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Spinal disc degeneration is a normal part of aging, like gray hair and liver spots. Sometimes, however, disc degeneration can end up squeezing a nerve or throwing the spine out of whack. When that happens, disc degeneration can hurt, making routine movements a challenge. Most people get better in a few months, but sometimes a doctor’s help is needed. Read more about the diagnosis and treatment of degenerative disc disease in the sections that follow.
What is degenerative disc disease?
Degenerative disc disease is a gradual wearing away of the integrity of the cartilage discs that separate the individual bones of the spine, making them thinner, weaker, and more vulnerable to damage.
The spine is a series of disk-like bones, called vertebrae, which run from the top of the neck to the pelvis. The spinal cord runs down the spinal canal at the back of these bones. At each vertebra, the spinal cord gives off a pair of nerves, called nerve roots, branching out supply nerves to one part of the body.
The vertebrae are separated from each other by thick disks of cartilage. They’re like the spine’s version of shock absorbers. The thick, fibrous outer layer, called the annulus fibrosus (or “fibrous ring”), does all the mechanical work of holding up the spine, keeping it in the right position, absorbing stress, and cushioning impacts. The inner part of the disc, called the nucleus pulposus, is a gel-like bubble of proteins and cells.
As we age, the disc nucleus slowly dries out and dies off. The disc becomes thinner and starts to tear. Sometimes, however, the inner part of the disc pushes out through one of the tears, a condition called disc herniation. The disc either bulges out of place, or the nucleus punches its way out of the disc.
Sometimes a herniated disc squeezes nerve roots coming out the spinal cord (spinal stenosis) or, more ominously, compresses the spinal cord itself (myelitis). Spinal stenosis causes pain at the nerve root as well as pain that radiates out to other parts of the body, a condition called radiculopathy. It can also reduce sensation and strength in that body part. Myelitis on the other hand is a potentially serious condition that can result in permanent loss of nerve function and even paralysis.
A degenerated or herniated disc can also throw the spine off balance. Neck or back muscles have to restore the balance, causing muscle pain and spasms. In other cases, the body “corrects” the thinner, weaker, or bulging disc by growing new bone in the vertebrae. This can lead to bone spurs, another source of pain due to degenerated discs.
Disc degeneration is caused by age, injury, and general wear and tear, but serious degeneration may be inherited. Disc degeneration happens in the neck (cervical spine), upper back (thoracic spine), and lower back (lumbar spine). Herniation, nerve compression, and muscle spasms, though, are more common in the lower back and neck.
Disc degeneration is a normal part of aging. It starts in a person’s late teens or twenties and progresses throughout a person’s life. Between 70% and 80% of people under the age of 50 and over 90% of people over the age of 60 have degenerative disc disease. Fortunately, the vast majority do not have symptoms other than loss of flexibility and the occasional back pain.
How is degenerative disc disease diagnosed?
Degenerative disc disease is diagnosed based on medical history, physical examination, and imaging. Most patients will be treated by a general practitioner, but severe disc problems may require the services of an orthopedist, neurologist, or surgeon.
Pain drives most people to seek medical care. Common symptoms of degenerative disc disease include:
- Pain that arises from twisting or bending the back or neck
- Pain that arises from lifting a heavy object
- Pain that gets worse or better depending on position
- Low back pain that worsens when sitting
- Muscle tension in the back or neck
- Pain or weakness in one part of the body, like the shoulder, arm, or leg
- Numbness, tingling, or weakness in one part of the body
In taking a medical history, the healthcare provider will want to know when the pain started, if the pain has spread to other parts of the body, and what causes the pain to get worse. The provider will also want to know if there’s any weakness or other symptoms. One important goal of a medical history is to rule out more serious conditions such as injury, infections, or cancer.
The physical exam will involve a complete neurological workup to test walking, balance, sensation, strength, range of motion, and reflexes.
Imaging will usually involve an X-ray of the affected area and sometimes of the entire spine. If the healthcare provider suspects a herniated disc, an MRI (magnetic resonance imaging) will give an accurate picture of the nature of the disc herniation and other soft tissue problems in the area. An MRI also gives a very accurate picture of any nerve or spinal cord compression.
Degenerative Disc Disease treatment options
Degenerative disc disease is initially treated conservatively with physical therapy, rest, activity modification, and pain management. Many patients will get better in a few months, and some may see near-complete symptom relief. Surgery is reserved for people with debilitating pain, an inability to carry out normal daily activities, or a significant loss of nerve function in one or more parts of their body.
Medications
Degenerative disc disease is initially treated conservatively with over-the-counter or prescription NSAIDs (non-steroidal anti-inflammatory drugs). More severe pain may require prescription medications such as corticosteroid injections for swelling and pain relief, neuropathic agents to relieve pain from a compressed nerve, muscle relaxants for pain due to muscle spasms, or opioids as a last resort.
