Disc Injury Causes Pain
Diagnosis of a traumatic injury has implications for treatment decisions, prognosis and patient education. The intervertebral disc is actually innervated with pain fibers from the recurrent meningeal nerve and a tear or fissure in the annulus fibrosis (annular tear) can result from a traumatic or degenerative etiology. These types of tears appear differently on MRI and close scrutiny of the MRI films, especially on the T2 sagittal view, can help to sort out a single traumatic event or degenerative process. This is important for many reasons, not to mention traumatic forces may have also affected additional anatomical structures.
Identifying the intervertebral disc as a source of pain is critical in the long term care of this patient population and is considerably different than a simple sprain/strain. A paper published in 2002 is the most recent research published on this interesting topic. Clinicians that examine and treat or examine and refer disc injuries should be familiar with this interesting information. Using the intradiscal electrothermal annuloplasty (IDET) procedure, the authors sought to reproduce patient pain patterns caused by intervertebral disc injury. The authors reported, “The pattern of pain reproduction was consistent; pain originated proximally and progressed distally as stimulus intensity increased” (O’Neill, Kurgansky, Derby, & Ryan, 2002, p. 2276).
“This study demonstrated that noxious stimulation of the intervertebral disc results in low back and referred extremity pain, with the distal extent of pain produced depending on the intensity of stimulation” (O’Neill et al., 2002, p. 2778). When we are looking at MRI and there are minimal findings related to disc herniation, it is important to evaluate the actual disc for annular tears. These tears can certainly be incomplete, but can convey a tremendous amount of pain in certain patients. Stabilization of inflammation while slowly increasing range of motion of these painful lesions is critical and should be complete prior to any rehabilitative care program.
Premier Alternative Health Center
Dr. Sean Billings
107 N Union Blvd
Colorado Springs, CO 80909
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.