FAQ’s on Degenerative Disc Disease
What is it?
Degenerative Disc Disease, or DDD for short, is a very common cause of low back pain. It is not really a “disease”, so the actual term is an unfortunate misnomer. It’s not something that can be “caught” from someone else like a virus and it is not always progressive as the word “disease” suggests.
Each level of the human spine has an intervertebral disc acting as a shock absorber. Humans have incredible range of motion in the spine due to the collective mobility of the discs.
The analogy that best fits the disc is that of a jelly donut. The inner, jelly part of the disc is called the nucleus pulposus. The harder, outer part of the disc is called annulus fibrosus. This outer part is the only portion of the disc that can feel pain as there are nerve endings.
Notice the tear in the disc with the inner part starting to squeeze out.
Notice the “tear” in the back part of the disc and the “jelly” squeezing out.
The jelly has no ability to feel pain, but it can create pain. If there is a tear in the outer portion and some of the jelly leaks out, it can inflame nearby nerve roots (or nerve endings) due to its inflammatory proteins.
As degeneration of the disc occurs, the annulus can suffer tears. As there are nerve endings in this area, these tears can lead to back pain as these nerve endings are irritated from the resulting abnormal motion. Muscle spasm can result, and the pain may also radiate in the buttock area and sides of the back.
Why Does it Occur?
As wonderful as a healthy disc is at absorbing shock and allowing range of motion, it is fairly fragile. It has very poor blood supply and minimal reparative power on its own. Blood is necessary for repair. Without it, the disc just cannot fix itself.
When a disc is damaged, the area starts to see abnormal motion and water starts to get
This is what a normal disc looks like with a normal outer part called the annulus fibrosus and a contained inner section called the nucleus pulposus.
Looking down on a normal intervertebral disc. The outer part is called the annulus fibrosus and the inner part is the nucleus pulposus.
lost. This may occur from one significant traumatic injury like an auto crash, but most commonly it is due to poor genetics or repetitive trauma (like being a truck driver or an athlete for many years).
Only a small percent of those with DDD experience significant pain. But in those afflicted, it can cause significant daily symptoms and prohibit people from playing with the kids, enjoying recreational activities, and hamper one’s concentration at work.
How Common is DDD?
Degenerative Disc Disease is extremely common. In fact, most adults over the age of 50 have some x-ray signs of the problem. But few actually have pain from it. Between the ages of 30 and 55 is prime time for someone to have symptoms from a degenerative disc.
There have been studies looking at the extent of DDD on imaging studies, with the most telling from Boden et al in 1990. Thirty five percent of people having no back pain at all showed evidence of DDD on MRI’s. So just having the problem on an MRI does not mean pain will ensue.
All in all, 5% of America deals with chronic back pain, which amounts to over 10 to 15 million people. If one out of five of those is dealing with DDD, that means approximately 2 to 3 million individuals in America are dealing with DDD.
How Does it Occur?
The healthy disc is mostly comprised of 3 things: 80% water, and the other 20% is collagen and items called proteoglycans. The main source of the problem when degenerative disc disease occurs is loss of water.
As individuals age, people lose water in the tissues. When coupled with trauma or poor genetics, one or multiple discs may dehydrate some and experience abnormal motion and tears. This may lead to pain, or in most cases people have no clue it’s occurring since it’s not painful most of the time.
Why some people have horrific pain from DDD and others have none is poorly understood. Right now it’s mostly theoretical, with ideas floating about inflammation reactions and differences in nerve ending sensitivity/penetration.
What are the Common Symptoms of DDD?
If pain is experienced from degenerative disc disease, it is usually intermittent and related to activity. At times it may be non-existent, and at others disabling. The worst position for a person is sitting, since that puts the most pressure on the disc.
Bending, lifting and twisting activities often exacerbate it, with symptoms ranging from low back pain to spasms, leg pain, numbness and tingling. There may not be direct pressure on a nerve root, but simply inflammation.
Usually the pain does not go below the knee. It may come on severely for a few days to weeks, and then may go back to a baseline level again.
Will it worsen as I age?
Usually when an individual with back pain from DDD presents for treatment, the pain has reached its apex. It may get slightly worse over time, but there is no evidence to show DDD continually worsens with time.
In fact, as the disc continues to “stiffen” and dehydrate, one’s back pain often begins to improve.
Should I curtail my activities? What about sports?
Remember that over time, the pain from degenerative disc disease will usually stabilize. In fact, less than 5% of those with symptoms from DDD end up having surgery.
DDD is a quality of life condition. This means pain levels should guide activity levels. If a person is a jogger and back pain continuously results from it, that is a sign the person should cut back or switch to swimming or something like that. There are no hard and fast answers.
Sports can be continued as well, with the same mindset. There is no evidence that being active and competing in sports will accelerate DDD or lead to significant symptoms as a result.
What are the Treatment Options?
Treatment options for DDD are numerous and include exercise/rehab, pain management, activity modifications and nutritional improvements.
- Exercise/Rehab: PT and rehab activities can help substantially. These may include ice/heat, electrical stimulation, TENS Units and activities such as active and passive range of motion, core strengthening, and flexibility training.
- Pain Management treatments include the following:
- Spinal Decompression Therapy – this intermittent spinal traction can help reduce the pain from DDD for months at a time.
- Acupuncture Scottsdale– this ancient Chinese technique has been shown to reduce back pain significantly. How it works is not exactly known, but a recent study confirmed its utility for low back pain (Vickers et al., Arch Intern Med, 2012).
- Interventional pain injections – these may consist of intra-discal injections, facet blocks, or epidural injections. All have potential usage in DDD, and patient symptoms and imaging study will help the pain doctor know what will help.
- Medication management – initially, over the counter acetaminophen and NSAID’s can help a lot. It may be necessary for an Arizona pain management doctor to treat with something stronger. What type of medication and dosage will be dependent on the person’s individual situation. For an acute exacerbation, short term narcotics may be necessary. Chronic narcotics for DDD pain is usually not in a person’s best interest as the risks start to outweigh the benefits.
What are my Chances of Needing Surgery?
Less than 5% of those with DDD end up opting for surgery. No one “needs” surgery for DDD, it is an elective quality of life decision, and one that should not be taken lightly.
Most individuals who undergo nonoperative treatment end up reaching an acceptable baseline level of pain control. They can work, socialize and hang out with their kids. Those activities may not include things like heavy duty mountain biking or playing professional football, but overall the end result is satisfactory.
Surgical outcomes for DDD may be great, or the person may be left with residual pain. Numerous studies in Spine have shown well over 75% good to excellent outcomes, however, the patient selection process is crucial (Carreon et al 2008, Spine).
If you or a loved one is suffering from low back pain and need the best pain management doctors in Arizona, then Arizona Pain Specialists can help. These AZ pain centers have multiple Valley locations serving Phoenix, Mesa, Chandler, Gilbert, Scottsdale, Peoria, Glendale, Goodyear, Avondale, Tempe, Surprise and more.
Arizona Pain has an exceptional success rate with the nonsurgical treatment of DDD. By offering both traditional and alternative treatment options such as chiropractic, physical rehabilitation, acupuncture, medication management, and interventional pain management, the patient outcomes are excellent.
Call (602) 507-6550 Today for one number scheduling.