Imaging back pain : part 1

Abstract

Managing back pain is often a complex diagnostic and therapeutic challenge because of the wide variety of causes. While direct neurological impingement by a herniated disc or bone is a frequent cause, inflammatory disease, and associated inflammation-inducing cytokines also play a highly active role in generation of back pain. The following article will discuss microscopic and macroscopic mechanisms that lead to back pain, as well as MRI imaging clues that help identify these mechanisms. Knowledge of these mechanisms and the ability to detect them through imaging findings help guide clinical management of back pain. Back pain is one of the most common clinical problems worldwide. It is estimated that back pain affects up to 10% of the global population at any given time. It causes considerable economic burden on individuals, families, employers, and the state. There are two mechanisms causing back pain: mechanical (macroscopic) and non-mechanical (microscopic). Back pain may also be classified based on the anatomical location as (a) discogenic pain, (b) neuropathic pain, (c) osseous pain, (d) facetogenic pain and (e) paraspinal/myofascial pain. Part 1 in this three-part series of articles will deal with the complex subject of the causes of discogenic pain with special reference to MRI findings that help us understand the pain mechanisms and guide management.