Low back pain is one of the most common reasons people miss work, limit activities, or seek medical care. Yet many patients struggling with discogenic back pain – pain that comes from a damaged or degenerated spinal disc – are left without solutions. Because this condition has a subtle appearance on imaging and doesn’t typically cause nerve compression, it can be misunderstood or misdiagnosed.
If you’re just joining our series, you may want to start with:
When Your MRI Looks “Normal,” but Your Back Still Hurts
One of the biggest challenges with discogenic pain is that an MRI can look unremarkable. Without an obvious disc herniation, some patients are told “everything looks normal” even while they’re experiencing significant pain. But disc degeneration, tiny annular tears, or inflammatory changes inside the disc can generate deep, aching pain that doesn’t radiate down the leg the way pain from a compressed nerve does.
The Impact: Long-Term, Activity-Limiting Pain
When discs are torn or damaged, it is possible the body can heal on its own. When it doesn’t, discogenic pain tends to be persistent and life-altering. The pain can be subtle at baseline, with more intense flares that occur after sitting, bending, or lifting. Over time, patients often scale back exercise, travel, and daily routines, to avoid those pain flares. Patients become frustrated because they’ve been told nothing is seriously wrong (or that nothing can be done).
Why Standard Care Often Falls Short
Typical first-line treatments such as rest, activity modification, physical therapy, and medications can help but often don’t provide long-lasting improvement. Some patients may receive steroid injections, which provide temporary pain reduction but do not repair the disc or slow the degenerative process.
When pain persists despite these approaches, options can feel limited. Surgical solutions for discogenic pain are few, and traditional spine surgery isn’t always effective in these situations.
Emerging Evidence for Orthobiologic Treatments
Research has begun to explore the potential of platelet derived orthobiologics to address disc degeneration at its source. A recent study evaluated the effectiveness of higher-concentration platelet-rich plasma (PRP) injections for patients with chronic lumbar discogenic pain. Researchers analyzed outcomes from 37 patients who received intradiscal injections with PRP concentrated more than tenfold (>10×) and compared their results to a historical group treated with lower concentrations (<5×). At an average follow-up of about 18 months, patients who received higher-concentration PRP experienced significantly greater improvements in pain and function, along with a higher satisfaction rate (81% vs. 55%). These findings suggest that PRP concentration plays a key role in clinical outcomes, with more concentrated preparations potentially offering enhanced benefits for disc-related back pain (1).
A Need for Precision & Advanced Treatment Options
Discogenic back pain requires accurate diagnosis and targeted treatment. At New Regeneration Orthopedics, our physicians use advanced imaging and diagnostic techniques to pinpoint painful discs. When appropriate, we offer platelet-rich plasma (PRP) delivered with precise, image-guided placement into the affected disc and/or supporting structures.
Key Takeaway
Discogenic back pain is common but frequently overlooked. Even in the absence of disc herniations, there can still be (painful) disc abnormality. With an accurate diagnosis to find these abnormal discs, and advanced non-surgical options to improve the integrity of these discs, patients may reduce pain and improve function without rushing to surgery.
Next step: If you’ve been told “your MRI is normal” but your back pain persists, read our previous posts, and explore how precision orthobiologic care might help.
References:
- Lutz, Cole et al. “Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain.” International orthopaedics vol. 46,6 (2022): 1381-1385. doi:10.1007/s00264-022-05389-y
