Desai mj, kapural l, petersohn jd, vallejo r, menzies r, creamer m, et al. Chronic lower back pain is also caused by bulge disk, disk herniation, and facet joint disease. Treatment of 94 outpatients with chronic discogenic low back. Original article efficacy of coblation annuloplasty. Discogenic pain and discography for spinal injections.
Patients with chronic back pain can present with a multitude of pain generators. Discogenic pain is a condition of the spine and is one of the most prevalent causes of chronic and acute back pain. It has a circular shape with two parts, outer layers of. The pain is exacerbated by activity, but may be present in certain positions, such as sitting. The term discogenic pain means one or more intervertebral discs are the pain source. Although the theory of this condition might make sense to some doctors, others find the diagnostic criteria to be less than exacting and a great number of physicians believe. Evidence for epidural injection, one of the most frequent interventions for chronic low back pain, has been highly variable. Discogenic low back pain is often localized medially in the back, and more detailed referral patterns were reported by ohnmeiss et al. Traction also can affect metabolism of disc, facilitate the transfer of oxygen and nutrient into the disc, relieving irritation and compression. It may include controlling pain with antiinflammatories, using ice andor heat and physical therapy. Although these examinations give an indication, they have not been validated and additional examination is needed to determine discogenic low back pain, such as mri and ct. Nonspecific low back pain, sometimes called mechanical low back pain, is diagnosed when no specific etiology of pain can be identified.
Discogenic pain definition of discogenic pain by medical. Diagnostic criteria and treatment of discogenic pain. Research suggests that 4 out of 5 adults are likely to develop low back pain at some point 1. Original article management of discogenic low back pain. Randomized controlled trials rcts with larger patient populations are required to validate these results. Discogenic low back pain back pain, neck pain, lower. Opponents of the discogenic pain have argued that there are no pain receptors within the intervertebral disc, therefore, discogenic pain cannot oc cur.
When discogenic pain occurs in the neck causing neck pain, the arms and hands can suffer from numbness, shooting pain, tingling, and weakness radicular pain. The pain is reproduced by a pressure of less than 50 psi above the opening pressure. Other tests may include plain radiographs, computed tomography scanning, or provocative discography. Physical therapy may consist of back exercises, traction and other treatments. The intervertebral disc ivd is the principal joint between two vertebrae in the vertebral column. Pathophysiology, diagnosis, and treatment of discogenic low back. Discogenic lower back pain dlbp is the most common type of chronic lower back pain lbp, accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain. Some studies report up to 85% having no detectable cause on xray or mri 3. Oct, 2009 discogenic lower back pain dlbp is the most common type of chronic lower back pain lbp, accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain. It is reported that annular disruption was the main and common pathological reason for chronic low back pain 4.
Chronic pain conditions can be very difficult to address clinically because treatment of the spinal condition may not resolve the central. Why lumbar disc degeneration leads to pain is one of the. Discogenic low back pain is a serious medical and social problem, and accounts for 26%42% of the patients with chronic low back pain. Enrollment criteria did not restrict the mri to be within any speci. While muscle strains and other issues can sometimes be the cause of the pain, in other cases, the pain can be traced back to a herniated disc. This study aimed to evaluate the efficacy of coblation annuloplasty combined with nucleoplasty in treating cervical discogenic pain with concurrent radicular pain. On the contrary, disc pain from an annular tear tends to cause low back pain that does not radiate to the buttock or leg. Conservative care is usually the first type of treatment thats tried. Traction also can affect metabolism of disc, facilitate the transfer of oxygen and nutrient into the disc, relieving irritation and compression on pain sensitive structures enhancing healing and repair.
