Zhou YiLi, Abdi Salahadin
University of Florida, Comprehensive Pain Management, Lake City, FL 32055, USA.
Clin J Pain. 2006 Jun;22(5):468-81. doi: 10.1097/01.ajp.0000208244.33498.05.
Diagnosis and treatment of lumbar discogenic pain due to internal disc disruption (IDD) remains a challenge. It accounts for 39% of patients with low back pain. The mechanism of discogenic pain remains unclear and its clinical presentation is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of IDD. However, relative low sensitivity (26.7% to 59%) and high false-positive (24%) and false-negative (38%) rates reduce the value of MRI in screening for the existence of painful IDD. Provocative discography can provide unique information about the pain source and the morphology of the disc. It may also provide information for selecting appropriate treatment for the painful annular tear. Adjunctive therapies, including nonsteroidal anti-inflammatory drugs, physical therapy, rehabilitation, antidepressants, antiepileptics, and acupuncture, have been used for low back pain. The value of these treatments for discogenic pain is yet to be established. Intradiscal steroid injection has not been proved to provide long-term benefits. Intradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. A block in the ramus communicans may interfere with the transition of painful information from the discs to the central nervous system. Disc cell transplantation is in the experimental stage. It has the potential to become a useful tool for the prevention and treatment of discogenic pain. Minimally invasive treatments provide alternatives for discogenic pain with the appeal of cost-effectiveness and, possibly, less long-term side effects. However, the value of most of these therapies is yet to be established. More basic science and clinical studies are needed to improve the clinical efficacy of minimally invasive treatments.
椎间盘内破裂（IDD）所致腰椎间盘源性疼痛的诊断和治疗仍然是一项挑战。它占腰痛患者的39%。椎间盘源性疼痛的机制尚不清楚，其临床表现也不典型。磁共振成像（MRI）可发现高强度区，作为IDD的间接指征。然而，相对较低的敏感性（26.7%至59%）以及较高的假阳性（24%）和假阴性（38%）率降低了MRI在筛查疼痛性IDD存在方面的价值。激发性椎间盘造影可提供有关疼痛源和椎间盘形态的独特信息。它还可为选择合适的治疗方法治疗疼痛性环状撕裂提供信息。辅助治疗，包括非甾体抗炎药、物理治疗、康复治疗、抗抑郁药、抗癫痫药和针灸，已用于治疗腰痛。这些治疗方法对椎间盘源性疼痛的价值尚未确定。椎间盘内注射类固醇尚未被证明能带来长期益处。椎间盘内电热疗法可能为一组精心挑选的患者提供一些疼痛缓解。尚未发现椎间盘内射频热凝术有任何益处。交通支阻滞可能会干扰疼痛信息从椎间盘向中枢神经系统的传递。椎间盘细胞移植尚处于实验阶段。它有可能成为预防和治疗椎间盘源性疼痛的有用工具。微创治疗为椎间盘源性疼痛提供了替代方案，具有成本效益高且可能长期副作用较少的吸引力。然而，这些疗法中的大多数价值尚未确定。需要更多的基础科学和临床研究来提高微创治疗的临床疗效。
