Back pain is one of the most common causes of pain and disability. There are many causes of back pain, and determining the source of the pain can help guide treatment of this common problem. Common causes of back pain include back muscle strain, herniated discs, spinal stenosis, and other conditions.
Sometimes the cause of back pain is thought to be de to degeneration, or wearing out, of the lumber intervertebral discs. This condition is called discogenic back pain, or lumbar disc pain.
What causes discogenic back pain?
Exactly what causes lumbar disc pain is not well understood. There are differences that can be seen between a normal lumbar disc and a degenerative lumber disc. The problem is, lumbar disc degeneration is part of the normal aging process. The vast majority of degenerative discs cause no symptoms at all. Exactly why some people have significant pain is not well understood.
Furthermore, disc pain often gets better with time. Even though it is considered a "degenerative" or aging process, patients with discogenic back pain often improve over time. Many patients worry that the onset of discogenic pain is simply the beginning of endless back pain. That is usually not the case! Most patients with discogenic back pain will improve with time and some simple treatments.
How is lumbar disc pain diagnosed?
Diagnosis of discogenic back pain can be difficult. There are characteristic findings on physical examination, but these same findings are seen in patients with other types of back pain as well. Imaging studies can also be performed, such as MRI. However, because disc degeneration is part of normal aging, MRIs show abnormalities in patients with no symptoms as well. Therefore, it is difficult to ensure that disc pain is truly causing the symptoms, even if the disc appears abnormal on MRI.
The primary test used to diagnose discogenic back pain is called a discogram. A discogram is done by placing a needle into the affected disc, and injecting a small amount of contrast dye into the disc. The discogram offers information both on the structure of the disc and on the source of the pain. If the pain caused by the injection procedure is the same as the disc pain experienced by the patient, then it is considered a positive, or concordant, discogram.
What treatments are available for discogenic back pain?
Discogenic back pain is a difficult treatment problem. Fortunately, most patients have their back pain problems solved with some basic treatments. These include the following:
- Anti-Inflammatory Medications
Anti-inflammatory medications, or NSAIDs, are helpful in treatment of both back pain and the associated inflammation. There are both over-the-counter and prescription NSAIDs, and both work well in the treatment of back pain. Side-effects of NSAIDs include problems of GI bleeding, and these medications should be avoided in patients with stomach ulcers.
- Exercises and Therapy
Strengthening of back muscles is probably the most important step in treatment of most causes of back pain. By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine.
Another potential treatment is IDET, or Intradiscal Electrothermal Therapy. This is a new treatment option that began in the late 1990s. The effectiveness of IDET is debated; for more information, read on about IDET in the treatment of discogenic back pain...