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The doctor just called me with the results of my MRI. It turns out my low back pain is coming from a disc herniation at L45. I'm supposed to start physical therapy tomorrow. With all the pain I'm in, I'd rather just have surgery. Should I try to convince my doctor to send me to a surgeon? Should I just go get a second opinion myself?

The current standard for treating lumbar disc herniation is conservative care first for at least six weeks. Some doctors prefer a longer trial before sending patients for surgery.

Conservative care consists of staying active but avoiding those motions and activities that cause pain. A program of physical therapy will help you maintain your motion and strength during the healing process. You will be taught how to avoid developing bad posture or unhealthy movement patterns often caused by painful symptoms.

You will be shown how to use proper breathing and movement patterns to restore all movements in a painfree manner. The therapist will also help you explore factors that may be adding to your back problems. Changes can be made in your workstation, sleeping habits,and psychosocial stressors that may be making your pain worse.

If, after a reasonable amount of time and effort, you are no better (or even worse), then surgery becomes a possible option. Even before surgery, the doctor may want to do an epidural injection. This is an injection of a steroid (antiinflammatory) and lidocaine (numbing agent) around the spinal nerve root for pain control.

Surgery does have the possible benefit of quick pain relief. But not all patients have speedy results with surgery. And surgery comes with its own set of complications and possible problems. Studies do show that patients with the worst pain and disability seem to do better with surgery. But people with moderate to severe lumbar disc herniation do get good results with nonoperative care. It's always worth a try first before taking a more invasive approach.

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