Most herniated discs do not cause back pain, even when they are indeed pathological and symptomatic. This fact is ironic, considering the vast majority of chronic back pain is blamed on herniated and degenerated discs.
Most people reading this essay will be shocked. They have been told that their pain is a direct result of one or more herniated discs, but if they have back pain or neck pain, the chances are extremely low that this speculation is correct. There has never been any study that has established inherent pathology in herniated discs, meaning that most are incidental to pain and not its source.
This important essay provides proof positive that most herniated discs do not cause back pain or neck pain. We will examine the reasons why this is true and the more sinister reasons why so many patients mistakenly believe their pain to be the direct result of a disc bulge or rupture.
Herniated discs have no internal blood supply or nerve endings. They do not feel pain. The only way a disc can produce symptoms is by influencing a local neurological structure in one of the following 3 ways:
The disc can compress a spinal nerve root, commonly called a pinched nerve. This is the most common diagnosis linked to the most frequently observed types of herniations, those of the posterolateral variety. If a pinched nerve does occur, localized pain should be transient, if it exists at all. True symptoms of a pinched nerve will include tingling in the innervated part of the body (usually an arm or leg), followed by objective numbness and weakness in that area. Back or neck pain is not expected and certainly should not endure for long if it does exist.
Herniated discs can compress the spinal cord or the cauda equina in the central vertebral canal, usually when they are central herniations. Spinal cord compression or cauda equina compression might produce pain locally for some time, but most often will progress quickly to include neurological deficits below the affected level, including the inability to stand, walk, control the bowels or even feel or move affected bodily locations. Chronic back or neck pain without these symptoms is extremely atypical.
Chemical irritation of a spinal nerve root is possible when the disc has suffered an annular tear and leaks proteins onto a nerve. This is called chemical radiculitis. This diagnosis might cause chronic pain locally, but not generally the type of severe pain blamed on it, nor the widespread muscular effects normally blamed on herniated disc diagnoses. Chemical radiculitis remains controversial as a diagnosis among even the most open-minded of care providers, since the condition seems extreme selective in who it affects and who is spared.
Herniated discs can cause symptoms through nerve compression. However, it is rare, since most stenosis created by disc issues is transitory and will resolve organically, unlike bone-enacted stenosis associated with arthritis.
No study has found herniated discs to be inherently pathological and countless studies have found them to exist almost universally in people who do not have back or neck pain. In fact, sampling the population will discover herniated discs in the necks and/or lower backs of most people past adult age.
There is little correlation between the severity of pain that is blamed on a disc issue and the clinical significance of the diagnosis. In essence, many chronic and debilitating pain syndromes seem to come from minor disc bulges, while some truly nightmarish disc herniations might produce no pain whatsoever. It makes no sense from a logical, scientific viewpoint.
The most compelling proof that herniated discs do not cause back pain is the countless people who have recovered completely from back pain even though they still have herniated discs.
This is where the facts take a dark turn. Medical science knows for sure that virtually all herniated discs are innocent and complete nonissues when it comes to causing back pain. This fact has been proven time and time again in countless millions of patients who have received targeted disc pain care and surgery that failed to provide relief even though the therapy was considered a success. Of all spinal surgeries, disc operations fare the absolute worst when it comes to their curative results. The reason for this is not the incompetency of the doctor or procedure, but a mistake in the diagnosis from day 1. The disc is simply not the cause of pain.
We also see proof of everything we have said in this essay in the rare examples where herniated discs are causing spinal stenosis, foraminal stenosis or chemical radiculitis for real. These cases generally respond very well to treatment and resolve. When disc pain defies treatment and becomes chronic, the most obvious and common explanation is the only one that makes any sense at all: misdiagnosis. It is an epidemic problem to be sure!