Idiopathic disc pain is a very common occurrence in the majority of diagnosed patients, since in many cases, no clear cut pathological process can be identified as sourcing the symptoms. Herniated discs are not inherently painful, unless they influence the form or function of some other sensitive anatomical tissue, such as a nerve root or the spinal cord.
Many herniated discs exist, but do not create any pain at all. In other patients, back pain is severe, yet does not correspond to the expected symptomatic profile demonstrated by the anatomical disc condition.
article will provide explanations for some forms of idiopathic pain,
but more importantly will discuss why far more cases of suspected disc
pain should actually be considered idiopathic, since no definitive
symptom-generating process can be found in direct relation to the disc
Ok, so a person has back pain and goes to the doctor for an exam. The doctor orders an MRI and the test clearly shows a small herniation at L4/L5, for example.
The test indicates that the herniation is not impinging on the neuroforaminal spaces, so no pinched nerves exist. The test also shows that this small centralized herniation is barely touching the thecal sac, which surrounds the spinal cord.
There is no obvious reason for the pain, yet pain exists. An enlightened doctor would immediately look for other explanations for this idiopathic back pain which does not seem to be related to the disc at all. However this is rarely the case.
Most doctors will merely see the incidence of a herniated disc as the perfect scapegoat on which to blame the painful symptoms, even though the pain does not even exactly correspond to the locations expected from a L4/L5 disc pathology. And so it begins…
The patient is placed into a treatment program designed to work at resolving that L4/L5 herniation. Conservative modalities do not help much, nor do minimally invasive techniques, such as epidural injections. The patient still has pain and their symptoms have actually worsened with time and treatment.
Once again, an enlightened doctor would question why this patient still has pain after weeks, but this patient has endured suffering for 3 years now and no one seems to think this is strange. This is almost unreal, since most herniations resolve in 2 to 8 weeks and are extremely unlikely to cause pain for years, especially when there seems to be no concrete reason for the symptoms to begin with.
Eventually, this patient is referred for herniated disc surgery and undergoes some form of barbaric and unnecessary torture.
Our poor patient recovers nicely from surgery, but still has pain. The surgeon tells them it is just residual discomfort from the operation and that it will pass. Well, days turn into weeks, then months and the pain is worse than ever. Now the patient can barely move and has suffered a reduction in their normal range of motion, due to surgical trauma. The surgeon seems puzzled and eventually stops returning the patient’s calls, since his insurance company fears litigation risks. It is a sad scene to be sure.
Unfortunately, this is not a fictional scenario. It is a compiled characterization based on literally thousands of letters and emails I receive every year from patients who have lived through this hellish experience.
You must take the lead in your own treatment and understand the facts about herniated discs. Do not let some care provider push you down the wrong road towards treatment and possibly eventual spinal surgery, when the disc condition is not the obvious source of lasting pain.
Sure, the herniation exists, but so what? Most herniated discs are not painful at all, especially if they are proven by MRI to be enacting no neurological symptoms.
There are many other explanations for chronic disc pain. Herniated discs are usually not the answer to the all too common questions: "Why is my back hurting and why won't it get better?"