Is Disc Degeneration Painful?
Authors: Samartzis Dino 
Published: May 2014

Low back pain (LBP) is the world's most debilitating condition, affecting every population. Although LBP can be multifactorial, disc degeneration has been suggested to be a determinant. Disc degeneration is characterized by chemical and morphological changes to the disc, which may usher in changes to its biomechanics, interplay with the endplates and subchondral bone, and may lead to an inflammatory response that can irritate invading nerve fibers. Such changes to the disc and its surrounding area may contribute to pain generation, whose duration and intensity is uncertain. However, a divide is present in epidemiological studies regarding the association of disc degeneration and LBP, leading to the conclusion that disc degeneration is not always synonymous with LBP. This could be attributed to study design, inadequate statistical analyses, and phenotyping issues of degenerative spine changes as well as LBP. In addition, throughout the years, advances in medical imaging have helped broaden the understanding of disc degeneration and imaging pain generators as well the predictive utility of such imaging for future pain development/severity. The evolution of pain genetics research has provided further understanding why some individuals may be more likely to experience pain than others in the setting of degenerative spine changes. Further attention to the phenotyping of spine degeneration has noted that patterns of spine changes may play a role in LBP. The field of OMICS-epidemiology and the identification of additional biomarkers (e.g., metabolomics, adipokines, etc.) could further broaden the understanding between the association of disc degeneration and LBP. In addition, the phenotyping of disc degeneration requires further attention, demanding revisitation and reclassification of long-held classification schemes as well as being conscious of a direct link to their clinical relevance. A global standardization of disc degeneration and LBP is needed to help facilitate the collaboration of large-scale consortiums to address such salient spine-related concerns.

Disclosure of Interest

None declared

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