs of depression in yourself and don’t wait to get professional help if you need it. There is a difference between caring and doing. Be open to technologies and ideas that help your loved one become more independent. Pain management is important for ongoing pain control, especially if you suffer with long-term or chronic pain. After getting a pain assessment,your doctor can prescribe pain medicine, other pain treatments, or psychotherapy to help with pain relief. Source: partnersagainstpain.com


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