Diagnosing and treating disc pain

1st February 2020

Believe it or not but last Saturday morning I spent over an hour chatting over the phone with my friend Dr Piotr Buczkowski. He is a renowned Spine Pain Specialist. We had met at Medical University twenty odd years ago and then again a few years ago at one of the pain conferences. Dr Buczkowski’s interest has always been discogenic pain, i.e. pain arising from a spine disc. Last year he gave a fascinating lecture on new method of diagnosing discogenic pain. It is a very difficult problem: neither patient history, nor clinical examination, nor  MRI scans can give us a robust answer whether patient suffers from discogenic pain. For many years a gold standard of discogenic pain diagnosis was so called Provocative Discography (PD). It was a fairly cruel procedure when clinician injected under pressure a contrast medium to suspected disc. If the injection caused the same pain as patient experienced daily the PD was considered positive. The procedure was very painful (obviously…) and carried out considerable risks to patient. And the result could be either false positive or false negative. This is was one of the reasons why treating discogenic pain was so challenging and often unsuccessful. Simply we treated a wrong disc.

Magnetic Resonance Spectroscopy (MRS).

Magnetic Resonance Imaging (MRI) has been known for many years. So has Spectroscopy. But the recent advance is a combination of these two into one diagnostic tool. MRI, as we all know, gives us a very detailed image of certain tissues and structures. It is a golden standard in diagnosing spine problems and so on. But the main drawback is that MRI scan is just a picture. If you look at a picture of a boat bobbing on waves you can see exactly that: a boat bobbing on the waves. But you can’t smell the scent, feel the wind and hear a seagull. It is the same with MRI scan: you can see bulging disc but you can’t say whether it is painful disc or not. Some data suggest that as many as 80% of discs which look degenerated on MRI scan are actually not painful.

And here comes Spectroscopy combined with MRI (actually it is simply a piece of software attached to ordinary MRI scanner). Spectroscopy is able to analyse a content of each and every disc and is able to show whether certain pain mediators are present in the disc or not. Some clever researchers compared MRS with PD. The results were striking. MRS was far more accurate in diagnosing painful disc.

Treatment.

Dr Buczkowski rang me on Saturday morning and said: “Hey, I have got this fantastic diagnostic tool. Using MRS I am able to precisely identify painful disc(s). And you have got this exciting new regenerative orthopaedic treatments. Let’s give the patients a unique chance to get a precise diagnosis and modern treatment of their painful disc(s)”. So here we are: we are announcing a new service for patients with low back pain and suspected discogenic pain. We are here to accurately diagnose discogenic pain and carry out  Platelet Lysate or Stem Cells injection into the painful disc(s). And no more Provocative Discography!

To find out more, please, contact us. We are here to help.