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Home/Biologics/What Generates Discogenic Pain? New Landmark Research Has Answers
Biologics

What Generates Discogenic Pain? New Landmark Research Has Answers

September 6, 2019 2 min read Premium comments

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What Generates Discogenic Pain? New Landmark Research Has Answers
Source: Wikimedia Commons and the University of Exeter
#osteoarthritisSecondary#discdegeneration#lowbackpain

The disc itself is hurting?

Researchers from Korea University in Seoul and Emory University in Atlanta have concluded important, fundamental research which tracked the location and path of sensory information in the intervertebral disc (IVD) and how it changes as a result of intervertebral disc degeneration (IVDD).

Their work, “Disc degeneration induces a mechano-sensitization of disc afferent nerve fibers that associates with low back pain,” was published in the July 18, 2019 edition of Osteoarthritis and Cartilage.

Hee Chul Han, M.D., Ph.D., with the department of physiology in the College of Medicine and Neuroscience Research Institute at Korea University in Seoul, explained the nature of the research to OTW, “This is fundamental research about the intervertebral disc. This article showed several important things as follows:”

“We found that there was sensory information directly coming from intervertebral disc itself and it was proved by electro-physiological recording in the sensory nerve fibers from the intervertebral disc.”

“The results showed that sensory nerves innervating the intervertebral disc responded to mechanical stimulations from both external and internal side of the disc. And these responses were used as a control in comparing with the responses obtained from intervertebral disc degeneration. And the response of the intervertebral disc sensory nerves was sensitized after intervertebral disc degeneration made by puncture and drainage of nucleus pulposus.”

“Until now there have been few methods of directly measuring disk pain. But this study showed that there is a change in dynamic weight bearing in intervertebral disc degeneration which means that the weight bearing during walking transferred from hind limb to fore limb when intervertebral disc degeneration existed. Also, these changes were alleviated by morphine administration which meant that the change in weight bearing was a pain behavior.”

“Actually, studies on intervertebral disc degeneration could not go forward because there has not been a good and secure parameter to measure the pain directly—although there were many good articles which showed biochemical, histological and pathological evidence for intervertebral disc degeneration. With our results we hope that more studies regarding intervertebral disc degeneration can go forward.”

“This finding can be very useful in clarify the pathogenesis of intervertebral disc degeneration which is known as a major cause of lower back pain. We recommend that researchers looking at lower back pain caused by intervertebral disc degeneration use this method in various ways because it can directly measure the pain behavior in intervertebral disc degeneration.”

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Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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