In the Pain Management field, one of the most common causes of “axial” low back pain (or pain that stays in the back as opposed to shooting down to the legs) is from degenerative disc disease. It is estimated that nearly 266 million people worldwide suffer from pain related to lumbar degenerative disc disease each year. [1]
What are Intervertebral Discs?
Your discs are like your body’s shock absorbers and are located between the bones of the spine, also known as your vertebrae. In addition to acting as the body’s shock absorbers, they work in conjunction with your vertebrae to create a protective barrier for your spinal cord and exiting nerve roots.
Typically, there are 24 intervertebral discs in our body. They consist of a strong fibrocartilagenous external layer, known as the annulus fibrosis, and a gelatinous internal layer known as the nucleus pulposis. [2] The third and final component of a disc is a thin layer of cartilage along the top and bottom of the disc. For simplicity's sake, it is helpful to think of your disc like a jelly donut with a stronger doughy outer layer and a gelatinous inner layer.
What is Degenerative Disc Disease?
Due to both modifiable and unmodifiable risk factors, more on this below, you can develop degenerative disc disease. This occurs as the gelatinous inner layer of your spine begins to dehydrate. This results in loss of disc height and breakdown of the annulus fibrosis and cartilaginous plates.
Typically this occurs when there is a disruption of the fine capillary network of vessels that feed your discs. Since the discs are no longer receiving the nutrients they require, they begin to dehydrate and release cytokines resulting in a degenerative process.
Unmodifiable vs Modifiable Risk Factors
Unmodifiable Risk Factors
These are the things in life you can’t change. For instance, you can’t change your genetic makeup. Unfortunately, a number of twin studies suggest there is a genetic predisposition to developing disc degeneration. [3-6]
You also can’t stop the aging process and are predisposed to developing degenerative disc disease as you do so. However, the jury is still out on this one as some researchers believe it's not necessarily the aging process itself, but the repetitive mechanical loading that occurs with time that is the causative factor. [6]
Modifiable Risk Factors–(aka Your Blueprint for Slowing Degenerative Disc Disease)
Are there any risk factors for degenerative disc disease that we can change? Yes! Let’s take a look how.
Activity Modification
Sports-related injuries and occupations that require frequent, heavy lifting or repetitive tasks may be a contributor to degenerative disc disease. Whenever performing heavy lifting, it is important to do so using good form, making sure to lift from the legs instead of the low back. Ergonomic changes at work can also help reduce the load on your spine when performing repetitive tasks.
Stop Smoking
Smoking is known to have disastrous effects on your cardiovascular system. If you recall the small capillary network that we talked about earlier, which is responsible for nutrient delivery to your discs, you can imagine the problem that this causes. Smoking can disrupt this capillary network resulting in decreased nutrient delivery, disc dehydration, decreased pliability – essentially degenerated discs.
Smoking also causes an increased concentration of carbon monoxide in our bloodstream. Ultimately, this inhibits hemoglobin, your body’s oxygen delivery system, from delivering adequate amounts of oxygen to your tissues such as your intervertebral discs.
A study by Jakoi and colleagues revealed a nearly 6-fold increase in the prevalence of degenerative disc disease in smokers compared to non-smokers. [7]
Maintain a Healthy BMI
Obesity is believed to be a contributor to degenerative disc disease. When a healthy BMI is not maintained, additional weight means additional biomechanical stress is applied to your intervertebral discs on a daily basis. Jakoi also showed that there was a 5-fold increase in the prevalence of degenerative disc disease in obese individuals compared to those who maintained a healthy BMI. [7]
Treatment options
A number of treatment options exist for helping to ease pain associated with degenerative disc disease including:
Activity modification: Avoiding repetitive movements that tend to produce pain, focusing on proper lifting mechanics, and making ergonomic changes at work can all help with pain reduction.
Physical therapy: A physical therapy routine focused on core strengthening and education about proper lifting mechanics can also be helpful for symptom reduction. Aquatic therapy can be considered as it temporarily reduces stress on the discs allowing for therapy to be performed possibly with greater comfort.
Medications: NSAIDs, topical ointments, and skeletal muscle relaxers can also be considered.
Complementary and Alternative Medicine: Acupuncture, chiropractic intervention, massage therapy, yoga therapy, cognitive and behavioral therapy are all treatment modalities that can be considered.
Injections: There are a number of injections that are indicated for treating axial low back pain depending on the pain generator. Medial branch blocks and radiofrequency ablation may be appropriate for patients with degenerative disc disease that also have osteoarthritis of the small joints of the spine known as facet joints.
A body of evidence exists which supports the use of epidural steroid injections as a possible treatment option for discogenic pain. Novel therapies, like intradiscal injections such as platelet-rich plasma (PRP) and stem cells may also help with treating degenerative disc disease and in some instances may even reverse disc degeneration.
Surgical options: Surgical options for treating degenerative disc disease exist, however, this is typically reserved for refractory cases that have not responded to more conservative treatment options. Surgery may include fusion, discectomy with fusion, and artificial disc replacement.
As always, before considering any of the above, it is important that you consult your doctor first for the development of an appropriate treatment plan based on your clinical picture.
We’d love to hear from you. Have you experienced pain related to degenerative disc disease? What treatment options have worked best for you?