Physical therapy
Physical therapy focuses on stabilizing the spine, increasing joint mobility, improving range of motion, and training patients in using correct posture. Physical therapy might include stretching, yoga, flexibility exercises, core or neck strengthening exercises, massage, or posture and body mechanics training.
Immobilization
Neck collars or low back braces can help reduce disc degeneration pain in the short term by limiting the motion of the neck or the back. Long-term use of braces or collars risks making the problem worse.
Surgery
When disc degeneration involves crippling pain or significant loss of nerve function, an orthopedic surgeon will operate on the spine. The most common spine surgery for degenerative disc disease is a discectomy—complete removal of the disc along with spinal fusion—or a disc replacement.
Alternative treatments
The bad news is that many people do not find adequate symptom relief from conservative medical treatments. Understandably, they are willing to try alternative treatments for their back or neck pain.
- Cognitive-behavioral therapy has been shown to improve the quality of life in some patients by training people on how to manage the perceived pain through mindfulness, relaxation, preventing flare-ups, and managing immediate needs.
- Acupuncture may reduce disc degeneration pain when combined with other standard treatments. Some back pain clinics offer acupuncture as part of their suite of medical services.
- Massage may or may not work. There are no standard massage therapies for pain caused by disc degeneration, so results will vary from therapist to therapist.
- Chiropractic care. Treatments vary by the individual practitioner, so, results may vary depending on the practitioner.
Degenerative Disc Disease medications
Unless there is significant nerve compression or loss of nerve function, degenerative disc disease is treated conservatively with over-the-counter pain relievers and activity modification. More severe pain or nerve compression will be managed with prescription medications.
NSAIDs
Most people with degenerative disc disease will be advised or prescribed an over-the-counter or prescription NSAID (nonsteroidal anti-inflammatory drug), usually ibuprofen or naproxen. For patients with bleeding or gastrointestinal problems, the healthcare provider will turn to celecoxib.
Pain relievers
For people unable to take NSAIDs, over-the-counter or prescription acetaminophen may help. Unlike ibuprofen or aspirin, acetaminophen does not reduce swelling, but it does relieve pain. Acetaminophen, however, is not recommended for long-term use.
Corticosteroids
A physician may inject a corticosteroid such as methylprednisolone to the affected disc to rapidly bring down swelling and pain. The injection is made directly into the spinal cord (epidural steroid injections or ESI) or into the backbone joint (intra-articular facet joint steroid injection). Oral corticosteroids are usually avoided.
Muscle relaxants
A healthcare professional will treat neck or muscle pain and spasms with a short course (5-7 days) of muscle relaxants such as methocarbamol, metaxalone, or orphenadrine. Benzodiazepines, such as diazepam may be prescribed, but doctors are usually advised to avoid these drugs because of their side effects.
Neuropathic agents
Patients with a pinched nerve or radiating pain may be prescribed a drug that specifically treats nerve pain (neuropathy) such as gabapentin or Lyrica (pregabalin). Originally developed as anti-seizure (anticonvulsant) medications, these drugs reduce nerve pain by blocking the pain signals right at the spinal cord.
Opioids
In cases of severe and debilitating pain due to degenerative disc disease, a physician may prescribe a short course (a few days) of an opioid such as tramadol. Doctors are advised not to use opioids as a long-term solution for chronic pain.
What is the best medication for degenerative disc disease?
Medications for degenerative disc disease are only used to provide symptom relief. They do not treat or cure the underlying disc problem. Symptom relief is always a delicate balance between effectiveness and unwanted and possibly harmful side effects. For this reason, there is no “best” medication for degenerative disc treatment. Effectiveness will depend on the unique circumstances of the problem, the patient’s responsiveness to medication, and the patient’s tolerance for side effects.
| Best medications for degenerative disc disease | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Motrin (ibuprofen) | NSAID | Oral | Two 200 mg tablets every four hours | Nausea, bleeding, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet every eight to 12 hours | Nausea, bleeding, stomach pain |
| Celebrex (celecoxib) | Prescription NSAID | Oral | One 200 mg capsule daily | Abdominal pain, diarrhea, stomach upset |
| Tylenol (acetaminophen) | Analgesic | Oral | 325 mg to 650 mg taken every six hours | Nausea, stomach pain, loss of appetite |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 40 mg injected once | Mood changes, edema, increased blood pressure |
| Robaxin (methocarbamol) | Muscle relaxant | Oral | One to two 500 mg tablets taken three to four times daily | Drowsiness, upset stomach, blurred vision |
| Norflex (orphenadrine) | Muscle relaxant | Oral | One 100 mg tablet taken twice a day, once in the morning and once at night | Dry mouth, fast heart rate, blurred vision |
| Neurontin (gabapentin) | Neuropathic agent | Oral | One to three 100 mg capsules taken once daily to three time daily | Dizziness, eye problems, coordination problems |
| Ultram (tramadol) | Opioid | Oral | One 50 mg tablet taken two to three times daily | Dizziness, nausea, constipation |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of degenerative disc disease medication?
