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What is discogenic pain?

Discogenic pain is chronic lower back or neck pain arising from problems within the intervertebral discs. These discs serve as cushions between the bones (vertebrae) of your spine, allowing for flexibility and shock absorption. Over time, due to wear and tear, injury, or ageing, these discs can degenerate or suffer damage, leading to pain.

The intricacies of discogenic pain involve the inner core of the disc, called the nucleus pulposus, and the outer ring, known as the annulus fibrosus. Damage or degeneration in these areas can irritate nearby nerves, leading to pain that is often localised in the lower back but can also affect the neck, depending on the disc’s location.

discogenic pain singapore
Discogenic pain is a chronic lower back arising from intervertebral disc problems.

Discogenic back pain is typically linked to conditions that affect the spine’s intervertebral discs. When these discs degenerate, become damaged, or develop abnormalities, it can lead to discogenic back pain. Common causes of discogenic back pain include:

  • Degenerative disc disease (DDD): degenerative disc disease is a common part of the ageing process in which spinal discs lose hydration and flexibility. This degradation leads to decreased disc height and potential disc bulging, significantly contributing to discogenic pain.
  • Internal disc disruption (IDD): internal disc disruption involves tears or fissures within the disc’s structure, allowing inflammatory substances to irritate nearby nerve endings. The inner material of the disc, which can cause inflammation when it comes into contact with nerves, is typically contained until these tears provide a path for irritation.
  • Slipped or herniated discs: a slipped or herniated disc  occurs when the inner gel-like substance of the disc (nucleus pulposus) bulges or protrudes outwards through a tear or weakness in the outer layer of the disc (annulus fibrosus). This can occur due to sudden trauma or repetitive strain on the spine, leading to compression or irritation of nearby spinal nerves and causing pain, numbness, tingling, or weakness in the affected area.
  • Annular tears: annular tears refer to small tears or fissures that develop in the outer layer of the intervertebral disc (annulus fibrosus).  Annular tears may lead to inflammation, nerve sensitisation and discogenic pain.
  • Trauma or injury: acute trauma, such as a fall, car accident, or sudden forceful movement, can damage the intervertebral discs, leading to discogenic back pain. 
discogenic pain old
Our spinal discs can dry out and become less flexible as we age, causing discogenic pain.

What are the symptoms of discogenic pain?

Discogenic back pain presents a set of symptoms primarily centred around the affected disc’s location and typically manifests as:

  • Localised pain: localised pain is the most common symptom. Depending on the disc’s location, it manifests as a persistent, often debilitating pain in the lower back (lumbar) or neck (cervical).
  • Activity-related discomfort: symptoms may worsen with actions that increase spinal pressure, such as bending, lifting, sitting for long durations, or even sneezing, indicating the disc’s compromised ability to absorb shock.
  • Pain relief in certain positions: lying down or changing positions can sometimes offer temporary relief, as these actions reduce pressure on the discs.
  • Radiating pain: though less common in discogenic pain compared to other spinal conditions, some individuals may experience pain that radiates to the buttocks, thighs, or down the leg if adjacent nerve roots are affected.
  • Muscle spasms: muscle spasms or tightness in the muscles surrounding the affected discs may occur in response to discogenic pain. These spasms can further contribute to stiffness, limited mobility, and discomfort in the back or neck.

 

Who is at risk of discogenic pain in Singapore?

Discogenic pain can affect certain individuals due to various risk factors such as:

  • Age: discogenic pain is more common in older adults, particularly those over the age of 40. As people age, the spine’s intervertebral discs undergo natural degenerative changes, including loss of hydration, reduced disc height, and structural abnormalities. These age-related changes increase the risk of disc degeneration and associated discogenic pain.
  • Occupation: individuals with jobs that involve heavy lifting, bending, or prolonged periods of sitting or standing are at higher risk.
  • Poor posture: poor posture, such as slouching with rounded shoulders and a forward head posture, can place excessive strain on the spine and increase the risk of discogenic pain. This is very common because of our heavy use of mobile phones and computers.
  • Lifestyle factors: a sedentary lifestyle, obesity, and smoking also contribute to increased risk due to their negative impact on spinal health.
  • Genetics: some individuals may have a genetic predisposition to discogenic pain. Certain genetic conditions or inherited traits, such as collagen disorders, spinal deformities, or structural abnormalities of the spine, can increase the risk of disc degeneration and discogenic pain.
Young,Woman,With,Poor,Posture,Using,Smartphone,While,Sitting,On
Poor posture has been linked to degenerative discs and discogenic pain.

How is discogenic pain diagnosed?

 

Diagnosis of discogenic pain involves a comprehensive evaluation, including:

 

  • Medical history and physical examination: your pain specialist (link to about us) will inquire about your symptoms, onset of pain, severity, and duration of pain. They may also inquire about any previous injuries, medical conditions, or activities that could contribute to the symptoms. A physical examination of the spine will be performed to assess range of motion, posture, muscle strength, and tenderness in the affected area. Spinal palpation, range of motion tests, or provocative tests will be conducted to identify areas of tenderness or reproduce symptoms.
  • Imaging tests: X-rays, magnetic resonance imaging (MRI), or a computed tomography (CT) scan may be conducted to help visualise disc degeneration and other abnormalities, although its specificity and sensitivity can be limited. 
  • Provocative discography: provocative discography is a diagnostic procedure in which dye is injected into the disc to replicate pain symptoms and identify damaged discs. However, this may not be accurate in the presence of multiple pain generators.

 

What are the treatment options for discogenic pain in Singapore?

 

The treatment options for discogenic pain aim to alleviate symptoms, improve function, and address the underlying causes of pain. Management strategies for discogenic pain, which focuses on pain relief and improving function, include:

 

  • Medications: medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and neuropathic pain medications may be prescribed to help reduce inflammation, relax muscles, and alleviate pain. 
  • Injection therapies: injection therapies, such as epidural steroid injections, facet joint injections , and trigger point injections , can provide temporary relief by reducing inflammation around the affected discs.
  • Annuloplasty (Biacuplasty): annuloplasty  is a minimally invasive procedure that applies heat to the affected disc to relieve pain by destroying nerve fibres that have grown into the tears in the disc.
  • Radiofrequency ablation: radiofrequency ablation  utilises heat to disrupt pain signals by destroying a small area of the affected nerve.
  • Lifestyle modifications: avoid or modify activities that exacerbate the pain, maintain a healthy weight, avoid smoking, and engage in appropriate exercise to strengthen your muscles and reduce the strain and pressure on your spine.
A,Male,Doctor,Explaining,Lumbar,Anatomy,To,Female,Patient,Complaining
Discogenic pain management strategies focus on pain relief and improving function.

Frequently asked questions

Discogenic pain is typically a deep, aching discomfort localised in the lower back. It’s often described as a dull, constant ache that can worsen with activities like bending or sitting for extended periods. Relief may be found when lying down or changing positions, and the lower back may feel stiff.

Management of discogenic pain starts with conservative treatments such as anti-inflammatory medications and physical therapy. For more severe cases, interventions like nerve root blocks or epidural injections may be necessary. The aim is to strengthen the spinal structure for long-term relief​.

Discogenic pain often requires ongoing management rather than a cure. Treatments vary in effectiveness, and while conservative methods can offer relief, some cases may benefit from minimally invasive pain interventions for a more definitive solution.

No, they are related but distinct. Discogenic pain is related to disc degeneration and irritation of nerve receptors in the disc’s outer part. A herniated disc, however, specifically refers to a condition where the disc’s outer layer cracks, allowing the inner material to bulge out and possibly compress nerve roots, which can cause radiating pain, numbness, or weakness​.