Another possible test is a lumbar overpressure test. Pdf clinical significance of highintensity zone for. The aim of this study was to investigate the effect of lowlevel laser therapy lllt on low back pain documented by history, clinical examination, mri findings of the lumbar spine and patients pain scores. Pathophysiology, diagnosis, and treatment of discogenic low. Lowlevel laser therapy lllt for discogenic back pain. Definition of discogenic low back pain according to the international association for the study of pain iasp, the definition of lumbar discogenic pain is lumbar spinal pain, with or without referred pain to the lower limb girdle or lower limb, stemming from a lumbar intervertebral disc. Low back pain is an extremely common cause of pain and disability. 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.
Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors. Discogenic low back pain symptoms, diagnosis and treatment. Chronic lower back pain is also caused by bulge disk, disk herniation, and facet joint disease. Lower back discogenic pain or lumbar discogenic pain. Various types of interventions aredescribed for this pathology. 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. A growing number of patients suffer from severe low back pain of discogenic origin that is not responsive to. The pain from a spinal tumour is a constant, dull ache, associated with loss of appetite and weight loss, and is not necessarily related to activities but is present at rest as well. Discogenic low back pain differentials bmj best practice. Pain which is described as being discogenic means that the source of the discomfort resides within the disc itself.
Original article management of discogenic low back pain. Similarly, when the compression occurs in the lower back, the legs are affected by the same types of sciatica symptoms. Pdf on feb 1, 2017, selaiman noori and others published lumbar discogenic back pain find, read and cite all the research you need on. In the low back, pain usually worsens when your spine is compressed. Leg pain caused by pinching of the nerves in the low back called radiculopathy may also accompany low back discogenic pain. Pathophysiology, diagnosis, and treatment of discogenic. Treatment of 94 outpatients with chronic discogenic low back. Why lumbar disc degeneration leads to pain is one of the. Original research articles intradiscal plateletrich plasma. Pdf an estimated 40% of chronic lumbosacral spinal pain is attributed to the discus intervertebralis. Treatment of 94 outpatients with chronic discogenic low. Discogenic pain is a form of low back pain, caused by chemically or mechanically damaged intervertebral discs.
Discogenic pain can usually be successfully treated with nonsurgical treatments, such as pain medication and physical therapy and exercise, but chronic discogenic pain that is severe and limits the individuals. Lumbar fusion may be considered for treatment of low back pain of discogenic origin in patients who fail to improve after a minimum of 6. It is challenging to successfully select surgical candidates who will benefit from lumbar fusion procedures for discogenic back pain. 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. Research suggests that 4 out of 5 adults are likely to develop low back pain at some point 1. The pain is exacerbated by activity, but may be present in certain positions, such as sitting. A significant place in its genesis is occupied by a degenerativedystrophic diseases of intervertebral discs. Discs invariably degenerate as we age, such that most people have mri evidence of disc degeneration by their 4th decade of life, and by their mid60s, over 90% of people have. Degenerative disc disease begins as early as the second decade of life, and the risk factors include obesity, smoking, and activities involving repetitive lumbar spine flexion and rotation, and or history of trauma 8,9. Pathophysiology, diagnosis, and treatment of discogenic low back. Annular tears within the outer annulus stimulate the ingrowth.
Mar 04, 2019 discogenic back pain is multifactorial. Original article management of discogenic low back pain with. Idd causing discogenic low back pain accounts for 26%42% of chronic low back pain patients4,6,7. Discogenic definition of discogenic by medical dictionary. Studies have revealed that pathologic features of painful discs were the formation of the zones of vascularized granulation tissue, with extensive innervation in annular fissures. 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.
Treatment of 94 outpatients with chronic discogenic low back pain. The article highlights the classification and mechanism of discogenic pain origin. Discogenic pain definition back pain and neck pain medical. Lumbar fusion may be considered for treatment of low back pain of discogenic origin in patients who fail to improve after a minimum of 6 months of appropriate nonsurgical care. Discogenic pain definition back pain and neck pain. Discogenic pain is one of the most common cause of lower back pain. In patients dealing with discogenic low back pain, there were findings of high levels of proinflammatory mediators cytokines. In simple terms, discogenic back pain involves pain associated with disc degeneration of the spine.
Discogenic pain can usually be successfully treated with nonsurgical treatments, such as pain medication and physical therapy and exercise, but chronic discogenic pain that is severe and limits the individuals ability to function may need to be treated with surgery. Consequently, this patient group is confronted with the option of living with persistent back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation. Index eq5d, and back pain related medication usage. Discogenic low back pain accounts for 26%42% of persistent low back pain problems 4. It is reported that annular disruption was the main and common pathological reason for chronic low back pain 4. 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 herniation usually the single most potent clinical assessment tool for. Discogenic low back pain is a common cause of disability, but its pathogenesis is poorly understood. Pdf diagnosis and treatment of discogenic low back pain.
