Lumbar / Pelvis

Lumbar Discogenic Pain

Definition

Lumbar discogenic pain is defined as pain primarily originating from the lumbar intervertebral disc.

Aetiology

In 45% of lower back pain (LBP) patients, the intervertebral disc is the cause. Age-related degenerative changes in the intervertebral disc and trauma are the main causes of lumbar discogenic pain.

Patients under 50 years of age form the greatest risk group. Aging, abnormal posture of the spine or trauma can weaken the intervertebral disc and, consequently, result in annular tears.

Signs and symptoms

Discogenic lumbar pain is localised or starts in the midline. Sometimes, the pain radiates to the upper leg.

Periods with acute LBP, mostly short lasting, which the patient calls 'a crick in his back', are typical of discogenic LBP. The patient sometimes has a period with a prominent lumbar scoliosis. This period of acute severe lumbar pain is associated with a tear in the inner part of the annulus fibrosis.

Pain is provoked by static load, such as prolonged sitting and standing, and sauntering along. Walking and cycling usually work the best.

Diagnostics

Physical Examination

No findings on physical examination are typical for the diagnosis of lumbar discogenic pain. Lumbar fixation in forward flexion (absence of lumbar delordosing), lumbar fixation in backward flexion (absence of increased lumbar lordosis) and biphasic retroflexion, are indicative of discogenic aetiology of LBP.

The provocation of pain by passive segmental translation of the lumbar vertebrae (Federung test) in the prone position is considered to be characteristic of discogenic LPB. However, this is also seen in pain of the lumbar facet joint. Discogenic pain can also be provoked with a tuning fork on the spinal process of the affected lumbar segment.  During examination, it is always important to realise that other structures such as muscles, intervertebral discs and the sacroiliac joint, co-determine the clinical picture.

Additional Somatic Diagnostics

  • Standard X-rays, CT and MRI scans do not provide any additional diagnostic value.
  • CT discography.
  • RAND-36 (quality of life)
  • PCS (catastrophising)
  • VAS Pain (maximal, minimal, actual, average/week) HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Weak opioids (no longer than 3 months)

Other Treatments

Interventional pain treatment