Discogenic Back Pain
Discogenic Back Pain is pain in the back, focal and specific, disk specific pain. It is a degenerative disk in which the sensitivity and pain is far beyond what is expected. The disk is normally the cushion between the bones that does degenerate with time, but is not necessarily painful. The disk is vulnerable to tears of the supporting ligament, the "annulus fibrosis". This is most typical to occur in the 30’s to 40’s.
The pain is usually sharp, but episodic, commonly associated muscle spasms. There is always a low grade pain in the spine, but it gets slowly worse year by year. Sitting is the most common complaint as it puts the most pressure on the disk. Pain is common when getting out of bed, but improves with a few hours of movement in the morning. Constant movement tends to make the pain better. The episodes are frequently triggered by over doing it or an awkward movement. This pain can be extremely severe to the point of incapacitation, but the pain is typically a spectrum of mild to moderate.
Treatment should always stay to the conservative. Medications, therapy and behavioral changes are the first treatment. When all conservative treatments fail, a test of an injection into the disk with pressure, “discogram”, will test if the disk is sensitive or not. If a degenerative disk is isolated, severe, with normal adjacent disks, surgery can be considered. I will restate, degenerative conditions of the spine are best not treated by surgery, but when conservative measures fail to improve and the pain is truly incapacitating, then surgery will always remain an option. Typically, the gold standard is a fusion surgery or new technology of the artificial disk replacement shows promise, but is not yet fully demonstrated superiority. This decision is clearly the most controversial in spine surgery and needs a great deal of thought best discussed with your spine surgeon.