The center of the disc, the nucleus, is filled with a jelly-like substance that has very high acidity. The acid in the nucleus is separated from the lumbar nerves by a ring, or anulus, of very strong collagen fibers. The inside of the disc does not have any nerves or blood vessels, just the nucleus and its acidic content and the surrounding collagen fibers. This is important, because the lack of nerves on the inside of the disc means normal discs do not hurt.
With the daily wear and tear, combined sometimes with injury, the fibers in the ring surrounding the nucleus can start unraveling and tearing. These so called anular tears can reach the outside of the disc, where the lumbar nerves travel down in a protective sac.
The formation of anular tears is the basis of low back pain originating in the lumbar disc. The body recognizes these tears as an injury. And, just like, say, a cut in the skin, the body tries to heal these tears. Blood vessels and nerves start growing inside these tears, so now the inside of the disc has nerves, and therefore it can hurt. Pressure on the disc will stimulate these new nerves and this creates low back pain.
Discogenic low back pain is diagnosed with a procedure called provocative lumbar discogram, or provocative lumbar discography. This is a controversial procedure, because it is very often poorly performed, and because it relies on the patient’s subjective report of pain during the procedure. However, provocative discography is a very valuable procedure if done correctly by an experienced practitioner, and it has been validated repeatedly by the spine literature. I am able most of the time to map my patients’ pain issues by using provocative discography. In my experience, this knowledge is useful to the patient by providing a logical explanation to why they have low back pain, which is reassuring. This knowledge is also useful in choosing the appropriate treatment.
Speaking of treatment, discogenic pain is not easy to treat. Depending on the degree of wear and tear of the painful disc, and depending on how many discs actually hurt, the treatments vary considerably.
Weight loss and core strengthening form the basis of discogenic pain treatment.
Briefly, there are non-surgical and surgical treatments for discogenic pain. In the non-surgical category, some experimental treatments attempt disc regeneration and repair using stem cells, platelet-rich plasma, and other agents. Some other non-surgical treatments attempt pain relief by using heat and other forms of energy to reduce the volume of the disc and destroy the painful nerves that have grown in the anular tears we spoke about.
Please call us or check our website for more information. This is a very important problem and correct diagnosis and treatment can potentially save time, money, lost workdays, unnecessary spinal injections and even psychological problems.
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