title: An update on the management of chronic lumbar discogenic pain.
abstract: Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY 42003, USA.|Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY 40292, USA.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.affiliation: NeuroInterventional Services & Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications*; D007405:Intervertebral Disc Displacement / Q000150:complications*; D059408:Pain Management; D016896:Treatment Outcome
keywords: behavioral therapy; chronic lumbar discogenic pain; epidural injections; intradiscal therapies; lumbar disc replacement; lumbar fusion; lumbar provocation discography; multidisciplinary rehabilitation; physical rehabilitation