Discogenic Back Pain

Lumbar Discogenic Back Pain Diagnosis and Treatment

disc pain
Back pain can be caused by disc problems.. Credit: Tom Merton / Getty Images

Back pain is one of the most common causes of pain and disability. Sometimes the cause of back pain is thought to be due to degeneration, or wearing out, of the lumbar intervertebral discs. This condition is called discogenic back pain, or lumbar disc pain.

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.

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 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 MedicationsAnti-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 TherapyStrengthening 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.

Unfortunately, between these treatments and surgical intervention, there are few treatment options. If surgery is done, a lumbar fusion procedure is usually performed. In the coming years, it is possible that lumbar disc replacement will be more commonly performed.

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...

What is IDET?
IDET, or Intradiscal Electrothermal Therapy, is a procedure that is being done to treat discogenic back pain. IDET uses a probe inserted into the disc to heat the tissues within the affected disc. Heating the inside of the disc causes the tissues to shrink. It also cauterizes, or burns, the small nerve fibers in the periphery of the disc. Whether or not it is one of these factors, or something else, that accounts for the results of IDET is not exactly known.

When is IDET an appropriate procedure?
IDET is considered in the following patients:

    • Back pain for at least 3 months
    • Nonsurgical treatments have been used for at least 3 months
    • No prior spine surgery at the affected level
    • Abnormal disc seen on MRI
    • Positive (concordant) discogram

How is IDET performed?
IDET is performed as an outpatient procedure. Using a x-ray to guide the small probe into proper position, the IDET probe is place into the affected disc. Once positioned, the probe is slowly heated to about 85 degrees Celsius. It is maintained at this temperature for about five minutes. The entire procedure uses only local anesthesia and some mild sedation.

After the IDET is completed, the patient is monitored for a period of one or two hours. The patient is then sent home with instructions to rest and to avoid lifting, twisting, and bending.

How long is the recovery from IDET?
Patients often have an increase in symptoms the first day or two following an IDET procedure. The symptoms are usually easily controlled with mild anti-inflammatory pain medications.

Improvement is commonly seen about 6 weeks after the procedure, and rehabilitation exercises are started 8- 12 weeks after the IDET.

How well does IDET work?
The results of early studies show encouraging results for IDET. The most important aspect is ensuring the right patients are being selected for this treatment.

Patients must fit into the criteria as mentioned above in order to have the best chance at success. It is very important that patients have undergone a minimum 3 month trial of regular medications and therapy prior to considering IDET.

IDET is a safe procedure with few reported complications. There are few studies investigating its use, but the best studies show that about 60-80% of patients find improvement in the months following an IDET procedure. Unfortunately, there are no long-term studies to evaluate how these patients are doing years down the road. Some orthopedists do not favor this procedure because of this potential problem. By heating the disc tissue, and destroying some of it, there is a potential for further problems down the road--we simply don't know.

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