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 References Battié MC, Videman T, Levalahti E, Gill K, Kaprio J. Heritability of low back pain and the role of disc degeneration. Pain 2007;131(3):272–280 Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72(3):403–408 Cheung KM, Samartzis D, Karppinen J, Luk KD. Are “patterns” of lumbar disc degeneration associated with low back pain?: new insights based on skipped level disc pathology. Spine 2012;37(7):E430-E438 Chou D, Samartzis D, Bellabarba C, et al. Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine 2011;36(21, Suppl)S43-S53 Eskola PJ, Lemmelä S, Kjaer P, et al. Genetic association studies in lumbar disc degeneration: a systematic review. PLoS ONE 2012;7(11):e49995 Fourney DR, Andersson G, Arnold PM, et al. Chronic low back pain: a heterogeneous condition with challenges for an evidence-based approach. Spine 2011;36(21, Suppl)S1-S9 Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D. Management of degenerative disk disease and chronic low back pain. Orthop Clin North Am 2011;42(4):513-528, viii Livshits G, Popham M, Malkin I, et al. Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK Twin Spine Study. Ann Rheum Dis 2011;70(10):1740–1745 Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine 2000;25(4):487–492 Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am 2011;93(7):662–670 Takatalo J, Karppinen J, Niinimäki J, et al. Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine 2011;36(25):2180–2189 Waris E, Eskelin M, Hermunen H, Kiviluoto O, Paajanen H. Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine 2007;32(6):681–684 Samartzis D, Ito K, Wang JC. Disk degeneration and pain. Global Spine J 2013;3(3):125–126