Discogenic Pain

Discogenic pain is severe lumbar pain that originates from the lumbar disc. It can be degenerative ("degenerative disc disease") cause by excessive stress in the disc (trauma, besity) or just be part of the "normal" aging process. A tear in the annulus (the tough outer ring of the disc) can also be a cause of the pain. This type of pain is different from the pain that results from a herniated disc pinching a spinal nerve. This latter mechanism causes sciatica (also known as radiculopathy). The disc pain is characteristically located in the paraspinal or axial areas of the vertebral column, most frequently the lumbar spine. This is because the lumbar spine bears most of the weight.

However, both types of pain can occur at the same time (disc pain and sciatica). This is because an annular tear of the disc (that causes discogenic pain) can lead to leakage of the nucleus material of the disc which, in turn, results in chemical irritation of the nerve fibers in the affected disc. In this circumstance, the inflammatory irritates the nerve root, a process that causes severe pain along the leg (sciatica or radiculopathy). There is increased sensitivity in movement such as bending, twisting and flexion.

The best test to diagnosed discogenic pain (pain originating in the disc itself; not on the spinal nerve) is a provocative discography and discogram. This test aims at reproducing the patient's usual pain by stimulating the damaged disc. In addition, it also gives a detailed view of the structure of the disc in order to accurately locate the tear and reveal the source of the pain.

Diagnosis can be complemented by the physical examination based on presentation of symptoms and by MRI and/or needle EMG.

The treatments for Discogenic pain are both surgical and non-surgical, depending on the severity of the condition. Non-operative care includes rest for acute and mild low back pain. Anti-inflamatory such as NSAID medications and others are used to reduce swelling and pain while physical therapy is used to improve muscle strength in the back and reduce pressure on the spine. Non operative treatments performed at our clinics include regenerative medicine protocols such as platelet rich plasma injections into the painful disc with and without the addition of bone marrow concentrate tissue. Current research suggest that these treatments may induce repair of damaged discs and reduce chronic pain. These treatments can be done as outpatient procedures in our clinics and may avoid the need for more invasive therapies such as a surgical fusion in some cases. Surgical intervention is referred to as fusion of the disc. There are several techniques. WHen the disc also pinches a spinal nerve, It involves removal of the disrupted disc and replacement with bone graft, a cage-filled bone graft or a bone graft substitute. Fusion can be anterior, posterior or combined. Another surgical option is arthroplasty, where a total disc replacement of the articulating disc is done.

More recently, encouraging results are being achived with intradiscal radiofrequency, also known as Intradiscal Electrothermic Therapy is a new procedure which is minimally invasive and consists of "stunning" the pain nerves that carry pain signals from the disc with special radiofrequency probes.