The Role of Central Hypersensitivity in the Determination of Intradiscal Mechanical Hyperalgesia in Discogenic Pain

Pain Medicine

Published Online: 23 Apr 2010 

Juerg Schliessbach, PhD,* Lars Arendt-Nielsen, PhD, ^† Paul Heini, MD, ^‡ and Michele Curatolo, MD, PhD*

  *University Department of Anaesthesiology and Pain Therapy,
  ^‡ University Department of Orthopaedic Surgery, Inselspital Bern, Switzerland;
  ^† Centre for Sensory Motor Interaction, Laboratory for Experimental Pain Research, University of Aalborg, Aalborg, Denmark

Correspondence to  Juerg Schliessbach, PhD, University Department of Anaesthesiology and Pain Therapy, Inselspital, 3010 Bern, Switzerland. Tel: +41-31-632-78-17; Fax: +41-31-381-30-28; E-mail: juerg.schliessbach@insel.ch.

Copyright © 2010 American Academy of Pain Medicine

ABSTRACT

Objective. The primary aim of the present study was to investigate whether there is a relationship between central hypersensitivity (assessed by pressure pain thresholds of uninjured tissues) and intradiscal pain threshold during discography. The secondary aim was to test the hypothesis that peripheral noxious stimulation dynamically modulates central hypersensitivity.

Patients. Twenty-four patients with positive provocation discography were tested for central hypersensitivity by pressure algometry before and after the intervention with assessments of pressure pain detection and tolerance thresholds. Intradiscal pain threshold was assessed by measuring intradiscal pressure at the moment of pain provocation during discography. Correlation analyses between intradiscal pain threshold and pressure algometry were made. For the secondary aim, pressure algometry data before and after discography were compared.

Results. Significant correlation with intradiscal pain threshold was found for pressure pain detection threshold at the toe (regression coefficient: 0.03, P = 0.05) and pressure pain tolerance thresholds at the nonpainful point at the back (0.02, P = 0.024). Tolerance threshold at the toe was a significant predictor for intradiscal pain threshold only in multiple linear regression (0.036, P = 0.027). Detection as well as tolerance thresholds significantly decreased after discography at the painful and the nonpainful point at the back, but not at the toe.

Conclusions. Central hypersensitivity may influence intradiscal pain threshold, but with a modest quantitative impact. The diagnostic value of provocation discography is therefore not substantially impaired. Regional, but not generalized central hypersensitivity is dynamically modulated by ongoing peripheral nociceptive input.