About pinched nerves and herniated disks—The final saga!!!

About pinched nerves and herniated disks—The final saga!!!

Nitin K. Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065


The last post ended with our patient officially getting the diagnosis of a pinched nerve due to a herniated disk.  He was in excruciating pain and the doctor had referred him for a MRI scan of the lower back (we call this MRI LS spine (lumbo-sacral spine) or MRI C spine (of the cervical spine) as the case may be).  I want to emphasize that the diagnosis of a herniated disk is usually a clinical one and hence a MRI scan is not warranted in each and every case. I usually refer a patient for a MRI scan only if the clinical presentation is atypical or if there are signs of pressure on the spinal cord itself and lastly if the patient does not respond to treatment.

Well enough of my views, let us get back to our patient, who at this moment finds himself saddled inside a MRI scanner. The magnet starts moving, making a thunderous noise with the patient inside wondering what he has got himself into (many people feel claustophobic inside a MRI machine and for many the scan itself can be quite unnerving!!!).

After seeing the MRI pictures, the doctor decides to treat our patient symptomatically. A few days rest, some pain killers to keep the pain in check and a referral to physical therapy is prescribed. For the majority of patients with herniated disks and pinched nerves, this conservative therapy usually is effective. Traditional pain killers such as Motrin and Advil may not be very effective for neuropathic pain (pain due to the pinched nerves).  Hence medications like gabapentin (Neurontin) and carbamazepine (Tegretol) are at times prescribed. These work well for neuropathic pain though have their own side-effects which patients at times cannot tolerate. 

In patients who do not respond to the above conservative therapy more aggressive and usually invasive treatment options may be pursued. These include epidural steroid injections (these are injections of steroids (anti-inflammatory agents)  and pain-killers administered in the epidural space. The jury is still out whether these injections are truly beneficial. They have their own risks and should be administered only a qualified pain specialist. Relief if any is short lived and I personally do not refer my patients for epidural steroid injections. Surgery to remove the herniated disk (the procedure is called discectomy) is the last option. It is usually reserved for patients who have a large central disk herniation with compression of the spinal cord.

Thankfully our patient responds well to conservative therapy with gradual resolution of pain and discomfort. Soon he is back to his usual state of good health and cheerfully lifting heavy office supplies.  Herniated disks, pinched nerves and other things that make him go ouch and ah are but a distant memory….. A happy ending indeed.



I have a pinched nerve-now what do I do?

I get a lot of patients who say thay have a pinched nerve either in their backs or in their necks. They are invariably on pain-killers and some of them even have had surgery for their pinched nerves. As there is a lot of confusion and misperception in the minds of patients when it comes to “pinched nerves” I thought this might be a good time to discuss this topic.

So what exactly is a “pinched nerve”? When patients say they have a pinched nerve, they are referring to what we as neurologists call “radiculopathy”. Let me try to explain this in simple terms. The nerves that supply the muscles of the arms and legs come out from the spinal cord. These nerves exit as small nerve rootlets (radicles) from inbetween the bones that make the vertebral column (spine). At times these nerve rootlets (radicles) may be compressed (pinched) by either a bony spur of the vertebral column or a disk might herniate out and compress the nerve rootlet. This compression of the nerve (radicle) leads to pain which characteristically radiates down along the length of the nerve. So for example if you have a pinched nerve in the neck, the pain shall radiate down your arm and if you have a pinched nerve in the back, the pain shall radiate down your leg. This is what is called RADICULOPATHY.

The pain of radiculopathy can be excrutiating causing much discomfort and distress. In the acute stage, patient may find it so painful that they cannot move. They complain of “current” running down their arm or leg.

So how do we treat a pinched nerve? Well in the acute stage (when the nerve is inflammed), bed-rest is prescribed. This may vary anywhere from 3 days to a week. The acute pain of a radiculopathy is treated with painkillers–these may range from simple analgesics like Tylenol to anti-inflammatory drugs like Motrin, Advil and even corticosteroids for a short duration. Other medications used include medications effective against neuropathic pain such as gabapentin (Neurontin) and carbamazepine (Tegretol).

Recent studies have shown than most radiculopathies shall settle down over time with the above conservative measures. At times a disectomy is carried out (removal of the herniated disk) for pain relief. Epidural steroid injections may provide temporary relief.


Nitin Sethi, MD