Is my back pain caused by a pinched nerve or degenerated disc?

When back pain is caused by a spinal disc problem, the source of the pain is either from a nerve being irritated by a protruding disc, or from the disc itself. Differentiating between the two can cause confusion, as doctors may use a variety of terms to describe the problem, such as a slipped disc, protruding disc, pinched nerve, and/or degenerated disc.

Pinched nerve pain

When a spinal disc causes mechanical compression, irritation, or inflammation of a nearby nerve root, it’s not the disc that hurts—it is nerve pain due to intrusion by the disc. Pain from a pinched nerve root in your lower back can radiate along the path of the nerve into your leg and foot. Neurological problems, such as numbness, weakness, tingling and/or a pins-and-needles sensation may also occur.

This type of pain is medically termed as radiculopathy. When radiculopathy occurs due to the irritation or compression of specific nerve roots in the lower back (L4 to S3), it is commonly referred to as sciatica.
Pinched nerves can be caused by:

• Herniated discs
• Spinal stenosis
• Bone spurs that occur as a result of osteoarthritis.

While less common, a pinched nerve may also be caused by other conditions, such as a tumor, infection, or spondylolisthesis.

Degenerated disc pain

If the source of your back pain is the intervertebral disc, it is called discogenic back pain. A spinal disc may degenerate due to wear and tear or trauma and cause pain by the following mechanisms:

• Inflammation. As the disc degenerates, inflammatory proteins may be released into the disc space. A degenerated disc may also herniate, causing its inner inflammatory contents to leak out. These inflammatory agents may irritate or inflame nearby nerves, causing pain. Herniated discs can also cause pinched nerve pain as described above.
• Shrinkage. Degeneration may cause dehydration within the disc, resulting in loss of fluid content and shrinkage. The degree of disc shrinkage can cause narrowing of the spinal canal, leading to radiculopathy.
• Motion segment instability. Disc degeneration can also cause the spinal segment to become unstable and not be as effective in resisting the motion in the spine.

As the body attempts to counteract the inflammation, instability, and pain, the muscles in the area may spasm, which can cause sharp, shooting pain, worsening the back pain. Pain from a degenerated disc may be localized or may radiate into your leg (radiculopathy)

Focus on the cause of your pain

By focusing on the underlying cause of your pain, as opposed to only symptom relief, you will have the best chance of finding an appropriate treatment plan for long term relief. Chiropractic has been shown to be very effective by helping the body heal itself. It is non-invasive and does not use medications, making it an optimal choice for many patients. There are various treatments that a chiropractor may use or recommend.

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References

• Lee YC, Zotti MG, Osti OL. Operative Management of Lumbar Degenerative Disc Disease. Asian Spine J. 2016;10(4):801–819. doi:10.4184/asj.2016.10.4.801
• Donnally III CJ, Hanna A, Varacallo M. Lumbar Degenerative Disk Disease. [Updated 2019 Sep 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448134/
• Fujii K, Yamazaki M, Kang JD, et al. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus. 2019;3(5):e10180. Published 2019 Mar 4. doi:10.1002/jbm4.10180