Seeking emergency care for a herniated disc can be a highly frustrating experience. In virtually every case, emergency room visits turn out to be useless for most suspected bulging discs, as well as for any variety of back, neck or musculoskeletal pain complaint.
Patients send us stories every week detailing episodes of truly terrible pain that led them to seek care from a hospital emergency room. In virtually every instance, these same patients were shocked to discover just how inadequate emergency care for acute back and neck pain can be. Worse still, most were forced to pay exorbitant fees and wait unconscionable amounts of time just to be told that there is basically nothing that can be done for them.
The vast majority of patients seeking care in the ER are discharged and told to follow-up with their regular doctor, regardless of the severity of their pain, the structural issues that may or may not have been discovered (if the patient was fortunate enough to undergo emergency diagnostic imaging) and any other factors which led them to seek out these emergency interventions in the first place.
Virtually every patient who seeks dorsalgia care from a hospital emergency room is in terrible pain and has usually either suffered an acute injury or has perceived that they have suffered an acute injury to their back or neck. Many people experience instant radiating pain, tingling, numbness or weakness in a limb, in relation to their back or neck suffering, and know that this may indicate a possible disc trauma.
Patients may have suffered a car accident, a fall, a sporting injury or some other traumatic occurrence. Some instances have the patient simply experiencing pain for no apparent reason whatsoever. Any of these circumstances can be terrifying and can certainly drive anyone to consider their local hospital emergency room as the best place to go for care.
Herniated discs are perceived to be universally pathological and serious spinal abnormalities in popular opinion. This is why people who are in pain will consider going to a hospital to be their best option when faced with a potential disc problem. Unfortunately, the truth of intervertebral abnormalities is far from what their sinister reputation suggests, as most bulging discs are innocent and almost universal occurrences in the human spine. Therefore, many herniated discs exist without causing any pain whatsoever.
Regardless of this seldom-discussed clinical fact, people are frightened to death by the mere threat of a herniated disc in their back or neck. They seek diagnosis and treatment from their local hospital and often regret this decision within hours of first arriving at the facility.
Once at the hospital, most patients will have to wait for an undisclosed amount of time in the waiting room. If the emergency department is busy, this wait can range from an hour to many, many hours time, spent suffering with no comfort provided. If the patient arrived by ambulance, this step is usually avoided, as they will immediately be placed inside the evaluation area.
During triage, the patient will have their vital signs checked and will have the chance to provide the basic details of their condition to a nurse. This step is often integrated into the waiting room time or is undertaking immediately upon arrival if the patient is transported by ambulance.
When a patient is placed in a bed, they will once again have to wait. This time might be short or may be excruciatingly long, depending on many factors, including the busyness of the department, the number of doctors on staff and the specifics of the most acute patients in the unit. Finally, a doctor or physician assistant will arrive to evaluate the patient.
In virtually all cases, the patient will receive a superficial physical exam to check for dire neurological deficits and will be given some type of analgesic, anti-inflammatory, and/or antispasmodic medication. If the condition seems particularly serious, the patient might receive basic x-rays of the affected area of the spine or a CT scan of the same region. Emergency use of MRI is almost unheard of, but a few patients were lucky enough to receive this technologically advanced diagnostic evaluation when the extent of their injury supported its application.
Regardless of whether diagnostic imaging is performed or not, the result of the evaluation is almost universal. Barring some truly pathological condition being found in the spine, the patient will not be admitted. Instead, they will be told to go home, get some rest and contact their physician in the morning. They may be provided with a prescription of the same types of medications provided in the hospital and may also be provided with the name of a specialist, if this type of focused care is deemed needed by the attending doctor or PA.
In patients who receive diagnostic CT scan evaluation that visualizes the presence of a herniated disc, nothing special will be done to treat the patient, unless the disc is shown to be causing some truly catastrophic condition, such as acute cauda equina or spinal cord compression, in which case the patient will likely be admitted to the hospital. Most herniations will simply be mentioned to the patient and they will once again be told to follow-up with their doctor.
In the time after discharge and before seeing one’s own doctor, the anxiety suffered by patients with positive herniated discs can be tremendous. Most feel that they have suffered a grave injury and have been abandoned to their own devices by the emergency room staff. Factually, there is really nothing that the hospital can do for them, since herniations are not considered emergency situations in 99.9% of affected patients, regardless of the amount of pain demonstrated.
Statistically, patients with back or neck pain that is theorized to be caused by a herniated disc report some of the worst satisfaction ratings with emergency care. Most spend between 4 to 10 hours at the emergency facility and receive little more than ineffectual pain relief in the form of conservative drugs that could be purchased over the counter at their local pharmacy. Most will have to pay a large sum of money for the unfulfilling service, in the form of co-pays or the virtually criminal practice of balance billing that is so commonly used in hospital emergency rooms.
Worse, most patients are not provided with the simple facts that virtually all herniated discs are nothing to worry about and that the disc abnormality might not even be related to the current pain problem. Just this simple information would save so many patients from the terrible worry they suffer, as well as the victimization by doctors who take advantage of the opportunity to get these folks into profitable long-term or surgical care.
Remember, medical fact demonstrates that most herniations require no care at all and the most common treatments demonstrate “no advantages when compared to no treatment”. This recommendation includes the wide range of surgical interventions that are performed to “treat” herniated discs each and every day. No wonder patients are dissatisfied with their ER experiences!
In a few cases, it is wise to seek emergency care for suspected disc injury. Some patients, such as those who are victimized by massive trauma, might have spinal or other injuries that truly require emergency care. However, the average person who injures their back falling, participating in sports or working, will almost invariably be let down by their experiences seeking emergency room care for a potentially bulging disc.
In the end, the hospital will do nothing of note for them and may even be the entity that refers them to a doctor who might take advantage of them from this point onwards, making them undergo unnecessary treatment for a condition that might resolve on its own, might not even be the source of the pain and may have existed far before their present “acute injury” even occurred.
Meanwhile, some patients have instead reported staying calm after injuring their back or neck and just resting comfortably at home until they were able to contact their regular doctor. The results of this decision to forego the ER are generally better, cheaper and more fulfilling. In some cases, these patients even enjoy a better chance of not suffering the nocebo effect of emergency or unneeded care, particularly when they have good, honest relationships with their primary caregivers.