Tender Point Examination in Low Back Pain Patients may improve the Understanding of Pain and the Management. Degenerative Disc Disease or Pain Syndrome, or Both?

Author(s): Ole Kudsk Jensen

Introduction

In the management of non-specific low back pain (LBP) patients, reassuring information to the patient is essential as highlighted in LBP guidelines. However, it is not easy to inform about non-specific LBP that has no known pathoanatomic cause [1]. In acute LBP with no imaging of the lumbar spine, the patient may accept the explanation ‘non-specific LBP’ supplied by information on the favorable prognosis and guidance of the management. However, in more chronic cases with disability, where the results of magnetic resonance imaging (MRI) are available, explanation of pain is more difficult [2,3]. In a patient with high-intensity long-lasting back pain and no or little degenerative changes of the lumbar spine, it is a challenge to inform about back pain. And it is also difficult to understand and explain the role of degenerative changes in back pain in the absence of radicular pain, since degenerative changes are frequent in people without back pain. Disc degeneration is primarily due to age and heredity [4] and occurs in over 50% over the age 50 in people without back pain. At 80 years, more than 80% have degenerative changes [5]. However, in people aged 50 or younger, disc protrusion, disc extrusion, disc degeneration, disc bulge, spondylolysis and type 1 Modic changes occur more often in people with back pain than in people without back pain [6], so these changes may contribute to back pain. Still, these changes are also prevalent in pain-free individuals, with the exception of disc extrusion only occurring in about 2-7% of people without back pain and spondylolysis in about 2%.