Chemical

Theoretically, if a drug or chemical compound could block nerve endings or stabilize the inflammatory process, it may potentially be beneficial in the treatment of discogenic low back pain. Some practitioners believe it is reasonable to use intradiscal injections (injections into the disc itself) for alleviating discogenic low back pain. Two compounds that have received considerable attention are:

Intradiscal Methylene Blue (MB)

  • Based upon the pathophysiology of disc degeneration, scientists hypothesized, if the nerve fibres and nerve endings growing into the disc along annular tears could be destroyed, discogenic pain would be alleviated. This is the basis for the recent investigation of methylene blue, a chemical capable of seeking and destroying nerve endings.
  • Early studies on the use of Methylene Blue in patients with IDDS (Internal Disc Disruption Syndrome) were very encouraging, yet controversial. One randomized controlled trial showed MB to be both safe and efficacious. However, these results have yet to be duplicated. Therefore this chemical is rarely used in the treatment of discogenic back pain, at present.

Intradiscal Corticosteroids

  • Basic scientific studies have identified enzymes and inflammatory mediators in degenerated disc tissue specimens. Thus, because of their anti-inflammatory properties, one can rationalize the use of corticosteroids in the treatment of discogenic pain (Specifically, DDD).
  • Studies investigating the efficacy of intradiscal corticosteroid injections have yielded mixed results. A review of the literature shows that if you inject steroids into the disc of every patient with the diagnosis of discogenic low back pain, the outcomes are unimpressive. However, if you are choosy about which patients are offered intradiscal corticosteroids, the results are much more encouraging! It seems patients with moderately severe DDD with inflammatory endplate changes (seen on MRI) have a much better chance of obtaining sustained relief from the procedure. Thus, the selective use of intradiscal corticosteroid injections is a viable option in discogenic low back pain patients.