Discogenic pain is pain in the back or neck, which is related to one or more intervertebral discs. About 40 percent of back pain is related to the discs. It is thought that disc degeneration is a chemical and physical process that dries out and deteriorates the discs that are supposed to cushion the spaces between the vertebrae. Degenerating discs, however, do not necessarily cause pain.
What causes Discogenic Pain?
When the disc becomes degenerative, the tiny nerves around the annulus become irritated. Inflammation is a part of this irritation. Often the annulus becomes torn, releasing chemicals that trigger the nerves around the annulus. This connection is what ultimately causes the discogenic pain. This is also referred to as internal disc disruption.
Some of discogenic pain appears to be hereditary. Heredity changes the chemistry of the discs so some dry out more easily than others. These dehydrated discs crush more easily and don’t hold the load of the spine. When the edge of the vertebrae is damaged, the vertebral discs are also damaged. Inflammatory chemicals are released, causing pain.
It may be true that mechanical factors and nutritional deficiencies play a role in who gets discogenic pain and who doesn’t.
Symptoms of Discogenic Pain
Patients with discogenic pain feel achiness in the low back that doesn’t refer to the leg or arm. The pain is worse with bending, sitting and sneezing. It gets better with lying down. There may be pain when turning or tilting the head when the disc disease is in the neck. Some people get muscle spasms on either side of the spine in the lower back or cervical spine.
Diagnosis of Discogenic Pain
Discogenic pain can be inferred with an abnormal MRI exam although the best test is the discogram. The discogram is pressurized with saline and the assessment of pain is made. If the disc is damaged, pressurizing it will cause the pain. It does carry the risks of false-positive results.
Treatment of Discogenic Pain
Much of the time, discogenic pain resolves on its own. Patients can take anti-inflammatory medication and ice to control both the pain and inflammation. Physical therapy can make a difference in the pain and injections of corticosteroids seem to work. Fortunately, surgery is rarely necessary but it is an option if other treatment methods fail.
There is a procedure called IDET or “Intradiscal Electrothermal Therapy”. It is minimally invasive and cauterizes the annulus fibers so that the tear heals. Nerve endings around the annulus die off and pain is minimized. The prognosis is very good. A spinal fusion is also common and it appears to heal discogenic pain. It is controversial in that the surgery is not always helpful.