FAQ’s on Degenerative Disc Disease
What Is Degenerative Disc Disease?
Degenerative disc disease is unfortunately one of the most common conditions that affect the lower back, resulting in chronic pain and debilitation in the most severe cases. People between the ages of thirty and fifty years old are among the leaders in developing this condition, at a rate of 30-40% in the population group. Of this percentage, many do not know they have the disease because they do not experience painful symptoms associated with it.
It is not truly a “disease”, so it is a bit of misnomer. In looking overall at back pain, degenerative disc disease (DDD) causes the pain 30% of the time. If painful and left untreated, the condition typically worsens and symptoms increase over time (Pain Physician, 2012).
What Causes Degenerative Disc Disease?
Aging and wear-and-tear are among the major causes of degenerative disc disease. Disc degeneration begins by the disc losing hydration. The normal and healthy disc contains about 80% water and the remainder is made up of proteins and collagen. As a person ages, the disc loses some of this fluid level, and degeneration begins.
Some people are predisposed to losing disc fluid as they age because of hereditary factors, even those without experiencing any injury or trauma. Those with a history of repetitive microtrauma, such as truck drivers, construction workers and the like, have a higher incidence of DDD.
The intervertebral disc is composed of two areas. The inner portion, known as the nucleus pulposus, does not have any nerve endings and cannot feel pain. The outer portion, known as the annulus fibrosus, has plenty of nerve endings and is able to feel pain. When the disc degeneration leads to tears in the annulus, it may irritate nerve endings and cause considerable chronic pain.
What are the Symptoms of Degenerative Disc Disease?
Pain is among the most common symptoms, however the degree of pain may vary from patient to patient. There are cases of early onset of degenerative disc disease that results in no pain or discomfort, in fact, the patient may not even be aware that they have the disease.
As degeneration progresses, the disc becomes susceptible to tears and injury. The tears may result in significant pain and discomfort. When a person is symptomatic from degeneration of the disc, there is often pain present in the low back that comes and goes or remains in the form of a dull ache.
Pain may radiate into the sides of the back and into the buttock region and upper thighs. Usually sitting is the worst position, as that is when the disc receives the most pressure.
When there is enough wear and tear on the disc there is the possibility that the surrounding nerve roots may become pinched. The pinched nerves result in radiating pain that travels down the back of the leg. In addition, the tears in the outer disc may spark up inflammation and a chemical reaction, leading to irritation of adjacent nerve roots even if they are not actually being pinched. The pain may worsen after a person sits or is on their feet for prolonged periods of time. Bending and twisting movements may also contribute to increased pain and discomfort.
How is the Condition Diagnosed?
A pain management doctor will collect a complete medical history, including an assessment of what activities you are able to do or not do. Anything that worsens the pain, from sitting or walking, should be discussed. Both physical and neurological testing will be conducted. Usually at that point the diagnosis presents itself basically.
X-rays may show a loss of disc height, which is suspicious for degenerative disc disease. There may also be bony endplate changes that are indicative of DDD as well. The best study to show degenerative discs is an MRI scan. The study will show a darkened disc that has lost height. The darkness indicates water loss and is often referred to as “black disc disease.”
If a person is undergoing treatment for back pain that is failing and surgery is being considered, a discogram may be ordered. It is not a therapeutic procedure, but simply a diagnostic one. It actually produces pain in an effort to reproduce the pain a person has on a daily basis to assess the disc as the person’s pain generator. So it is not ordered during the initial workup, but rather as a surgical precursor.
What are the Treatments for Degenerative Disc Disease?
A number of non-operative treatments are available for degenerative disc disease. Medication has proven to be beneficial in reducing symptoms of degenerative disc disease. These medications include non-steroidal anti-inflammatory drugs and pain relievers. Narcotics may be helpful for sudden flare-ups but are not recommended for pain relief over the long-term.
Physical therapy and chiropractic care have proven to be successful in treating the condition and reducing pain. Stabilizing the core muscle groups through exercise and strengthening can help lessen pain. Physical therapy treatments such as ice and heat application, ultrasound and electrical stimulation have also proven to be effective.
One of the best treatments for reducing pain is aerobic exercise. Not the type of exercise that is high impact, rather, swimming or cycling can help substantially with pain reduction.
Chiropractic manipulations are used to relieve pain and increase blood flow to the area where compression exists. The spinal adjustments work to provide pain relief by releasing endorphins into the system. Chiropractic manipulations are becoming a highly noted and effective treatment for this kind of low back pain (Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 329-340).
Spinal decompression therapy often provides pain relief from DDD by increasing oxygenation to the damaged, ruptured discs. The treatment is FDA cleared, and provides intermittent traction in painless sessions. A TENS unit may also help with relief. The unit is the size of an iPod, worn on the belt 2 hours at a time, and often effective at changing the way a person’s brain perceives pain.
For interventional pain management, there are numerous procedures available. Intradiscal electrothermal treatment, known as IDET for short, was very popular for a while but has fallen out of favor due to lack of long term pain relief. Nucleoplasty has gained somewhat in popularity due to some initial promising results.
Intradiscal steroid injections may help along with facet injections, medial branch blocks and radiofrequency ablation if facet arthritis is also present. If the tear in the outer part of the disc is causing a chemical inflammation with nerve root irritation, then an epidural steroid injection may relieve associated leg pain.
What are the Outcomes for Patients with Degenerative Disc Disease?
Studies have shown that with considerable conservative pain management treatment, over 75% of those with degenerative disc disease are able to achieve a satisfactory nonsurgical baseline. Patients are typically able to avoid disability, depression and get back to working and playing with their kids.
Over 80% of patients who undergo spinal decompression therapy achieve significant pain relief for upwards of six months. With intradiscal steroid injections, over 50% of patients are able to achieve months of pain relief (Spine, 2004).
There are studies ongoing looking at regenerative medicine treatments into the disc space with stem cell injections and platelet rich plasma therapy. No definitive results are available, but the treatments have shown promise so far. The disc itself has a very slow metabolism and a poor blood supply. Therefore, anything that can help the disc increase its ability to heal may work well for reversing the degeneration.