From the Guidelines
Discogenic pain and radicular pain require distinct treatment approaches based on their underlying causes and characteristics, with discogenic pain often managed through core strengthening exercises, NSAIDs, and physical therapy, and radicular pain typically addressed through nerve compression relief with medications, physical therapy, and potential surgical decompression. Discogenic pain originates from damage or degeneration of the intervertebral discs, presenting as a dull, aching pain in the lower back that may worsen with sitting, bending, or lifting, often localized to the midline of the spine and radiating to the buttocks or thighs, but usually not below the knee 1. In contrast, radicular pain results from compression or irritation of a spinal nerve root, causing sharp, shooting pain that follows the path of the affected nerve, typically radiating down the leg (sciatica) or arm (cervical radiculopathy), often accompanied by numbness, tingling, or weakness in the affected limb 1. Key differences in treatment strategies include:
- Discogenic pain management: core strengthening exercises, NSAIDs like ibuprofen (400-800mg three times daily), physical therapy, and sometimes epidural steroid injections
- Radicular pain management: medications like gabapentin (starting at 300mg daily and titrating up) or pregabalin (75mg twice daily), physical therapy, and potentially surgical decompression if conservative measures fail Accurate diagnosis through clinical examination and imaging studies like MRI is crucial for determining the appropriate treatment strategy, as findings on MRI or CT are often nonspecific and require clinical correlation between symptoms and radiographic findings, severity of symptoms, patient preferences, surgical risks, and costs 1.
From the Research
Discogenic Pain vs Radicular Pain
- Discogenic pain is a type of chronic low back pain that originates from the intervertebral discs, whereas radicular pain is caused by compression or irritation of the spinal nerves 2, 3.
- Discogenic pain is often characterized by axial low back pain without radicular pain, and is associated with degenerative changes in the intervertebral discs, including structural defects and inflammation 3, 4.
- The diagnosis of discogenic pain can be challenging, and existing imaging modalities such as MRI may not be specific to pain symptoms 3, 4.
- Treatment options for discogenic pain include noninvasive treatments such as drug therapy and physical modalities, interventional modalities such as intradiscal therapies and epidural injections, and surgical approaches such as fusion and artificial disc replacement 2, 5, 6.
- The evidence for the effectiveness of these treatments is limited, and more research is needed to determine the best approach for managing discogenic pain 2, 3, 4, 5, 6.
Comparison of Treatment Options
- A study comparing surgical and nonsurgical treatments for discogenic back pain found that surgery showed a limited benefit over nonsurgical treatment at 1 year follow-up, with a composite success rate of 33% for surgery and 15% for nonsurgical treatment 6.
- Another study found that transforaminal epidural steroid injections (TFESI) can provide significant improvement in pain and physical function for patients with discogenic axial lumbosacral back pain, with a medium effect size on pain and function 5.
- Regenerative therapies such as biologics, cell-based therapy, and gene-based therapy may offer promising alternatives for the treatment of discogenic pain, but more research is needed to determine their effectiveness 3.