Low back pain costs the U.S. about $100 billion dollars per year. While there are numerous causes of back pain, “discogenic,” or pain caused by a disc, makes up about 39 per cent of all low back pain cases. Diagnosis of the disc as the cause of pain is challenging as the gold standard diagnostic, “provocative discography,” is known to frequently misdiagnose disc pain. Additionally, discogenic back pain is difficult to treat due to psychological and emotional factors affecting the perception of the pain and often surgery does not alleviate symptoms.
If surgery is not the most effective treatment for discogenic pain, then what is? Researchers recently had this question and combed the research to find evidence to back up available treatment options. They found 11 quality studies investigating traction therapy, ablative techniques (either via methylene blue injections to deaden nerve endings or by heating them to destroy them) and injections.
Lidocaine injections were found to be just as effective as steroid injections in six of the studies. There was also no difference in reported pain with traction therapy versus placebo traction. Methylene blue injections proved effective in one study for two years after the procedure. (This was the only quality study that the authors could find on the topic, however, so more research is needed to see if the same results are obtained.) Nerve ablative therapies, with either radio frequencies or electricity, was found to not be effective for the general population because of the coinciding disability that comes with it. There also still remains a debate over which portion of the nerves to destroy for greatest benefit.
Overall, the two take-home points from the evidence review are that methylene blue injections are showing promise but there is more research needed and that there are no notable differences between steroid and lidocaine injections with pain relief. Discogenic pain remains allusive both diagnostically and with treatment, but hopefully with further research future treatments can be more specific and effective.