While incompletely understood, the concept of painful internal disc derangement (the discogenic or discopathic pain mechanism) has progressively gained acceptance as one source of chronic low back pain.2-4 Discogenic pain is typically characterized by axial mechanical midline low back pain, usually exacerbated by sitting or standing for prolonged periods of time. Hallmarks are reports of sitting intolerance with temporary relief when walking. The pain may be aching or stabbing, and there may be some discomfort radiating into the legs, although back pain is typically the more significant complaint. The diagnosis of disco-genic pain is based on classic clinical history (including a pain diagram showing the patient's pain distribution) and pain-provocative discog-raphy with provocation of typical concordant pain symptoms on disc distention.
Theories for the exact pathophysiology of the pain mechanism abound, but most revolve around pathological tears of the posterior annulus of the disc and mechanical or chemical stimulation of noci-ceptive fibers located in and around the posterior annulus fibrosus and relayed through the sinuvertebral nerve. The present therapy for persistent axial back pain begins with conservative pain management regimens including elements such as rest, physical therapy, anti-inflammatory agents and analgesics, epidural steroids, chiropractic, and acupuncture. Patients who report persistent and debilitating pain after a 6-month course of conservative measures would be considered to have chronic pain and would be candidates for more aggressive intervention.
The choice of surgical intervention may vary depending on local preferences and geographic location. These typically consist of fusion or discectomy and interbody fusion. Both these interventions have yielded mixed results in treating discogenic pain.5-10 Additionally, fusion may be costly; it carries some risk for significant morbidity, may require a long recovery period, and predisposes patients to functional changes in weight-bearing capacity that may concentrate stress above and below the fusion. All these factors have resulted in increased interest in developing other options to treat discogenic back pain.
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Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.