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Discogenic Pain

Overview

Discogenic pain literally means pain from the intervertebral disc. The disc is the strong mobile structure that forms the major connection between each of your vertebrae. Pain originating from the discs is considered to be the most common cause of chronic low back pain. Studies performed by an Australian Specialist, Dr. Anthony Schwarzer, showed that around 40% of patients attending a spinal pain practice for chronic back pain were suffering from discogenic pain.

It is considered that discs become painful as a result of single or repetitive trauma. Specifically, lifting and twisting stresses can lead to disc injury. These stresses may cause the bony plate between the disc and the vertebra to creak. This then leads to a weakening of the disc. A radial tear may then occur in the outer part of the disc. It is then possible for the soft, internal part of the disc (the nucleus) to spread along the radial tear into the outer part of the disc. This material is highly irritating when it comes into contact with the small nerves in the outer part of the disc. Once a tear reaches the nerves in the outer part of the disc pain symptoms will commence. This is most likely to produce low back pain.

Symptoms

The classic symptom of discogenic pain is low back pain. The nature of the pain is usually deep and aching. It can spread to the legs and groin as well. However, pain in the back will be worse than the leg pain. When pain spreads from the disc into the leg, the pain is known as referred pain. The pain that may be felt down the leg is not sciatica, as is sometimes thought. In the case of discogenic pain, the sciatic nerve is not being pinched or aggravated. Rather, the pain is referred from inside the disc itself.

Severe discomfort in a sitting position is often the most incapacitating symptom of discogenic pain. Patients with pain originating from the disc also have problems standing and generally feel best when moving about. However, these aggravating features also occur with pain associated with other causes, so no assumptions can be made before proper diagnosis has been done.

Diagnosis

Examinations by your doctor may produce varied results. The strange thing about discogenic pain is that the spinal range of movement can be normal and straight leg raise tests normal, also. There may be tenderness but the essential feature is that there are no neurological type symptoms present.

Plain x-rays are unhelpful. Likewise, CT does not offer any further diagnostic value. They are both used to exclude other causes of back pain.

MRI is the best preliminary test. However, it is not possible to tell from MRI whether or not a disc is the source of back pain. The most common finding on MRI is degeneration, which occurs in all people eventually.

The most effective test for discogenic pain is a procedure called a discography. This is an invasive test that requires insertion of needles inside the lumbar discs.

Treatment

There is no proven treatment for discogenic pain. It is OK to exercise despite this pain. Treatment options, should the pain persist and be extreme, include surgery (discectomy with disc replacement or spinal fusion), with about a 40% mildly successful rate, intra-disc regenerative therapies such as PRP and stem cells, which are experimental and only more recently available, or pain control using a neuromodulation system.

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