Discogenic low back pain is the most common type of chronic low back pain. Discogenic low back pain symptoms, diagnosis and treatment. It may also feel like the pain is coming from your buttock areas and even down into the upper thighs. Aug 19, 2016 evidence was best for herniated discs with radicular pain. This was a prospective, clinical, observational study of 20 patients with cervical discogenic and radicular pain. Discogenic pain usually causes pain felt in the lower back. Discogenic pain is pain arising from stimulation of pain sensitive afferents within the annulus fibrosus and is a separate condition from disc herniation with associated radiculopathy. Diagnosis, management, and treatment of discogenic pain a volume in the new interventional and neuromodulatory techniques for pain management series presents stateoftheart guidance on the full range of discogenic pain relief techniques performed to. T1 diagnostic criteria and treatment of discogenic pain. Discogenic lower back pain dlbp is the most common type of chronic lower back pain lbp, accounting for 39% of cases. Apr 18, 20 idd causing discogenic low back pain accounts for 26%42% of chronic low back pain patients4,6,7. Treating discogenic lower back pain is like treating many other musculoskeletal ailments. Pathophysiology, diagnosis, and treatment of discogenic.
The topic of todays discussion is discogenic low back pain. Management of discogenic low back pain with intradiscal. University of groningen discogenic low back pain coppes. However, for those with persistent discogenic pain despite a conservative approach, epidural steroid injection may be warranted to provide pain relief to allow for more active participation in conservative treatment. Discogenic definition of discogenic by medical dictionary. Magnetic resonance imaging is the imaging study of choice for degenerative disc disease due to its unique detail on the representation of the disc status. Another possible test is a lumbar overpressure test. Progressing through phases of a conditioning program is based on the safe and effective execution of. The prevalence of discogenic low back pain is 39% in those with low back pain persisting for at least 6 months and who have an unremarkable diagnostic workup and 26% of patients without radicular pain after facet joint pain was eliminated by either performing a diagnostic median branch nerve block or an intraarticular facet joint injection. Lower back discogenic pain or lumbar discogenic pain ldp is the cause of low back pain in 39% of the patients.
The most common charac teristic of discogenic low back pain was low back pain with or without referred pain, and usually lack of objective neurological signs 2, 3. The intensity of this pain has a nrs score of at least 7 on an 11point numerical scale. Most back pain is mechanical in nature and maybe caused by bad posture, bendingtwisting, pulling or lifting injury. A statistically significant difference was found among the three periods, with f2,32 78. Discogenic low back pain accounts for 26%42% of persistent low back pain problems 4. Research article diagnosing discogenic low back pain associated with degenerative disc disease using a medical interview juichi tonosu1, hirohiko inanami2,3, hiroyuki oka4,5, junji katsuhira6, yuichi takano2,3, hisashi koga2,3, yohei yuzawa2,3, ryutaro shiboi3, yasushi oshima5, satoshi baba3, sakae tanaka5, ko matsudaira4,5 1 department of orthopedic surgery, kanto rosai hospital, kanagawa. Discogenic pain most commonly affects the lower back, buttocks, and hips and is thought to be related to injury and subsequent repair of the anulus. The concept of primary discogenic pain, particular in the lumbar spine, is well accepted in. A complex, multifactorial, clinical condition characterized by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologicallyconfirmed degenerative disk disease. Discogenic pain overview and treatment verywell health. Idd had been assigned as a separate clinical entity to differentiate it from other types of disc degenerative low back pain, such as. Diagnosis, management, and treatment of discogenic pain.
Efficacy of prone lumbar traction on chronic discogenic. The use of digital roentgen stereophotogrammetric analysis drsa with. Discogenic facetogenic of sij origin pain that includes the midline is not necessarily discogenic, but dominant or isolated midline pain is almost certainly discogenic centralisation and directional preference discogenic pain in most cases radicular pain is neurogenic, but caused by disc. You may experience only a few days of pain, or you may suffer prolonged periods of moderate to severe and recurring pain. Once a fully degenerated disc no longer has any inflammatory proteins that can cause pain, the disc enters into a stable position. A prospective, randomized, multicenter, openlabel clinical trial comparing intradiscal biacuplasty to conventional medical management for discogenic lumbar back pain. Pain related to a disc herniation rarely causes low back pain, and most often causes buttock and leg pain. Discogenic pain can cause back pain, neck pain and sciatica. Discogenic medical definition merriamwebster medical. Flexion or extension directional preference flexion directional preference definition. The pain is exacerbated by activity, but may be present in. Discogenic low back pain southend university hospital.
