title: Lumbar discogenic pain: state-of-the-art review.
abstract: 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.
authors.affiliation: University of Newcastle, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, New South Wales, Australia. nbogduk@bigpond.net.au
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bogduk
authors.forename: Charles
authors.initials: C
authors.lastname: Aprill
authors.forename: Richard
authors.initials: R
authors.lastname: Derby
mesh_terms: D001416:Back Pain / Q000209:etiology* / Q000503:physiopathology*; D019317:Evidence-Based Medicine; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000503:physiopathology*; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000503:physiopathology*; D008959:Models, Neurological; D013116:Spinal Cord / Q000503:physiopathology*