There are a number of potential treatments for herniated discs. The aim is to control pain, maintain activity and muscle tone and prevent further injury. Except in extreme cases, physicians will not recommend surgery as an initial form of treatment. Instead, other therapies will be used to treat the problem.

After an intervertebral disc herniates, the portion that protrudes and pressures the nerve tends to shrink over time. In many cases, partial or complete shrinkage occurs within six months to a year after injury. The vast majority of herniated discs are treated successfully without resorting to surgery.

The goal of nonsurgical treatments of herniated discs is to reduce irritation to the disc and the nerves. This will give the body time to heal itself. Such pain management treatments include:

• Rest or decreased activity. In many cases, a day or two of rest in a bed with a firm mattress will relieve a patient’s pain. Other patients are more comfortable lying with their back on the floor with hips and knees bent and legs elevated.

However, patients should not rest for more than two days unless pain is so severe that it cannot be relieved in any other way. Too much rest prohibits patients from maintaining the muscle tone they need to recover. It has been seen in studies that people tend to have less chronic back pain if they return to their normal regular activity (not involving heavy weight lifting) early.

• Medication. Over–the–counter drugs such as nonsteroidal anti–inflammatory drugs (NSAIDs) can help relieve inflammation and pain. Analgesic medications such as acetaminophen relieve pain but do not reduce inflammation.
  
  In cases of more severe pain, prescription narcotic pain medications (opioids) may be suggested. Injection or oral ingestion of corticosteroids may become necessary if all other medications fail to relieve pain. These drugs help suppress inflammation. When injected, they are given as an epidural steroid injection into the area around the spinal nerves, providing quick and substantial relief for many patients. However, these medications must be used sparingly and under a physician’s close  supervision because they can have significant side effects.

Other medications that may help relieve pain brought on by herniated discs include:

TNF (tumor necrosis factor) inhibitors, a class of anti-inflammatory drugs used to treat rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease, are being studied as a form of biologic therapy to treat herniated discs.

• Cold therapy or heat therapy. Cold packs (cryotherapy) can be applied to painful areas for 15 to 20 minutes at least four times daily. It is recommended that ice be wrapped in a towel or used in a cold pack – ice should not be applied directly to the skin. At least 15 minutes should separate sessions of therapy with ice. Heat therapy (thermotherapy) is also sometimes effective in treating pain associated with herniated discs. Methods of treatment include warm packs, heat lamps or heating pads kept on the lowest setting. Patients who continue to experience pain can alternate cold and warm therapy.
  
  
• Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS) is a technique in which small doses of electrical current are delivered along the nerve pathway. It is believed that this treatment stimulates the release of pain–inhibiting molecules (endorphins) or blocks pain fibers that carry pain impulses.
  
  
• Physical therapy. In many cases, treatment will involve physical therapy that includes exercises to help correct posture, strengthen the muscles supporting the back and improve flexibility. A program called dynamic lumbar stabilization focuses on exercises that coordinate the use of both the abdominal and back muscles in a balanced spine posture. Physical therapy can help the patient both recover from the herniated disc and lower the risk of suffering a similar injury in the future.
  
  Nonsurgical spinal decompression therapy. The U.S. Food and Drug Administration (FDA) has approved systems in which the patient lies on a special mechanical table designed to relieve pressure on the discs. A patient may have sessions of up to an hour most days of the week for several weeks.
  
  Spinal orthoses (back braces). The FDA has approved a wide range of orthoses to relieve pressure on the intervertebral discs, including flexible, semi-rigid and rigid models.
  
  
• Occupational therapy. A physician may recommend occupational therapy if a patient has difficulty performing daily tasks and could benefit from instruction or equipment to adapt.

Some patients will also seek complementary and alternative approaches to treating their back pain, the most popular of which include:

• Acupuncture. Although this therapy is not used to treat herniated discs, it may help relieve back pain. It involves insertion of hair–thin needles under the skin. Patients feel little or no pain and the needles usually remain in place for 15 to 30 minutes a session over several sessions.
  
  
• Chiropractic treatment. This therapy involves spinal adjustment (manipulation) to treat restricted spinal mobility by restoring spinal movement. According to proponents, this improves function and decreases pain. However, most physicians do not recommend chiropractic care to treat a herniated disc, except when methods such as FDA-approved spinal decompression therapy are used. Other methods may sometimes be harmful in an unstable spine.

In some cases, nonsurgical techniques are not sufficient to effectively treat back pain, leg pain and neck pain associated with a herniated disc. Unless there is a need for immediate surgery – indicated by symptoms such as progressive muscle weakness or lack of bladder control – most physicians will urge patients to wait at least six to 12 weeks after the onset of unrelieved pain before considering surgery as an option.

Spinal surgery may be performed to keep the herniated disc from pressing on and irritating nerves, thus relieving pain. Open decompression procedures are one type of surgery used to treat herniated discs. They include:

• Discectomy. Removal of all or part of a disc to relieve pressure on a nerve. The herniated portion of the disc and any pieces that have broken loose are removed. When possible, just the fragment of the disc that is pinching the nerve is removed. In many cases, this is performed in tandem with a procedure called a partial facetectomy, which involves removing a small part of an area of the spine called the facet joint that may be compressing the nerve.
  
  
• Laminotomy and laminectomy. Both procedures involve removing a small amount of the back part of the bone over the spinal canal (lamina). A portion of the lamina is removed in a laminotomy, whereas the entire lamina is removed during a laminectomy. These procedures are often performed in conjunction with a discectomy.
  
  
• Microdiscectomy. Similar to a standard discectomy except that the procedure is performed through a small incision while the surgeon looks through a microscope.

Minimally invasive procedures are also used to treat herniated discs. They have the advantage of reducing the risk of complications and the need for a long recovery period, but have certain drawbacks. These procedures include:

• Endoscopic procedures (arthroscopy). Allow parts of the disc to be removed from between vertebrae with a mechanical device that fits into a large needle. Percutaneous (by way of the skin) discectomy involves use of continuous real-time x-ray (fluoroscopy). However, because endoscopic procedures are done through a smaller incision, the surgeon is unable to see the nerve root and may not be able to tell if the correct part of the disc has been removed. There has been lot of research into percutaneous decompression of herniated discs, but data are still preliminary.
  
  Intradiscal electrothermal therapy (IDET). In this form of electrical therapy, a wire is placed into an injured intervertebral disc, then electrically heated to seal and toughen the tissue.
  
  
• Chemonucleolysis. An enzyme (protein that acts as a catalyst for biochemical reactions) called a chymopapain is injected into the disc to dissolve the protruding disc and reduce pressure on the nearby nerve. However, chemonucleolysis generally is not used in the United States because of the risk of neurologic complications and allergic reactions to the enzyme.

In rare cases, vertebral fusion may be used to treat herniated discs. The procedure permanently connects two or more vertebrae to improve stability, correct a deformity or treat pain. Small pieces of extra bone are used to fill the space between two vertebrae and fuse the spin. The disc is removed first if the front of the spine is fused. Spinal fusion eliminates some spinal flexibility, which can be beneficial if movement between spinal segments is the source of a patient’s pain. However, most physicians do not recommend this procedure for a herniated disc.

Once a herniated disc has been successfully treated with surgery, the patient may undergo physical therapy.

The recent 11-state Spine Patient Outcomes Research Trial (SPORT) compared discectomy to nonsurgical treatment of herniated discs. It found that patients in both treatment groups showed comparable improvement over two years, with the surgery group having only a slight edge.