Lumbar Discogenic Back Pain: What you need to know
What is Discogenic Back Pain?
Discogenic pain is one of the most common causes of lower back pain. Intervertebral discs act as shock absorbers between the two spinal vertebrae. As people age, the intervertebral discs undergo wear and tear like the cartilages of joints. It is a natural process whose exact cause is unknown. As a result, the physical and chemical properties of discs change over time, decreasing spine stability and flexibility. The prominent symptom of these changes is lower back pain. However, not everyone with intervertebral disc degeneration has lower back pain—a phenomenon yet to be explained.
What happens in Lumbar Discogenic Pain?
The intervertebral discs have three parts: the inner nucleus pulposus, the outer annulus fibrosus, and there are end plates above and below. The inner part (nucleus pulposus) has no nerve supply. But the nerve supply of the outer third of the annulus fibrosus makes it susceptible to pain upon any damage to it. Due to the process of degeneration, cracks appear in the outer part. The gelatinous material of the nucleus pulposus enters these cracks and irritates the nerve supply. The degenerating disc also releases many pain-causing substances in addition to growth factors that result in nerve growth into the disc. All these factors lead to the inflammation of the nerves and cause pain in the lower back.
What are the causes of Discogenic Back Pain?
Many factors increase the risk of getting this condition, such as:
- Sitting positions and vibratory forces
- Bending for excessive periods
- Physical activities that increase stress on the discs
- Being a male
- Tobacco smoking
- Genetics and family history
What are the symptoms of Lumbar Discogenic Pain?
As the name suggests, the pain is felt in the lower back (lumbar area). Everybody experiences back pain differently. The general characteristics of lumbar discogenic pain include:
- Acute or chronic low back pain
- Pain increases with activities that increase pressure on the discs, such as sitting, bending, twisting, lifting, coughing, and sneezing.
- Patient suffers from pain goes away by changing position or walking.
- Pain does not radiate into the buttocks or leg (although it may radiate in chronic cases)
Other symptoms include tenderness, back weakness, muscle spasms, and the feeling of back instability. Some people also experience numbness and tingling sensation.
How to make a diagnosis of Lumbar Discogenic Pain?
Your doctor will make the diagnosis of lumbar discogenic back pain based on a combination of the following:
- Signs and symptoms of lower back pain, weakness, numbness, etc
- Medical history of your activities such as excessive driving, lifting heavy objects, bending for excessive periods, tobacco smoking, etc.
- Physical examination to check for tenderness, numbness, and the range of back motion. The doctor will observe your gait and ask you to bend or twist your back to check for the range of back motion.
- X-rays don’t help diagnose lumbar discogenic back pain but help rule out other spine-related conditions.
- MRIs and CT discography can make a diagnosis. These tests can clearly show the degeneration of intervertebral discs and damage to other soft tissues.
What is the prognosis of Lumbar Discogenic Pain?
The prognosis of lumbar discogenic back pain is good with conservative treatments. Physical therapy, exercise, pain medications, and modifying activities relieve symptoms successfully. If pain and other symptoms remain for a longer duration (more than six months), surgery may be necessary.
What are the treatments of Lumbar Discogenic Pain?
There is no permanent cure for degenerating intervertebral discs. The goal of treatment is to manage symptoms and slow disease progression. Your doctor may recommend the following for this purpose:
- Over-the-counter anti-inflammatory and pain medications such as ibuprofen to relieve pain initially.
- Prescription pain medications such as muscle relaxants and opioids to relieve acute intense pain. Due to their addictiveness, these are used cautiously.
- Rest and reducing or modifying activities that aggravate the pain
- Applying heat and ice alternatively to the back every two or three hours when awake to relieve pain
- Massage therapy and manual manipulation of the back to reduce tension in the back muscles and joints for pain relief
- Physical therapy consisting of stretching exercises, strengthening exercises, and low-impact aerobic exercises is recommended. These are to relieve pressure on the back and build a healthy posture of the back. A physical therapist may help devise an individualized exercise plan.
- Epidural steroid injection to relieve pain if all other treatment options fail.
- Ozone nucleolysis is another interventional procedure that gives long term results.
- Biacuplasty is another advanced interventional procedure which have good evidences.
- Surgery is the last resort to relieve lower back pain. The standard surgery for relieving pain is lumbar spinal fusion, in which two spinal vertebrae are grafted together. The doctor may also recommend removing part of the disc or replacing the disc with an artificial one. But surgery has long list of side effects and is the last option.