A complex, multifactorial, clinical condition characterised by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologicallyconfirmed degenerative disc disease. A concise discussion of the mechanism, diagnosis, and treatment of lumbar disc pain table of contents. Discogenic pain treatment page 1 of 16 unitedhealthcare commercial medical policy effective 02012019 proprietary information of unitedhealthcare. Discogenic pain is a form of low back pain, caused by chemically or. Idd had been assigned as a separate clinical entity to differentiate it from other types of disc degenerative low back pain, such as lumbar disc herniation, degenerative disc disease ddd and lumbar segment instability 8. The annular tear in combination with other spine conditions by michael n.
In our a previous study, according to discography, we classified discogenic low back pain into two types. Discogenic pain often subsides on its own, or it may come and go. Diagnosing discogenic low back pain associated with. Discogenic pain back pain, neck pain, lower back pain.
In a population of chronic lbp patients 39% had an internal disc disruption, with concordant pain provocation in discography indicating the discogenic origin of their pain schwarzer et al. Discogenic pain is pain that actually comes from the injured disc itself. Discogenic pain is pain originating from a damaged vertebral disc, particularly due to degenerative disc disease. The experience of feeling pain in an area away from the real spot causing the pain is common in many areas of the body, not just the spine. Discogenic pain is another very controversial diagnosis in the back pain treatment arena, involving discomfort which is suspected to emanate from the disc structure itself. Pdf an estimated 40% of chronic lumbosacral spinal pain is attributed to the discus intervertebralis. Discogenic low back pain, annular disruption, discography, intradiscal electrothermal therapy, microen doscopic discectomy.
Stimulation of target discus reproduces con cordant pain. The concept of discogenic pain has emerged as a chronic low back pain induced by a degenerative disc disease by itself. Of all the patients who are dealing with low back pain, it appears that in approximately 28 to 40% of these cases, pain is caused by a discogenic affliction. Lower back discogenic pain or lumbar discogenic pain. Perispinal tnfalpha inhibition for discogenic pain 172 a repeated measures analysis of variance was conducted to determine whether the mean oswestry values differed over the three time periods. The causes for most back pain problems are unclear. It is likely most people will experience low back pain at some point in their lives. Between 80 and 90 percent of adults will experience it at some point in their lives.
The pain is exacerbated by activity, but may be present in certain positions. Discogenic pain treatment page 3 of 15 unitedhealthcare oxford clinical policy effective 09012017 19962017, oxford health plans, llc and therapeutic injections, and other interventional and surgical treatments, have been proposed for the treatment. Lower back pain is one of the most common physical complaints. Treatment for discogenic lower back pain spinehealth. Efficacy of prone lumbar traction on chronic discogenic low. Discogenic pain is one of the most common cause of lower back pain. The pain is exacerbated by activity, but may be present. Oneyear outcomes of surgical versus nonsurgical treatments. Jul 30, 2014 a concise discussion of the mechanism, diagnosis, and treatment of lumbar disc pain table of contents. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the. Idd causing discogenic low back pain accounts for 26%42% of chronic low back pain patients4,6,7. Any of these activities can put a strain on the various.
Similarly, when the compression occurs in the lower back, the legs are affected by the same types of sciatica symptoms. Low back pain is a common condition, can be caused by lumbar sprain, spinal stenosis, disc herniation, and different degenerative spinal disorders. Pathophysiology, diagnosis, and treatment of discogenic low. The objective of the study was to test the safety of idet compared with sham treatment for lbp of at least 3 months. Learn more about herniated discdiscogenic pain lower back pain is one of the most common physical complaints. This article explains what this type of pain is, as well as the more common cause of pain with spinal disc conditions. Discogenic pain definition back pain and neck pain. Basi pilates as movement therapy for lumbosacral discogenic. Stimulation of the two adjacent discs is not painful. Discogenic pain entails adjusting expectations as practitioners and allowing for a radically slower progression, likely maintaining a more fundamental approach for a much longer period of time. The nerve pain can range from intermittent, shooting pains to a. Jan 30, 2019 lower back discogenic pain or lumbar discogenic pain ldp is the cause of low back pain in 39% of the patients. Most discogenic pain occurs in the lumbar spine lower back. The diagnosis of discogenic back pain was established by the surgeon.
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