What is the source of chronic low back pain and does age play a role?

Michael J DePalma, Jessica M Ketchum, Thomas Saullo
Pain Medicine: the Official Journal of the American Academy of Pain Medicine 2011, 12 (2): 224-33

OBJECTIVE: The objective of this study was to estimate the prevalence, mean age, and association of prevalence and age of lumbar internal disc disruption (IDD), facet joint pain (FJP), sacroiliac joint pain (SIJP), spinal and pelvic insufficiency fractures, interspinous ligament injury/Baastrup's Disease, and soft tissue irritation by fusion hardware.

DESIGN: The study's design was a retrospective chart review.

SETTING: The study was set in an academic spine center.

PATIENTS: A total of 378 cases from 358 patients were reviewed of which 170 cases from 156 patients who underwent diagnostic procedures were included.

INTERVENTIONS: Discography, dual diagnostic facet joint blocks, intra-articular sacroiliac joint injections, anesthetic injections of painful interspinous ligaments/opposing spinous processes/posterior fusion hardware, or percutaneous augmentation were performed.

OUTCOME MEASURES: Prevalence and age were analyzed for each diagnosis group.

METHODS: Patients with recalcitrant low back pain underwent diagnostic procedures based on their clinical presentation until the pain source was identified.

RESULTS: The prevalence of internal disc disruption, facet joint pain and sacroiliac joint pain was 42%, 31%, and 18%, respectively. Patients with internal disc disruption were significantly younger than those with facet joint pain or sacroiliac joint pain. Increased age was associated with a decreased probability of internal disc disruption and increased probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain until approximately age 70.

CONCLUSION: Our data confirm the intervertebral disc as the most common etiology of chronic low back pain in adults. Based on our sample, the younger the patient, the more likely low back pain is discogenic in origin. Facetogenic or sacroiliac joint pain is more likely in older patients.

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