Pathophysiology of Discogenic Back Pain

Female clinician assisting a male patient with low back pain perform a lumbar extension

Chronic back pain is one of the most common causes of disability worldwide. Low back pain can result from many etiologies including disc herniations, spinal canal stenosis, facet joint osteoarthritis, myofascial or spontaneous causes, and discogenic causes. In particular, discogenic back pain arises from degeneration to the intervertebral disc and subsequent irritation of the nerves surrounding it. The literature suggests that degeneration itself does not lead to discogenic back pain, but it is likely the persistent inflammation and subsequent innervation that leads to symptom onset. This narrative review summarizes the current understanding of biomechanical and biochemical processes that contribute to the development of discogenic back pain.

The pathophysiology of discogenic back pain remains incompletely understood but it is likely that degeneration leads to inflammatory activation and immune cell recruitment. It is important to note that it appears intervertebral disc degeneration itself is not sufficient to induce pain. Rather, pain occurs following neovascularization and innervation in the area, as well as nociceptive sensitization. Identifying the nuances of these biochemical pathways will be important to develop targeted therapeutic approaches that seek to improve treatment towards discogenic back pain.

From Dr. Thistle: Although not the topic of this paper, the specific role of manual therapy in general, and spinal manipulation specifically, for discogenic low back pain is also a nuanced one. As noted, many of our patients with back pain have a current, or emerging contribution to their back pain syndrome arising from some level of pathology in one or more of their lumbar discs. This can range from early degeneration all the way to pending or present herniation. This sort of pathology occurs over time, so astute clinicians will always be mindful of changes in symptom patterns and emergence of any new neurological signs or symptoms.

RESEARCH REVIEW: Pathophysiology of Discogenic Back Pain

This paper was published in the Journal of Clinical Medicine (2023)

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