Management of Degenerative Disk Disease and Chronic Low Back Pain

Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans.

Low back pain (LBP) affects every population and is one of the world’s foremost debilitating conditions. Such pain may lead to diminished function and quality of life, psychological distress, and loss of wages. LBP is one of the most common conditions motivating individuals to seek medical care and often results in prolonged therapeutic interventions. Therefore, LBP is a global burden associated with severe socioeconomic and health care consequences.

LBP can be divided into several groups based on cause: 80% to 90% mechanical (eg, degenerative disk or joint disease, vertebral fracture, deformity); 5% to 15% neurogenic (eg, herniated disk, spinal stenosis), 1% to 2% nonmechanical conditions (eg, neoplastic disease, infection, inflammatory), 1% to 2% referred visceral pain (eg, gastrointestinal disease, renal disease, abdominal aortic aneurysm), and 2% to 4% other (eg, fibromyalgia, somatoform disorder, malingering). Typically, patients with LBP complain of local pain aggravated by mechanical loading, usually at worst when being upright, and they have no or minimal symptoms at rest. It is generally agreed that intervertebral disks are a major tissue source in chronic LBP. Typically, chronic LBP has been defined as pain occurring for 3 months or more, frequently recurring, or lasting beyond the normal healing period for a low back injury. If, in case of prolonged LBP, magnetic resonance imaging (MRI) is obtained and a common finding is disk degeneration at the 2 or 3 lowest lumbar levels ( Figs. 1–3 ).