Discogenic low back pain, annular disruption, discography, intradiscal electrothermal therapy, microen doscopic discectomy. Why lumbar disc degeneration leads to pain is one of the most important topics in medical field. He states the pain started while he was at work and he now has a difficult time working a full day. Treatment of discogenic back pain with autologous bone marrow.
A comprehensive literature search was conducted on pubmed, ovid medline, ovid embase, ebsco, and web of science from database inception through on september 10th, 2015. However, this is not the major cause of pain in most cases. Discogenic pain can cause back pain, neck pain and sciatica. The pain is exacerbated by activity, but may be present. Although several structures within the spine have been identified as pain generato rs, the intervertebral disc is felt to account for 40% to 50% of chronic low back pain 1,2. Hence, discogenic pain rarely occurs after 60 years of age. This damage can find its origin in traumatic events, as well as in deterioration due to ageing. The pain is exacerbated by activity, but may be present in. Intradiscal biacuplasty effectively treats discogenic low. Degenerative disc disease is a pathologic process, not entirely related to aging, of uncertain etiology that may cause acute or chronic low back pain. Treatment of discogenic back pain with autologous bone. Jan 30, 2019 lower back discogenic pain or lumbar discogenic pain ldp is the cause of low back pain in 39% of the patients.
Nearly 80% of the adult population will suffer from back pain at some point in their lives. The main symptom of discogenic pain is an achy pain that does not refer to your leg or arm and is not associated with decreased ability to use your limbs. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 4050% of chronic low back pain 3. Pathophysiology the intervertebral disc is the main joint between two consecutive vertebrae in the vertebral column. Pdf share on tweeters share on facebook share on linkedin share on. Discogenic pain, or pain arising from the intervertebral discs, is a common cause of chronic spinal pain, constituting approximately 40% of cases of low back pain. Lower back discogenic pain or lumbar discogenic pain ldp is the cause of low back pain in 39% of the patients. This seems illogical, since intervertebral discs do not have any interior nerve tissues or blood vessels.
As a result, discogenic back pain is often hard to treateven more so when clinical treatment strategies are of questionable efficacy. Management of discogenic low back pain with intradiscal. Discogenic introduction low back pain is a very common cause of pain and disability. Pain iasp, the definition of lumbar discogenic pain is lumbar. Original research articles intradiscal plateletrich. A benign or a malignant spinal tumour can present with back pain with radicular symptoms.
Jun 28, 2011 nearly 80% of the adult population will suffer from back pain at some point in their lives. It is estimated that up to 84 percent of adults have low back pain at some time in their lives. Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. For many individuals, episodes of back pain are selflimited.
Radiofrequency intradiscal biacuplasty idb may be a viable option for the management of patient with discogenic lumbar back pain, according to the results of a new study. 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 back pain. The pathogenesis of discogenic low back pain semantic scholar. Prevention of low back pain is extremely important, as symptoms can recur on more than one occasion. 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. Treating discogenic lower back pain is like treating many other musculoskeletal ailments. Discogenic low back pain lbp is a significant medical condition that carries a heavy socioeconomic burden. Of that 80%, almost half will suffer from some form of discogenic low back pain.
Methods a total of26patients11 male,15female, aged18 61 years, single level, two level that met inclusion criteria of chronic 6 months discogenic low back pain, degenerative disc pathology assessed by magnetic resonance. Discogenic pain is pain that actually comes from the injured disc itself. 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. We collected 19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, 12 from physiologically ageing discs. Discogenic pain refers to back pain arising from the disc itself. First, lets uncover what leads to disc degeneration. The incidence of chronic low back pain that is attributable to discogenic causes is reported to be approximately 40% to 45% 8. 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. 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. It is likely most people will experience low back pain at some point in their lives. Cellbased therapies for lumbar discogenic low back pain. Crock 5 rst proposed the concept of internal disc disruption idd, which indicated the discogenic pain syndrome caused by disc degeneration and nonnerve root referred pain. Discogenic lower back pain dlbp is the most common type of chronic lower back. We included clinical trials that evaluated stem cells or chondrocytebased therapy in patients with discogenic back pain.
We collected 19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, 12 from physiologically ageing discs and ten from normal control discs. An estimated 40% of chronic lumbosacral spinal pain is attributed to the discus intervertebralis. Discogenic low back pain southend university hospital. Discogenic low back pain is the most common type of chronic low back pain. Tips remove unwanted tissue, such as herniated discs. Degenerative changes following loss of hydration of the nucleus pulposus lead to circumferential or radial tears within the annulus fibrosus. Low back pain lbp is one of the most common causes of disability in the adult population. Diagnosis and treatment of discogenic low back pain.