If you have been diagnosed with degenerative disc disease, or DDD, and are experiencing back pain, don’t assume your discs are to blame, says Richard Deyo, MD, Kaiser-Permanente Endowed Professor of Evidence-Based Medicine at Oregon Health and Science University, in Portland.
MRI studies show that almost everyone older than age 60 has degeneration of the discs – pads of jellylike tissue with a hard outer rim that separate and cushion the bones of the spine – but most people don’t have back pain. Therefore, the finding of degenerative discs in someone with back pain could well be coincidental, he says.
At the same time, that doesn’t mean disc degeneration isn’t a source of pain – either directly or indirectly, says David G. Borenstein, MD, clinical professor of medicine, division of rheumatology at the George Washington University Medical Center, and author of Heal Your Back: Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain (M. Evans & Company, 2011).
“There’s a big debate about whether discs are painful on their own or whether it’s the surrounding tissues,” says Dr. Borenstein. “The insides of the discs don’t have nerves, but if they are damaged, nerves can grow into them, so there is a question if they are damaged enough, if that by itself can cause pain.”
What is known is that degenerative discs can play a role in osteoarthritis, or OA, of the lower spine, which is painful, says Dr. Borenstein. In the healthy, young spine, he explains, the discs are like pillows between the vertebrae, cushioning the joints of the spine. But as discs wear out over time, they lose water and flatten and become more like pancakes. The loss of cushioning causes the joints of the spine to become weight-bearing joints, which they were not intended to be, and like all weight-bearing joints, they become susceptible to OA, he says.
In fact, OA is the most common cause of low back pain in people between the ages of 45 to 65. In some people, osteoarthritis of the spine leads to another problem – spinal stenosis, a condition in which the overgrowth of bone leads to narrowing of the spinal canal, compressing nerves. Spinal stenosis usually occurs after age 65.
Degenerative Discs May Not Be Real Cause of Back Pain
If you have degenerative disc disease it may or may not be the crux of your back pain.
By Mary Anne Dunkin
If you have been diagnosed with degenerative disc disease, or DDD, and are experiencing back pain, don’t assume your discs are to blame, says Richard Deyo, MD, Kaiser-Permanente Endowed Professor of Evidence-Based Medicine at Oregon Health and Science University, in Portland.
MRI studies show that almost everyone older than age 60 has degeneration of the discs – pads of jellylike tissue with a hard outer rim that separate and cushion the bones of the spine – but most people don’t have back pain. Therefore, the finding of degenerative discs in someone with back pain could well be coincidental, he says.
At the same time, that doesn’t mean disc degeneration isn’t a source of pain – either directly or indirectly, says David G. Borenstein, MD, clinical professor of medicine, division of rheumatology at the George Washington University Medical Center, and author of Heal Your Back: Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain (M. Evans & Company, 2011).
“There’s a big debate about whether discs are painful on their own or whether it’s the surrounding tissues,” says Dr. Borenstein. “The insides of the discs don’t have nerves, but if they are damaged, nerves can grow into them, so there is a question if they are damaged enough, if that by itself can cause pain.”
What is known is that degenerative discs can play a role in osteoarthritis, or OA, of the lower spine, which is painful, says Dr. Borenstein. In the healthy, young spine, he explains, the discs are like pillows between the vertebrae, cushioning the joints of the spine. But as discs wear out over time, they lose water and flatten and become more like pancakes. The loss of cushioning causes the joints of the spine to become weight-bearing joints, which they were not intended to be, and like all weight-bearing joints, they become susceptible to OA, he says.
In fact, OA is the most common cause of low back pain in people between the ages of 45 to 65. In some people, osteoarthritis of the spine leads to another problem – spinal stenosis, a condition in which the overgrowth of bone leads to narrowing of the spinal canal, compressing nerves. Spinal stenosis usually occurs after age 65.
In younger adults, Dr. Borenstein says the most common cause of back pain is muscle injury rather than DDD.
The most common cause of back pain directly related to discs occurs when a disc ruptures – referred to as a herniated disc – and the filling leaks and presses upon the nerve that is coming out of the spine. A herniated disc in the neck may cause arm pain or numbness. In the lower spine a herniated disc may also result in sciatica or leg pain. But this is more commonly a problem for people in their 30s or 40s, rather than older people who are more likely to have disc degeneration.
So what can you do if you’re experiencing back pain? In most cases, treatment is largely the same, regardless of cause, and may include:
- Losing weight. If you are overweight, losing weight can reduce stress on the spine.
- Maintaining physical activity. Gentle exercise, such as walking or yoga, can both keep the back flexible and strengthen the muscles that support the spine.
- Using over-the-counter medications. Most people benefit from acetaminophen, or Tylenol, or nonsteroidal anti-inflammatory drugs, or NSAIDs; however, doctors may prescribe other medications, including corticosteroids, if needed. Always talk to your doctor before taking any medication for pain.
- Waiting it out. Muscle pain usually resolves in a week or two, says Dr. Borenstein, and even the pain from herniated discs gets better with time, although it may take six to eight months.
If your pain persists or is accompanied by other symptoms such as inflammation, fever or weakness, Dr. Borenstein recommends seeing a doctor to uncover the source of your pain and prescribe treatment. In some cases, back pain is not due to strain or aging, but to an inflammatory process such as ankylosing spondylitis that requires different treatment. In other cases, problems like herniated discs or spinal stenosis may require surgical intervention.
