Noncancer Pain: Discogenic Low Back Pain

Discogenic low back pain is the most common cause of chronic lower back pain, though it can be challenging to evaluate and treat. Disc disruption and the subsequent inflammatory response result in nociceptive activation with midline lower back pain and limited range of motion. Radicular pain and sensorimotor deficits are uncommon. Patients typically report pain with standing, walking or straining, and pain relief when lying supine. Degeneration of intervertebral discs results in characteristic radiologic findings (low signal intensity, high-intensity zones and Modic endplate changes), best appreciated on MRI. Provocative discography, while potentially useful for diagnosis, is still a debated practice due to issues of sensitivity, specificity and predictive value. While techniques including intradiscal electrothermal annuloplasty and biacuplasty have been utilized in the past, these treatments have fallen out of favor due to conflicting data. Surgical treatment of discogenic low back pain, including fusion and artificial disc replacement, are commonly utilized in the treatment of this challenging condition. There is growing interest in the development of bioinjectable therapies to repair or regenerate the disc, though this treatment method requires further evaluation.