Discogenic Pain Overview and Treatment

spine doctor

 

Dean Mitchell / Getty Images

In This Article
Table of Contents

About 40% of all chronic spine pain is related to a problem in one or more intervertebral discs. If you have chronic neck or low back pain, there are many causes that can be contributing to it. If you don't have a herniated disc, another potential cause could be discogenic pain.

Discogenic pain is thought to occur in relationship to disc degeneration, a condition in which the physical and chemical properties of the disc slowly deteriorate. But the problem is, degenerating discs don't always cause pain, and experts have yet to explain this relationship in full.

Causes

The theory goes that discogenic pain occurs when nerve receptors located in the outer part of the annulus are irritated.

Inflammation or other conditions in the disc may irritate these nerve receptors. For example, if the inflammatory chemicals from an annular tear reach the nerves in the outer part of the annulus, the tear may be the cause of your discogenic pain. This type of injury is called internal disc disruption, or IDD.

Genetics likely play a role in the formation of discogenic pain. Genetics can influence the chemical composition of discs and may make certain metabolic changes in the body more likely to occur. The result is that the discs dry out faster than normal, which renders them less capable of bearing the spinal load evenly. Then, normal everyday wear and tear puts pressure on one or a few small areas in the disc, increasing the risk of an annular tear. Damage to the edge of the vertebra adjacent to the disc may also occur.

Along with genetics, nutritional and mechanical factors as well as nutrient supply to the disc may also influence discogenic pain.

Risk Factors

Discogenic pain occurs most often in middle-aged and elderly people.

Symptoms

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.

In the low back, pain usually worsens when your spine is compressed. Activities like sitting, bending, coughing and sneezing tend to bring it on, while lying down tends to relieve it.

In the neck, there may be pain when you turn or tilt your head. The pain may worsen if you hold your head in one position too long. Muscle spasms sometimes accompany discogenic pain in the neck.

Diagnosis

An MRI is s typically the first step after radiographs in diagnosing discogenic pain, however, it may not always detect the cause of pain. A discography may also be used to help with the diagnosis. Discograms are used to definitively confirm that the pain arises from a specific disc or discs. But a number of researchers have found that because of the subjective nature of the discogram, it may yield false-positive results, particularly if you have pain from other sources, if you have mental impairment, or if you are afraid of pain. However, guidelines exist for testing technique that can help maintain a low rate of false-positive results. As mentioned above, you may have pain or other sensations down your arm or leg. These are called radicular symptoms. But radiculopathy and discogenic pain are not the same disorder. Like radiculopathy, discogenic pain can also result from irritation of nerves.

The difference is that radiculopathy affects spinal nerve roots, while discogenic pain irritates the nerves located in the outer rings of the annulus. (The annulus is the tough fibrous covering of the intervertebral disc. It contains and protects the centrally located nucleus pulposus.)

It can be difficult to determine the exact source of pain when working up a diagnosis.

Yet the distinction will make a difference in the treatment you receive.

Treatment

Discogenic pain can subside on its own, or it may come and go. Conservative care is usually the first type of treatment that's tried. It may include controlling pain with anti-inflammatories, using ice and/or heat and physical therapy. Physical therapy may consist of back exercises, traction and other treatments. An injection may help quell the pain and make you more comfortable.

As far a surgery goes, generally, it's not necessary, but individual cases may differ. But if you're in debilitating pain for 3 months or longer and/or have spinal instability, it may be an option. Ask your doctor about your options.

The most common surgery for discogenic pain is spinal fusion. However, its use in this setting does not always provide relief. In the United States, the number of spine surgeries performed has been on the rise since the early 1990s, and one study suggests that up to 17% are unnecessary, although differences in surgeon preferences and criteria may factor into this finding. Disc degeneration is a part of aging, but this does not automatically mean you need a spinal fusion when the pain shows up. Be sure to research your options, including your health care providers, and work with your chosen doctor to determine the best course of action for you.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Benzel, EC. Spine surgery: techniques, complication avoidance, and management. New York, NY: Elsevier Health Sciences; 2012.

  2. Peng BG. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013;4(2):42-52. doi:10.5312/wjo.v4.i2.42

  3. Patient Education Committee, North American Spine Society. Chronic low back pain. Updated 2020. 

  4. Epstein NE, Hood DC. "Unnecessary" spinal surgery: A prospective 1-year study of one surgeon's experience. Surg Neurol Int. 2011;2:83. doi:10.4103/2152-7806.82249+

Additional Reading
  • Ahmed, AU. MD, MPH., Low Back Pain: A Brief Review. NeuroNews.

  • Bogduk, N., M.D. Lumbar Discogenic Pain: State of the Art Review. Pain Medicine. Oxford University Press.

  • Cluett, J. MD. Discogenic Back Pain. About.com.

  • U Washington Cohort Study for Treatment of Discogenic Back Pain.

  • Windsor, RE, MD. Cervical Discogenic Pain Syndrome: Treatment & Medication. eMedicine.

  • Zang, Y., Tuan-mao, G, Xiong, G, Shi-xun, W. Clinical diagnosis for discogenic low back pain. International Journal of Biological Sciences. 2009; 5(7).

Related Articles