For drug treatment of a herniated disc are mainly used. Many of them are available without prescription in pharmacies. – pain-relieving drugs (analgesics)
- But also medicines with anti-inflammatory (antiphlogistic) drugs and
- Relaxant (muscle-relaxing) active ingredients
So-called non-steroidal anti-inflammatory drugs (NSAIDs) are used in particular.
Common products such as ibuprofen, diclofenac and naproxen belong to this group of drugs. They mainly have analgesic and anti-inflammatory effects. It should be noted that this group of drugs can lead to gastrointestinal ulcers and increase the risk of bleeding because of their effects on blood clotting.
If there are contraindications against NSAIDs, paracetamol, which does not belong to this drug group, can be used. In comparison, paracetamol is better tolerated. It should be noted, however, that paracetamol should be taken in a maximum dosage of four grams per day (equivalent to 8 tablets of 500mg each), as otherwise life-threatening liver damage may occur.
Prescription drugs
Also muscle relaxants, which lead to a relaxation of the muscles, are used to treat the herniated disc. Taking them often leads to fatigue and light drowsiness, so that the ability to drive can be impaired. Opioids (strong painkillers) can also be prescribed by doctors for treatment.
Sometimes they are also prescribed in the form of a pain patch. Opioids are available in stronger and weaker forms. The best known opioid, morphine, has a very strong pain-relieving effect.
If it is used purely for pain relief, there is no need to fear dependence. However, they should not be used on drug addicts. Therefore, stronger opioids can only be prescribed on a narcotic prescription (BTM prescription).
Opioids can cause respiratory depression, nausea, dizziness, constipation and mood swings, among other things. Drugs that are normally used to treat epilepsy are also used to treat herniated discs, as they are also approved for the treatment of nerve pain. Like muscle relaxants, they also lead to fatigue and slight disturbances of consciousness.
Like antiepileptic drugs, antidepressants can also be used. More specifically, the so-called tricyclic antidepressants, such as amitryptiline, are used. They are mainly used to treat chronic pain when conventional painkillers are no longer effective.
These antidepressants can set the pain threshold high, so that pain is only noticed later. Side effects can include nausea, dry mouth, low blood pressure, cardiac arrhythmia and fatigue. The last two groups of drugs, anticonvulsants and antidepressants, are only used in cases of prolonged pain when conventional painkillers are no longer effective.
Alternative pain treatment – PRT /PDI
If the pain cannot be treated with medication, another conservative measure can be applied before choosing the step to surgery. This is periradicular therapy (PRT) or peridural infiltration (PDI). In these procedures, pain-relieving, anti-inflammatory and tissue-killing drugs can be injected into the painful nerve root under imaging control (computer tomography, CT).
This is done with millimetre precision. A corticoid (cortisone preparation) is used for the injection, which belongs to the group of glucocorticoids. In the case of peridural infiltration, the drug is injected into the so-called epidural space surrounding the spinal cord.
The nerve roots also lie in the epidural space. In the case of peridural injection, 68% of patients experience an improvement in symptoms or even complete freedom from pain. Especially in acute pain, peridural injections often provide relief compared to other conservative treatment options.
An injection should not be given if the patient has an increased tendency to bleed, or if tumour diseases have been diagnosed and inflammatory processes are taking place in the area of the vertebral bodies. In periradicular therapy, drugs are also injected under computer tomography control. Periradicular therapy usually involves a local anaesthetic and a cortisone preparation.
The aim of therapy is to place the anti-inflammatory drug (cortisone) as close as possible to the painful and swollen nerve root. Cortisone has a decongestant effect, so that the nerve swelling decreases and the pressure and thus the pain (also increased by the local anaesthetic) decreases. The symptoms of the herniated disc usually improve within a few days under periradicular therapy (PRT).
A PRT must usually be repeated 2 times. Decisive for this is the decrease of symptoms. Both procedures are contraindicated in pregnant women. Manual therapies such as massages and physical therapies using heat, cold or infrared radiation can also relieve pain in the case of a herniated disc. The use of acupuncture treatments is also considered helpful by many patients.
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