Ask the Experts
I have been diagnosed with a herniated disc. What is that, and can you treat it?
A herniated disc is a very common condition of the spine that can cause severe pain. Our spinal columns are composed of many bones, called vertebral bodies, that are stacked on top of one another and which bear the weight of our body. In between each of these vertebral bodies is a disc which gives our spine flexibility. These discs are made up of a strong fibrous ring which surrounds a jelly-like substance in the center called the nucleus pulposus. The fibrous ring holds the inner jelly substance back like a dam holds back water. If this ring becomes degenerated, weak, or torn, the substance can push through the ring. When the disc bulges backwards towards the spinal cord or nerves it is considered herniated, this is typically seen on an MRI or CT scan and a “herniated disc” is diagnosed.
The area where you experience pain depends on where the disc herniation occurs. If the disc herniation occurs in the neck, you may have pain in one or both of your hands and arms. It is possible that you will also have neck pain with the arm pain. If the herniation occurs in your low back, you could have pain in one or both feet or legs with or without back pain. The pain is often described as a burning, tingling, stabbing, or electrical pain that shoots down the arm or leg. Conversely, you may only feel an achiness or soreness in the neck or back without pain in your arms or legs. Since everyone experiences pain in a unique fashion, do not be surprised if your symptoms are not the “textbook” symptoms.
A couple of symptoms that are very concerning are new weakness and loss of control of bowel or bladder. If you develop new weakness or loss of control of your bowel or bladder, you should see your doctor immediately or be seen in an emergency room.
The treatment of a herniated disc depends on the severity of the symptoms. At times all that is required are some oral anti-inflammatory or anti-nerve pain medicines. In addition to these treatments, physical therapy or chiropractic care can also be helpful by reducing the pressure on the herniated disc. Narcotic pain medications are not usually the best choice for this type of pain and are also associated with severe side effects such as nausea, vomiting, constipation, dizziness and confusion.
If you have failed to get better with conservative care (rest, anti-inflammatories, PT/Chiropractic care), an epidural steroid injection in the spine may be the best course of treatment. This medicine helps to reduce any inflammation as a result of the herniated disc. It also helps to turn down the pain signals in the nerve itself. One of the most important benefits of an epidural injection is that the doctors at Arizona Pain Specialists can target the specific area where the pain is generated. This allows for a significant reduction of pain in most cases. In some cases the herniation can be severe enough that surgery is required to reduce the pain and/or weakness.
-Tristan Pico, M.D.
I have heard that Tylenol can be a dangerous medicine if used improperly. Can you tell me more about this?
First it is important to know that Tylenol is often called by two other names: acetaminophen and APAP (a name usually used on prescription bottles). All three refer to the exact same medicine. Acetaminophen is used for one of two reasons: to reduce fever and to treat pain. By itself it is not the strongest of pain relievers, but when it is used in combination with other pain medicines such as opiates (like codeine, hydrocodone, oxycodone, etc) it improves the effectiveness of the opiate medicine. This is the reason why so many commonly prescribed opiate pain medicines also contain acetaminophen.
When used as directed, acetaminophen is a fairly safe medication. However, like any medicine, it can be dangerous if not taken as directed. If too much acetaminophen is taken there is a risk of severe liver damage. In fact, according to the FDA, the most common cause of acute liver failure in the United States is likely acetaminophen (from either intentional or unintentional) overdose.
How much acetaminophen is too much? The most commonly described maximum dose of acetaminophen is 4 grams (or 4000mg) in any 24 hour period in a healthy adult who does not have liver disease. The maximum amount for patients with liver disease or for patients who are heavy users of alcohol will be even lower. Tell your Pain Physician about all of the medications that you take, and let them know if you have liver disease or if you regularly consume alcohol. With this information, it can be determined what the safest total dose of acetaminophen is for you, but remember that it will never be higher than 4000mg in a 24hr period.
The big issue arises from the fact that acetaminophen is very regularly found in combination with other medicines and the only way to know for sure whether or not a combination medication contains acetaminophen is to actually READ THE LABEL. Take a look at some of the bottles in your medicine cabinet, in particular cold and flu medications and headache medicines, and you will surely find that a lot of them contain acetaminophen as an ingredient. Also take a close look at your pain medication bottles, as many commonly prescribed pain medicines contain very high amounts of acetaminophen: Vicodin ES for example contains 750mg of acetaminophen per pill.
If you are prescribed or are taking any medications that have acetaminophen, I recommend that you carefully read the label and write out the amount of acetaminophen in each pill. Also do this with all of your other medication bottles. Then keep a daily tally of the amount of acetaminophen you are taking.
It’s important that you never exceed the daily recommended amount of acetaminophen, as this can cause severe liver problems.
