Discogenic pain

Abstract

Low back pain is the most common cause of disability. The prevalence of low back is substantial. Discogenic pain is responsible for 40 % of the low back pain cases. Zygapophyseal joint pain is present in 15 %, and sacroiliac joint pain is found in 21 % of low back pain patients. Internal disc disruption (IDD) is the single most common cause of low back pain. Pain on discography provides the anatomical basis for diagnosing back pain. Provocative diagnostic test to determine disc as "pain generator", detects presence of painful annular tears. CT/discography reveals IDD. The diagnosis of IDD relies upon provocation discography that reproduces pain and CT discography that reveals the IDD. A recently released study was the first to correlate MRI and discomanometry in determining lumbar disc disease. Despite increasing knowledge of disc innervation and referred nociceptive pathways, blocking these structures have not demonstrated long term therapeutic effects in uncontrolled clinical trials.