From the Guidelines
For lumbar herniated disc treatment, the most effective approach is a multimodal strategy that includes conservative management, epidural steroid injections, and surgical options, tailored to the specific pathology, severity of symptoms, and patient characteristics, as recommended by the American College of Physicians and the American Pain Society 1, 2, 3.
Treatment Options
- Conservative management: + NSAIDs (e.g., ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) to reduce inflammation by inhibiting prostaglandin synthesis + Contraindications: GI bleeding, renal impairment, or heart failure + Side effects: gastric irritation, renal dysfunction, and increased cardiovascular risk
- Muscle relaxants: + Cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 6 hours) to reduce muscle spasm by acting on the central nervous system + Contraindications: glaucoma, urinary retention, and myasthenia gravis + Side effects: drowsiness, dry mouth, and dizziness
- Epidural steroid injections: + Methylprednisolone (40-80mg) or triamcinolone (40-80mg) to reduce inflammation through immunosuppression + Contraindications: systemic infection, coagulopathy, or uncontrolled diabetes + Side effects: transient hyperglycemia, adrenal suppression, and infection risk
- Physical therapy: + Core strengthening and flexibility exercises + No specific contraindications except acute severe pain
- Surgical options: + Microdiscectomy for persistent radicular symptoms + Contraindications: patients unfit for surgery + Risks: infection, nerve damage, and recurrent herniation
Mechanism of Action
- NSAIDs: inhibit prostaglandin synthesis to reduce inflammation
- Muscle relaxants: act on the central nervous system to reduce muscle spasm
- Epidural steroid injections: reduce inflammation through immunosuppression
- Physical therapy: improves core strength and flexibility to reduce pain and improve function
- Surgical options: remove herniated disc material to relieve pressure on nerves and reduce pain
Common Dosages
- NSAIDs: ibuprofen 400-800mg three times daily or naproxen 500mg twice daily
- Muscle relaxants: cyclobenzaprine 5-10mg three times daily or methocarbamol 750mg every 6 hours
- Epidural steroid injections: methylprednisolone 40-80mg or triamcinolone 40-80mg
Contraindications
- NSAIDs: GI bleeding, renal impairment, or heart failure
- Muscle relaxants: glaucoma, urinary retention, and myasthenia gravis
- Epidural steroid injections: systemic infection, coagulopathy, or uncontrolled diabetes
- Surgical options: patients unfit for surgery
Side Effects
- NSAIDs: gastric irritation, renal dysfunction, and increased cardiovascular risk
- Muscle relaxants: drowsiness, dry mouth, and dizziness
- Epidural steroid injections: transient hyperglycemia, adrenal suppression, and infection risk
- Surgical options: infection, nerve damage, and recurrent herniation
From the Research
Treatment Options for Lumbar Herniated Disc
- Epidural steroid injections: used to alleviate radicular symptoms from lumbar herniated discs 4
- Conservative therapy methods: include physiotherapy, drug treatment, manual therapy, and injection therapies 5
- Surgical interventions: considered in special symptom constellations, such as severe cases of inability to ambulate and cauda equina syndrome 6
Mechanism of Action
- Epidural steroid injections: work by reducing inflammation and relieving pressure on the neural elements 4
- Conservative therapy methods: aim to reduce pain and improve functional abilities through a combination of different treatment approaches 5
- Surgical interventions: involve the removal of the herniated disc material to relieve pressure on the neural elements 6
Common Dosages
- Epidural steroid injections: typically administered in a single dose, with the possibility of repeat injections if necessary 4
- Conservative therapy methods: dosages vary depending on the specific treatment approach, with physiotherapy and manual therapy typically involving multiple sessions 5
- Surgical interventions: dosage not applicable, as surgery is a one-time procedure 6
Contraindications
- Epidural steroid injections: contraindicated in patients with certain medical conditions, such as bleeding disorders or active infections 4
- Conservative therapy methods: contraindicated in patients with certain medical conditions, such as severe osteoporosis or spinal instability 5
- Surgical interventions: contraindicated in patients with certain medical conditions, such as active infections or severe medical comorbidities 6
Side Effects
- Epidural steroid injections: may cause side effects such as pain, swelling, or bruising at the injection site, as well as more serious complications such as nerve damage or infection 4
- Conservative therapy methods: may cause side effects such as muscle soreness or fatigue, as well as more serious complications such as worsening of symptoms or injury 5
- Surgical interventions: may cause side effects such as pain, swelling, or bruising at the surgical site, as well as more serious complications such as infection, nerve damage, or spinal instability 6, 7