Patient information from BMJ

Slipped disc (lower back): what treatments work?

Last published:Apr 25, 2022

A slipped disc can be very painful. But in most people the pain gets better on its own within about six weeks. If it doesn't get better there are treatments that can help, including surgery.

You can use our information to talk to your doctor and decide which treatments are right for you.

What treatments work?

Although people talk about a slipped disc, nothing in your spine has actually slipped out of place. If your doctor says you have a slipped disc it means one of the discs that sit between each of the bones in your spine has been damaged.

The outer shell of the disc has torn and the spongy inner pad, which cushions the bones, is bulging out. It may be pressing on a nerve. This is what causes the pain. 

Most people with a slipped disc get better in time, and very few go on to need surgery. There are things you can try that may ease your pain in the meantime, such as taking painkillers.

If your pain doesn't get better you may want to consider having surgery. This works well for many people. But some people need a repeat operation if the pain returns.

Things you can do for yourself

If your symptoms are not too serious your doctor will probably recommend a few things you can do to help yourself, including staying active, taking paracetamol, and using heat treatments such as hot water bottles.

Staying active means getting on with your normal activities, including going to work, as much as possible. Long periods of bed rest - or any inactivity - are not recommended. You should try to avoid sitting still for long periods. Walking or swimming may help to reduce pain and stiffness.

Whatever activities you choose to do, be careful not to do things that might make the pain worse. Don't do any heavy lifting or any strenuous bending or twisting.

Painkillers called non-steroidal anti-inflammatory drugs (or NSAIDs for short), such as ibuprofen, may help with the pain in your back, but they don't seem to work for sciatica pain. People who have heart problems shouldn't take an NSAID called diclofenac.

Paracetamol may help in the short term. If you still have bad pain your doctor may recommend painkillers that combine paracetamol with stronger drugs like codeine. You need to be sure not to take more than the recommended dose of painkillers as too much can be dangerous.

Some people say using ice packs or heat treatments like heat lamps or hot water bottles can help ease some back pain. But don't put ice or strong heat directly on your skin, as this could cause damage. Don't use heat or ice for more than 15 minutes at a time.

Physiotherapy may also help some people. Your doctor may be able to refer you to a physiotherapist, who may be able to show you how to help strengthen your back and stop the muscles from stiffening up too much.

Other treatments

Many other treatments have been tried for different types of back pain, including the type of pain caused by a slipped disc.

But the evidence about how well they work is often unclear. Some of these are prescription treatments while others are treatments that you are more likely to have to pay for.

Prescription treatments that doctors might suggest include:

• injections of long-lasting anaesthetic into the spine, to numb the pain. These injections also sometimes include drugs called corticosteroids, which help to reduce swelling

• drugs that relax your muscles. These can help people with other types of back pain. But it's not clear from research whether they work for a slipped disc. These drugs may make you drowsy.

• antidepressant drugs. Some antidepressants have been found to reduce pain. 

Your doctor might also suggest that you try spinal manipulation. Having this type of treatment from a trained therapist may ease your pain. A trained therapist can be a physiotherapist, osteopath, or chiropractor.

The therapist uses his or her hands to move the small joints between the bones (called vertebrae) in your spine. This may relieve pain, stiffness, and other symptoms.

If you have spinal manipulation it's important to go to someone who has experience doing this treatment and who has been trained properly.

Serious side effects of spinal manipulation are extremely rare. But they include making your sciatica worse, breaking a bone in your spine, or damaging your spinal nerves.

There are other treatments your doctor may suggest if your pain is severe.

Other treatments that have been tried, but about which the evidence is unclear, include:

• acupuncture, where therapists put thin needles into specific points on the body, and

• massage, where therapists rub your skin and muscles to try to relieve pain.

Surgery

Most people with a slipped disc don't need surgery. But some people with severe symptoms benefit from an operation to repair the damaged disc. If the surgery stops the disc from pressing on a nerve this should relieve the pain. But the operation doesn't work for everyone.

Before you have an operation you need to be sure that your back pain is caused by a damaged disc. This is done with an MRI scan. If the scan shows that your pain is not caused by a disc, then this type of surgery won't help.

The operation to repair a slipped disc is called a discectomy. There are several types of discectomy depending on what method your surgeon uses, but the aim of all of them is the same.

Although this operation can work well, some people find that the pain comes back eventually and they need a second operation.

Like all kinds of surgery, discectomy has some risks, including bleeding, infection, and having an allergic reaction to the anaesthetic. You can discuss these risks with your doctor before deciding whether to have surgery.

New types of surgery are being developed all the time. For example, some people may be able to have artificial discs put into their spine to replace the damaged ones.

But the type of surgery you are offered will depend on several things. These include the type of surgery that is likely to help you most, and the particular specialist skills of surgeons in your area.

What will happen to me?

Pain from a slipped disc gets better without treatment for 9 out of 10 people. Most people feel better within six weeks, but it can take longer.

Back pain from a slipped disc may come back, whether or not you have treatment. It's important to learn how to avoid over-straining or damaging your back again. A physiotherapist can advise you about ways to protect your back when lifting things, or when sitting for a long time.