Intervertebral Disc and Pain Patterns

Intervertebral Disc and Pain Patterns

Determining the source of pain in a traumatically injured patient/client is one of the most important aspects of practice. Objectifying what is wrong, how it relates to the injury and what the patient/client cannot not accomplish as a result, is what we do in practice. There are many sources of pain in the body following a traumatic injury and these can be influenced by accident physics and co-morbidities (prior injuries, diabetes, and patient physiological age). This is certainly true when it comes to pain emanating from the intervertebral disc.

In a recent study in Spine, by O'Neill, Kurgansky, Derby, & Ryan (2002), the authors looked “To determine the pattern of pain response to noxious [painful] stimulation of the intervertebral disc" (p. 2776). The main issue was the difference between radicular pain and referred pain.

The following definitions may be helpful in understanding this information. "Radicular pain [a.k.a. radiating pain] results from irritation of axons of a spinal nerve or neurons in the dorsal root ganglion" (O’Neill et al., 2002, p. 2776). This means that the nerve is either being compressed or irritated. This follows a dermatomal pattern down the arm or leg. This is very specific to each nerve level coming out of the spine. This is where you see POSITIVE EMG testing.

"In contrast to radicular pain, referred pain results from activation of nociceptive free nerve endings (nociceptors) in somatic or visceral tissue, a common example being upper extremity pain from cardiac ischemia [heart attack]" (O’Neill et al., 2002, p. 2766). This is where you get NEGATIVE EMG results.

The authors used the IDET procedure to heat the intervertebral disc thereby activating pain fibers. In a healthy disc, pain sensation is provided to the outer 1/3 of the annulus fibrosis [outer ring]. Research has shown that as the disc degenerates, these nerve endings grow farther and farther into the middle of the intervertebral disc and is some cases, pain fibers have been found in the nucleus pulposus (center). This is why pain patterns can be so intense in degenerative discs.

The results of this study were very interesting. The authors stated, "Noxious stimulation of the intervertebral disc may result in low back and referred extremity [pain] in patients presenting with these symptoms. The distal [away from the body] extremity pain produced depends on the intensity of stimulation" (O’Neill et al., 2002, p. 2776).

In conclusion, pain in the lower back that goes to the legs may not necessarily be a radiculopathy at all. Using this knowledge will be very helpful in developing a proper diagnosis, prognosis and treatment plan in patients with discogenic and referred pain patterns.

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Spine & Injury Centers of San Antonio is a local network of 5 chiropractic offices. As a group, we are raising the standard of care for injured patients and their families.

If you have recently been in a car accident, or had a personal injury, sports injury, or exercise injury, and are experiencing back pain, neck pain, knee pain, whiplash, headaches, leg pain, etc, our San Antonio injury chiropractors can help!

Our goal is to get you back to living a pain-free life as quickly as possible.

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Reference:

O'Neill, C. W., Kurgansky, M. E., Derby, R., & Ryan, D. P. (2002). Disc stimulation and patterns of referred pain. Spine, 27(24), 2776-2781.