All medications may have side effects, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
NSAIDs (nonsteroidal anti-inflammatory drugs) are widely available and safe. NSAIDs interfere with blood clotting, so their most serious side effects are bleeding, bruising, and digestive system pain and bleeding. However, celecoxib is often prescribed because it does not affect bleeding.
Acetaminophen is also widely available and safe. However, it can be toxic if taken in excess, so it should only be taken as directed and should not be used on a daily basis for a long time.
Corticosteroid injections often provide rapid pain relief and motion recovery that can last for several weeks or months. However, they have several unpleasant and commonly-experienced side effects including mood and behavior changes, aggressiveness, increased appetite, weight gain, and high blood pressure.
Muscle relaxants come in two major drug categories: anticholinergics and benzodiazepines. Anticholinergics block nerve signals to involuntary muscles, so they cause unpleasant side effects such as dry mouth, blurred vision, constipation, and sedation. For this reason, physicians typically start with muscle relaxants that have mild anticholinergic effects, such as orphenadrine.
Benzodiazepines are powerful sedatives; they relax muscles by slowing down the brain. Most people will experience drowsiness, sleepiness, memory problems, fatigue, and fogginess when taking a benzodiazepine. They also carry a significant risk of abuse, dependence, and withdrawal. A doctor may prescribe a benzodiazepine like diazepam for degenerative disc disease, but their use is discouraged.
Neuropathic agents and opioids block pain signals by slowing down the central nervous system. Most people, then, will experience side effects like sleepiness, fatigue, dizziness, and general fogginess. They also have the potential for drug abuse and overdose. In addition, opioids also carry a risk of withdrawal.
What is the best home remedy for degenerative disc disease?
Degenerative disc disease cannot be cured, but home remedies can help reduce pain and improve quality of life.
Rest
Disc degeneration symptoms usually lessen in a few days or weeks. Resting for one or two days often greatly reduces pain and swelling. After a couple of days, mild exercise is permitted but do not put abnormal strain on the spine.
Maintain good posture
Good posture reduces nerve compression and abnormal strain on the spine.
Use warm compresses
A warm compress or heating pad will help relieve muscle pain caused by nerve compression.
Use over-the-counter pain relievers
When the pain is too much, over-the-counter ibuprofen or naproxen can help.
Lose excess weight
Excess weight puts stress on the spine. Losing excess weight can help relieve back pain and discomfort considerably.
Frequently asked questions about degenerative disc disease
Is degenerative disc disease serious?
Degenerative disc disease is a normal part of aging. Most people experience no or very minor symptoms due to disc degeneration. However, a herniated disc may put pressure directly on the spinal cord. Called myelitis, this pressure can irreparably damage the spinal cord resulting in weakness, muscle spasm, or paralysis.
Is walking good for degenerative disc disease?
Regular exercise such as walking, stretching, yoga, or swimming helps strengthen and stabilize the spine, reducing degenerative disc pain and swelling.
Is degenerative disc disease considered a disability?
Degenerative disc disease qualifies as a disability when it involves chronic and severe pain over a certain period that prevents a person from performing normal work routines. It is a common basis for disability claims.
Can a degenerative disc ever heal?
A degenerated disc does not “heal” in the sense of returning to its former state. Instead, the body compensates for the disc problem by reabsorbing herniated material, strengthening muscles, and growing new bone or soft tissue.
Can degenerative disc disease cripple you?
Degenerative disc disease can cause nerve root compression or spinal cord compression that can permanently disable a person by both weakening muscles and decreasing the ability to move.
What is the best treatment for degenerative disc disease?
For degenerative disc disease, non-surgical treatment is first used to manage symptoms. 90% of degenerative disc patients see significant improvements in symptoms in three months using symptom management.
How should you sleep when you have degenerative disc disease?
Most people with lower back degenerative disc disease find the best symptom relief sleeping on their stomachs. People with cervical degenerative disc disease should sleep on their backs and use a cervical roll in their pillowcase.
How can I prevent degenerative disc disease from getting worse?
The key to treating degenerative disc disease is reducing abnormal stress on the spine. Lose excess weight, learn and practice good posture, avoid activities that cause neck or back pain, stretch, and do core or neck exercises to strengthen the muscles that stabilize the spine.
Does degenerative disc disease get worse?
Disc degeneration is a progressive condition. It is a normal part of growing older.