PROLOTHERAPY FOR DISCOGENIC PAIN AND ANNULAR TEARS
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"My doctor, who does Prolotherapy, has said that my chronic pain is likely due to discogenic pain (pain coming down from the torn disc itself). He said that he does not believe Prolotherapy can help. Everything I have read about discogenic pain is horrible. Some say it cures itself in 2 years or so, others say that it is chronic and will never go away. Have you had success treating patients with this condition?"
The answer is a resounding yes! When other Prolotherapists say “not a candidate,” often we believe the opposite is true.
MRIs, CT scans and Discograms are all types of imagining techniques that show problems in the discs. The real problem however is that you can not definitely correlate that the finding on imaging correlates with a person’s symptoms. In other words, people have degeneration in discs, annular tears and other abnormalities and have no symptoms. Your disc bulges every time you bend over. So disc bulging by itself doesn't mean that is causing a person’s symptoms. In other words, the history is the most important determining factor in the majority of pain cases including low back and neck pain. Imaging just confirms what the clinician already knows.
If someone has exhausted all possible treatment options including Prolotherapy and then is considering surgery, in that instance an imaging technique like MRI, discogram or CT scan makes sense. For the person not contemplating surgery, how will getting the MRI or discogram change the course of treatment? If it won’t change the course of treatment why get the scan?
The discs in the spine have a gelatinous material in the middle and are surrounded by ligamentous tissue called the annulus. This ligamentous tissue can tear. This is an annulus tear. Also when the ligamentous tissue gets stretched it can cause buldging discs. Ultimately if the condition continues the disc material in the middle can herniate (out through) the annulus and pinch on a nerve.
Typically discogenic pain gives symptoms of low back pain that is worse with prolonged standing or sitting. Pain can go down the buttocks or down the back of the leg, but typically stays over the knee. As you can imagine these types of symptoms can occur with sacroiliac problems, facet joint issues, and other low back conditions.
As you all know I like simple. Typically disc problems are posterior. Every time we bend over we have increased pressure on the posterior (back) portion of the disc. So if someone’s pain is increased with flexion (like bending down or sitting) then we know the problem is occurring posterior. If the pain is central (right in the midline of the lumbar spine, not sacroiliac joints), then most likely it is discogenic pain. What the person needs is to increase the anterior pressure forces.
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