Going 'Round and 'Round on Tests for the Problem DiscThe cause of most back pain remains a mystery. Researchers are trying to find clues to help doctors treat the problem. Knowing the cause would help direct treatment. Specific remedies could be provided.
There is a test called discography that can be used to see if low back pain is being caused by disc disease. The disc is an oval-shaped cushion located between the bones of the spine. Pain with disc disease can occur when there is a tear in the covering around the disc. The tear itself can cause pain. It may also produce inflammation and pain due to irritation of the nerves near the problem disc.
One group of doctors at the Stanford University School of Medicine used discography to test an idea. They wanted to see if this test could prove the disc was the source of back pain. A dye is injected directly into the disc. The patient's pain response is charted, and an X-ray of the disc is taken. Two groups of patients were tested. One group had a mild but persistent backache. The second group had chronic low back pain.
The hope was to find a test that could detect disc disease when it is the primary cause of back pain. Current ways to image the parts of the spine tend to show a spectrum of degenerative changes, regardless of whether a person has pain or not. Also, psychological and social factors are known to influence back pain. Finding a single test to rule out one cause of back pain would be helpful.
After studying all the results, the researchers made several conclusions. Discography isn't a reliable test for disc disease as the cause of the back pain. Both groups had equal amounts of positive test results. The group with chronic low back pain was more likely to report severe pain at many levels. However, this group didn't have more disc damage when examined with magnetic resonance imaging (MRI).
The cause of chronic low back pain still remains a mystery. Discography couldn't be used to separate those patients with back pain from those with disc disease. There was an equal number of positive tests, even among people who had mild back pain that went away.
Eugene J. Carragee, MD, et al. Provocative Discography in Volunteer Subjects With Mild Persistent Low Back Pain. In The Spine Journal. January/February 2002. Vol. 2. No. 1. Pp. 25-34.
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