Question: I have deteriorating discs in my neck, and I have been prescribed a muscle relaxer and Darvocet for the pain along with Aleve. Except for Aleve, the medications cause a reaction running from chills to being unable to function. I've had a flare-up, and I am establishing a relationship with a new orthopedic surgeon. Apparently, the disc problem is not serious enough for surgery since my arms are not affected. What is the best strategy to handle this chronic condition without prescription medication?

Dr. Hibberd's Answer:

I assume your problem is what we call degenerative disc disease (DDD). It is usually an age-related condition that may become more symptomatic with trauma, injury, or infection.

As discs shrink and become more stiff and less compliant, some loss in range of movement is noted, and occasionally nerve root pressure results from inadequate space as the nerve exits from the spinal cord through the intervertebral foramen (a hole the nerve passes through). This nerve pressure may cause a wide spectrum of pain, variable numbness, or even loss of motor function if left to advance.

DDD is not usually treated with surgery. The only exceptions are when changes advance to the point where paralysis or spinal cord or nerve function is compromised, or there is risk of permanent damage, or pain is intractable.

Minimally invasive surgery, such as laser, is often far more acceptable to selected patients than full open surgical procedures that involve bone grafts, resection, and fusion.

Physiotherapy, occupational therapy, and pain management strategies with medications (oral, patch, and injectable) serve as the mainstay of DDD treatment we use most often.

Medications often used are:

1) Pain (narcotic, non-narcotic, oral, and topical)

2) Inflammation (mostly NSAID meds such as naproxen etc., but occasional steroid medicine pulses for four to six days)

3) Muscle relaxants

4) Anticonvulsant and antidepressant medications that moderate pain-signal thresholds.

Muscle relaxants as well as anti-inflammatories serve as the mainstay treatment for flare-ups of degenerative disc disease.

When oral and topical medications fail, we often resort to considering epidural blocks, combining local anesthetic with epidural steroid injections to try to relieve discomfort and swelling. We usually reserve invasive treatments, which include surgical management by laser or open techniques, for risks due to deterioration or to prevent the condition from progressing to permanent disability.