Functional Pain: Lumbar Disc Disease, Part 1

By | November 19, 2011

The herniated portion of the disc is pressing on the exiting nerve root, but is it causing pain?

The herniated portion of the disc is pressing on the exiting nerve root, but is it causing pain?

If there were ever a chronic pain syndrome that fit the old pathologic anatomy theory of disease, lumbar disc disease would appear to be a perfect candidate. In its simplest for a small section of a single damaged disc makes contact with a single nerve root and produces neuropathic pain in a predictable distribution. The problem is that for every “textbook case” like this that I see, there are 5 that don’t follow the pattern well or at all.

There are many patients who come into the office with severe pain in the distribution of a single nerve root who either no abnormalities or only a tiny disc bulge at that level. Conversely there are many patients whose MRI films show large disc protrusions compressing a nerve root with little or no symptoms. Sometimes there is a large disc protrusion and severe pain but on the wrong side or the wrong level. Clearly a protruding lumbar disc is neither a necessary nor a sufficient condition for lumbar radiculopathy.


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