Review: Discogenic Back Pain: Update on Treatment

Abstract

Purpose of Review Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography. Recent Findings Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on data derived from treatment of chronic LBP (CLBP). Summary Despite the scarcity of data for the treatment of DBP, treatments do exist with varying efficacy for DBP. Novel techniques such as the use of biologics may provide another avenue for treatment though further studies are needed to better evaluate the most efficacious regimen for both novel and existing treatments.

Efficacy of Medical Ozone as an Adjuvant Treatment in Dogs with Intervertebral Disc Protusions—A Retrospective Study

“…In humans, intervertebral disc degeneration is a progressive and invalidating disease involving high socioeconomic cost with a multifactorial etiology and is the consequence of failure in tissue repair. In its chronic form, it initiates with mild pain, which gradually intensifies, often leading to an inability to walk [7,8]. Similar pathological changes have been reported in degenerated intervertebral discs from humans and dogs.…”

“…Therefore, the usual disc herniation sites in the terminal lumbar area (L3-L4, L4-L5, L5-S1) in humans result in only nerve roots of the cauda equina being affected, while the usual thoracolumbar or lumbar localization of disc herniations in dogs will directly compress the spinal cord [9]. Therefore, pain in humans with chronic discopathies is mainly associated with nerve root compression, without forgetting the other multifactorial components such as facet or discogenic pain especially in low back pain [7,8]. However, in dogs, the main source of pain is stimulation of the nociceptors of the dorsal longitudinal ligament as a consequence of spinal cord compression [10], although they may also suffer from radicular pain [11].…”