Unraveling Mystery of the Painful Lumbar Intervertebral Disc

Abstract

Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by removing the offending disc and limiting motion in the lumbar spine. Understanding the pathophysiological basis of disc degeneration is essential for the development of treatment strategies that target the underlying mechanisms of disc degeneration rather than the downstream symptom of pain. Researchers are working on novel treatment strategies which aim to induce disc regeneration or to replace the degenerated disc. These strategies involve stem cells, growth factors, and gene therapy. At present, treatment options for degenerative disc disease remain suboptimal, and the novel treatment strategies are not accepted as the standard of care. Is there any difference between the aging and the degenerated disc? Is Discogenic pain the main cause of back pain, How do we explain back pain in the absence of any imaging abnormality. Or for that matter why do we find asymptomatic patient with features of gross degenerative changes in MRI of lumbar spine. Are some individuals genetically more predisposed to develop lumbar degenerative disc disease? These are some questions which need to be answered with a firm scientific conviction. Adding on to the complexity is the path physiology of pain mechanism. The pain of Low back pain which is nociceptive during the acute stage acquires central sensitization on assuming chronicity. There occurs a functional reorganization within the pain matrix of the brain. A brief outline is provided of our present understanding of, the anatomical basis of pain mechanism based on the current, available body of literature. In current scenario it is also proposed that since the cause of low back pain is multimodal, medical care providers should adopt a multi-disciplinary model in order to provide pain relief. The treatment modalities should include physical therapy, pharmacotherapy, interventional local pain modulating therapy and surgical intervention.