When the annulus – the cover around the disc – tears, pain may occur. The annulus has nerve fibres, unlike the nucleus. When a tear occurs in the annulus, you may feel pain in the neck or lower back and areas overlying and around the tear. Pain may also travel down the arm or leg as with a true disc herniation.
Although an annular tear may produce pain that is referred or travels from the neck to an arm or from the lower back to a leg, it can never produce weakness or numbness. Only compression of the root can do that. Annular tears usually heal inn two to three months. However, they can tear again and cause pain again. This phenomenon is part of chronic discogenic pain. Discogenic pain, to the extent it is understood arises from abnormalities within the disc iteself and has nothing to do with pain from a herniation, which occurs as a result of root compression by herniated disc.
Diagnosing Discogenic Pain
If an MRI shows a tear in the annulus or disc covering, usually coupled with other signs of disc degeneration.
Conservative Treatment of Discogenic Pain
Most people with annular tears recover with rest, pain medications, and a gradual resumption of normal activity. NSAIDs, muscle relaxants for spasm, and narcotics should be used as needed. Sometimes physiotherapy or epidural steroid injections may be used.
Most discogenic pain comes from an annular tear, although that may not be the whole story. Although there is no pressure on a spinal root in this condition, it does hurt. Activity reduction and lifestyle modification so as not to bear down – risking a further tear or a disc herniation through the tear – is important.
The vast majority of annular tears causing discogenic pain heal without difficulty. For those that don’t, there are several minimally interventional treatments presented below.
Epidural Steroid Injections
Besides acting on the swollen, inflamed nerves, the liquid in the steroid epidural injection also flushes away the chemicals produced by the annular tears that cause root inflammation and pain. Studies on epidurals show that they work well for a very small specific group of people, such as those under forty who have not previously has surgery or those with pain lasting less than three months. If used at all, epidural injections are most appropriate as a short-term treatment for those whose spine-related pain also travels or radiates down a leg or arm.
Key Points about Discogenic Back Pain
- Discogenic back pain arises from abnormalities within the disc itself. It has nothing to do with pain from a herniation, which occurs as a result of root decompression by the herniated disc.
- Most people with discogenic back pain recover with rest, pain-relieving medications, and other conservative treatment.
- Epidural injections work well for short-term relief on some people with this type of pain.
- There is no need surgery for most discogenic back pain.