PINCHED NERVES

What is a Pinched Nerve?

The term pinched nerve refers to a nerve root that is compressed or damaged by arthritis, a bulging disc, or a herniated disc. Each of the nerve roots exits the spine in a small hole which is between the back of the disc and the front of the facet joint. The disc can push into the hole, or foramen. The small facet joint can enlarge if it is damaged.

A damaged facet joint can also push into the nerve's exit hole. If the hole becomes too small, the nerve can become pinched. The term pinched nerve is not a medical name. It is, however, a commonly used phrase which describes the cause of arm or leg pain due a spine injury.

The difference between midline neck or back pain, and pain in an arm or leg is significant. Pain in the middle of the neck or back is usually due to arthritis, a broken bone, or a torn disc. This type of pain, called cervicalgia in the neck and lumbago in the back, is treated differently than the pain from a pinched nerve.

Neck pain (cervicalgia) and back pain (lumbago) are usually treated conservatively with medications, exercise, lifestyle changes, or occasionally a brace. Injections and surgery are rarely required for neck pain or back pain. Occasionally trigger point injections can control muscle spasm (which is common when the pain is severe) and facet blocks can calm pain due to an arthritic joint. Operations are usually only considered when there is a broken or unstable vertebral bone.

Arm or leg pain which radiates to the hand or foot, and which is caused by a pinched nerve, can also be treated conservatively. Steroid injections can be very helpful. See epidurals, and selective blocks. If the pain does not go away after 6 to 12 weeks, is disabling, or is associated with signs of permanent nerve damage, surgery may be required. The surgery is usually a simple minimally invasive procedure that takes about 45 minutes to an hour and can be done as an out patient. It can sometimes be done using a needle and without any skin incision.

When Arm or Leg Pain is an Emergency:

You should see a doctor immediately if you have the following: severe pain shooting down your arm or leg; if you have numbness or weakness; if you have had a recent injury; if the pain lasts more than three to six weeks; if your pain becomes worse at night or wakes you up from sleep; if the pain is accompanied by a fever; or, if you have bladder or bowel problems.

What If I Have a Herniated Disk?
If you have a herniated disk, you should see a spine specialist. The doctor will first diagnose the cause of the problem. Unless there is severe pain or weakness, conservative care will usually be recommended. Exercise and pain medications are used first. Chiropractic or acupuncture may be helpful. If these do not help, a steroid shot may be advised. Surgery is usually the last resort.

Other Causes of Arm or Leg Pain?
Not all arm and leg pain is caused by herniated discs. Other causes include: fibromyalgia (a generalized pain syndrome); facet syndrome (damage to the small joints in the back); referred pain from the chest or abdomen; an injury to the arm or leg itself; or one of hundreds of uncommon medical problems. See a doctor if you are unsure.

ACUPUNCTURE and PINCHED NERVE