What is Discogenic Back Pain?

What is Discogenic Back Pain and what are my treatment options?

Discogenic back pain is a condition in which the normal aging processes of one or more discs produce chronic back  pain.  When this occurs in the lumbar spine patients frequently note pain that radiates from their back into the buttock or upper thigh.  Symptoms are frequently aggravated by sitting, and episodes of intense exacerbation lasting several weeks are common.  Diagnostic imaging frequently results in the diagnosis of a ” Bulging Disc”.  This diagnosis is made based on MRI imaging that demonstrates bulging of the ligament that contains the disc as a result of loss of the normal water content in the aging disc.  Unfortunately this inaccurate diagnosis can lead to ineffective and unnecessary treatments, as this condition may be confused with a herniated disc.  Treatments for sciatica due to a herniated disc, such as epidural steroid injections and microdiscectomy procedures, are ineffective and potentially harmful when applied to individuals with discogenic back pain.  The mainstay of treatment for discogenic back pain is exercise and flexibility based therapy.  This includes trunk isometrics, neutral spine stretching of the hips and hamstrings, as well as low-impact aerobic conditioning.  Acute episodes of discogenic back pain may require the use of analgesics and antiinflammatories to manage discomfort and facilitate activity.  This may include transient use of medications such as Vicodin or other narcotics depending on the severity of symptoms.  Narcotic analgesics are not recommended for long term management of this condition.  Occasionally short courses of oral corticosteroids (Medrol Dosepack) are prescribed when symptoms are refractory to the use of standard pain medications or significant symptoms of nerve irritation (Sciatica) are present.

For most patients with discogenic back pain the treatments outlined previously will manage symptoms effectively allowing satisfactory quality of life.  The natural history of discogenic back pain is generally favorable with most affected individuals experiencing gradual resolution of symptoms over several months.  Although symptom resolution may occasionally occur over a several year period, it is relatively uncommon for this type of back pain to develop into a chronic functionally limiting condition.

Chronic functionally disabling back pain due to disc dysfunction is a relatively rare but problematic condition.  Patients experiencing this condition frequently receive inaccurate diagnosis and inappropriate treatments.  It is common for those affected to seek alternative therapies and ineffective minimally invasive procedures due to the failure of standard medical treatment to provide symptom relief and reasonable quality of life.  Reliance on chronic narcotic usage is a frequent result of ineffective management.  For patients with chronic, functionally limiting back pain due to disc degeneration who have failed appropriate medical management of their symptoms for at least 6 months surgical treatment MAY be an appropriate option.  Surgical treatment is specific to the diagnosis and generally invokes removal and fusion of the affected disc.  Prior to surgical consideration the diagnosis must be confirmed by a procedure called discography.  In this procedure a needle is placed in the disc(s) suspected of being the source of pain based on MRI findings.  Fluid is injected into the disc center under low pressure.  If the injection reproduces the patients pain pattern this is considered to be confirmatory of a discogenic source of pain.  For those in whom discography fails to reproduce their pain pattern surgical treatment is not an option.