What is discogenic pain?
When we think of “discogenic pain”, we usually think of pain caused by a herniated disc. However, with this so-called disc herniation, it is not the disc per se that causes pain, but the neighboring spinal nerve, which is constricted or irritated by protruding disc material. Such pain is typically perceived in the area supplied by the affected nerve, i.e. in the arms or legs.
Typical symptoms of patients
However, the actual disc pain, known as “discogenic pain” in specialist terminology, can occur without a herniated disc with nerve compression. Discogenic pain mainly manifests itself as pain in the back or neck. Occasionally there may be radiation to the legs, but this is usually less intense than back pain and does not correspond to a clear nerve territory.
Discogenic pain is common, especially at a younger age, can increase in intensity episodically and is often aggravated by coughing, sneezing or pressing. MRI may show non-specific signs such as a reduction in disc height, loss of water content or so-called high-intensity zones. However, these do not allow a clear diagnosis of discogenic pain.
Intervertebral disc provocation test
The diagnosis of discogenic pain can be provided by a disc provocation test (so-called provocation discography). Under X-ray control, a cannula is inserted into the suspected painful disc and the pressure within the disc is measured using a special instrument. This pressure is then continuously increased by injecting a contrast medium to check whether and at what pressure the known back pain is provoked. To assess the result, we then apply a list of criteria from the international “Spine Intervention Society”.
It is important to know that provocation discography is only a diagnostic test. It is not a therapy. Depending on the individual situation and level of suffering, surgical treatment may have to be considered.
