What is discogenic pain?

Discogenic pain is the one that occurs as a consequence of disc degeneration. 

The intervertebral discs are a fundamental part of the structure of the human spine- There are cervical, dorsal, and lumbar discs. These spinal discs are highly hydrated structures that are located between the vertebrae and their main function is to serve as shock absorbers for all the forces and impacts that pass through the spine. To do this, they must maintain their physiological structure, which consists of a nucleus pulposus and a fibrous ring.

Degenerative disc disease, or discopathy, is the term used for the process by which the disc alters its physiological structure and becomes unable to perform its function normally. In general, this is an evolutionary process that usually begins with the loss of its liquid content (disc dehydration) and, subsequently, causes the disc to gradually lose height.  

The most serious stage of this process is one in which the disc has lost all its hydrated content due to an annular tear (a tear in the fibrous ring) and its height has collapsed to the point where there is contact between two contiguous vertebrae. 

The pain resulting from such disc degeneration is one of the most frequent sources of chronic low back pain or neck pain in the population. In most cases it has a benign cause and can be resolved with conservative pain management and physical therapy. 

Causes of discogenic pain

The primary cause of degenerative disc disease is aging. With age, the discs suffer from wear and tear. In the human species, this disc degeneration is more marked than in other mammals because we walk upright on two feet (unlike most mammals who usually walk on all four). When walking on two legs, the load forces that affect our spine are much greater.  

Additionally, there are risk factors such as high-impact sports, like basketball, or jobs that include carrying heavy objects, or other types of demanding physical activity, that can increase the pressure on the spine and promote disc wear. 

However, there are also life-style habits that can favor and accelerate this disc wear. Perhaps two of the most important are use of tobacco and being overweight. Furthermore, there are other risk factors including several diseases that have been shown to be related to the process of disc degeneration. Other, less frequent, but no less important, causes can be injury, fracture, or medical conditions such as neoplastic processes. 

Symptoms of discogenic pain

Discogenic pain is a pain of varying intensity located in the affected area (usually, the lower lumbar area). This pain, does not of itself, irradiate or extend to other areas, which differentiates it from lumbar disc herniation pain which usually takes the form of sciatica. 

In addition, discogenic pain tends to be increased by the following factors: 

  • A sitting position. 
  • Bending over forwards. 
  • Axial loading (force directed through the top of the head down through the spine) 

In general, disc degeneration is a condition that does not usually cause neurological disorders such as loss of sensation or strength. 

Diagnosing discogenic pain

Two things are key for diagnosing discogenic pain: First, an interview with the patient, and a physical examination carried out by one of the specialists on our team. 

After this, we will be able to proceed to the second step, consisting of imaging tests. There is a broad selection of imaging technologies available (x-rays, CT…) to use for diagnosing and gathering information on the disc degeneration. Perhaps the most useful today is magnetic resonance (MRI), but in many cases more imaging tests are required to finish studying each individual patient. 

Treatment of discogenic pain

There is an extensive variety of treatments available for discogenic pain, to address the different stages. The first stage treatment option is conservative treatment, which consists of exercises and physical therapy to strengthen the trunk and abdominal muscles, and specific changes in lifestyle, such as losing weight, giving up smoking, among others. 

Pharmacological treatment also has an important role in pain management. There are various analgesic medications (anti-inflammatories, corticosteroids, opiate derivatives ...) that are useful for reducing discogenic pain, including minimally invasive steroid injections. It is important that analgesic guidelines and patient monitoring be carried out by specialists in this type of pathology.  

Finally, there are several surgical alternatives for those individuals who, despite conservative treatment, continue to suffer discogenic pain. The classic technique consists of spinal fusion or arthrodesis of the level affected by the discopathy.  

This surgery can be carried out with different materials, techniques or approaches, depending on each specific case. An alternative to spinal fusion is arthroplasty surgery. This procedure consists of replacing the pathological disc with a prosthesis that mimics the structure and function of a healthy natural disc.  

Who are the doctors at Instituto Clavel who treat discogenic pain?

The pain can be treated by any specialist on the team.

Sources

  • Kallewaard JW et al. Discogenic low back pain. Pain Pract 2010 Nov-Dec;10(6):560-79.
  • Engers A et al. Individual patient education for low back pain. Cochrane Database Syst Rev. 2008 Han 23;(1):CD004057.
  • Kim KS et al. Disc degeneration in the rabbit: a biomechanical and radiological comparison between four disc injury models. Spine (Phila Pa 1976) 2005 Jan 1;30(1):33-7.
  • Simmons ED et al. Radiographic assessment for patients with low back pain. Spine (Phila Pa 1976) 1995 Aug 15;20(16):1839-41

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