Back pain, especially in the lower back, is the single most common reason for sick leave among Swedish men, and the second most common reason among women. About 80 per cent of the Swedish population suffer from low back pain at some point in life.
This problem is costly for the society and studies indicate that the costs for back pain in the Western world are about 1-2 per cent of GNP, including healthcare and sick-leave expenses.
Problems with intervertebral discs, connecting the vertebraes in the spine, are believed to be the most common reason for low back pain. Discography, where a contrast agent is injected into a disc is a method trying to determine which disc that is causing the pain. If the patient experience pain when a disc is injected, it has been assumed that this disc is causing the problem.
However, researchers at the Sahlgrenska Academy, University of Gothenburg, have now shown that the method is unreliable and should not be used.
Affects adjacent discs
Doctoral student Hanna Hebelka Bolminger’s research shows that the injection given with discography increases the pressure not only in the injected disc, but also in adjacent discs. Consequently, the pain reported by the patient may come from a different disc than the one being tested.
Discography is already a controversial procedure, partly because of disagreements regarding its validity and partly because of the risk of causing damage by the needle punction. Nevertheless, the method has remained in use, internationally in particular.
‘Our conclusion is that there is a considerable risk of misdiagnosing non-painful discs as painful, and that discography therefore should be avoided. Especially since spine surgery, which often is a major procedure, risks to be performed at the wrong disc levels if they are based on discography findings,’ says Hebelka Bolminger.
Improving imaging methods
‘The problem is that there are no good diagnostic methods to determine the cause of non-specific back pain. For example, you can’t “visualize” pain using X-ray or other imaging techniques, such as MRI, since painful and non-painful discs can appear the same says Hebelka Bolminger, who believes that the research in this area should focus on improving imaging methods.
The doctoral thesis Discogenic Pain – A Diagnostic Challenge will be presented and defended on the 21 February.
Hanna Hebelka Bolminger, MD, doctoral student at the Sahlgrenska Academy, University of Gothenburg
+46 (0)705 667 867
Supervisor Tommy Hansson, +46 (0)703 283 406; [email protected]