Discogenic non-radicular low back pain: a clinical case report

Abstract

Back pain is often considered under the diagnostic heading “nonspecific pain” because of difficulties in identifying the primary source of pain in everyday clinical practice. However, despite the difficulties in identifying the specific etiology of chronic low back pain, diagnostic procedures can identify its source in 90% of patients. We report a clinical case of typical discogenic pain. The 6-week pain, which developed after barbell exercising in a 42-year-old man, resulted in the loss of professional employment. The pain was localized to the midline of the lower back (axial pain) and intensified in a sitting position. Computed tomography images demonstrated subchondral changes in L5-S1 vertebral bodies (Modic-1). A holistic diagnostic approach, including a vibration test, made it possible to diagnose the degenerative disc disease (L5-S1 intervertebral disk disease) with subacute discogenic pain. The patient received Dexalgin®25 at a dose of 25 mg x 3 times a day in combination with omeprazole 20 mg per day for 5 days, then the patient was switched to Nimesil 200 mg per day in two divided doses. A complex drug of the SYSADOA group containing glucosamine and chondroitin was used as adjuvant therapy. Pain intensity was reduced by 70 % at 6 weeks (2 points on VAS scale, which corresponds to the level of mild pain syndrome) as compared to the baseline level. This clinical case stresses the importance of accurate diagnosis of back pain and demonstrates the potential for successful combination non-surgical treatment of discogenic pain in primary outpatient settings.