Lumbar Discogenic Pain: State-of-the-Art Review
| Autor: | Charles Aprill, Richard Derby, Nikolai Bogduk |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Discography Magnetic resonance imaging Intervertebral disc General Medicine State of the art review Anesthesiology and Pain Medicine Lumbar medicine.anatomical_structure Lumbar discogenic pain medicine Back pain Physical therapy In patient Neurology (clinical) medicine.symptom business |
| Zdroj: | Pain Medicine. 14:813-836 |
| ISSN: | 1526-2375 |
| DOI: | 10.1111/pme.12082 |
| Popis: | Objective To test the null hypotheses that: lumbar intervertebral discs cannot be a source of pain; discs are not a source of pain; painful lumbar discs cannot be diagnosed; and there is no pathology that causes discogenic pain. Methods Philosophical essay and discourse with reference to the literature. Results Anatomic and physiologic evidence denies the proposition that disc cannot be a source of pain. In patients with back pain, discs can be source of pain. No studies have refuted the ability of disc stimulation to diagnose discogenic pain. Studies warn only that disc stimulation may have a false-positive rate of 10% or less. Internal disc disruption is the leading cause of discogenic pain. Discogenic pain correlates with altered morphology on computerized tomography scan, with changes on magnetic resonance imaging, and with internal biophysical features of the disc. The morphological and biophysical features of discogenic pain have been produced in biomechanics studies and in laboratory animals. Conclusions All of the null hypotheses that have been raised against the concept of discogenic pain and its diagnosis have each been refuted by one or more studies. Although studies have raised concerns, none has sustained any null hypothesis. Discogenic pain can occur and can be diagnosed if strict operational criteria are used to reduce the likelihood of false-positive results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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