Spectroscopy to diagnose back pain

June 18, 2010

Back pain is very common among the adult (and young) population. However, it is not always easy to diagnose the source of the pain. Currently, patients with lower back pain must undergo an invasive procedure known as provocative discography to help determine where the pain comes from. A die is injected into the disk via a needle until the patient reaches his or her pain threshold. Based on the level of pain expressed by the patient, the physician forms the diagnosis.
Nocimed (a Californian-based company) is currently testing Nociscan, a software that combines an MR spectroscopy sequence and postprocessing to identify chemical biomarkers of painful disks (degenerative disk disease MR – DDD MR).
There are two metabolites associated with painful disks: lactate and proteoglycan:
– Lactic acids build up in painful disks (the same phenomenon that makes muscle hurt).
– Proteoglycan holds water in the disks. A normal disk has a high content of water and proteoglycan. However, disk degeneration involves dehydration and proteoglycan breaks down. This also prevents nerve in-growth, creating a permissive environment for innervation of nociceptors [pain reporting nerves] that has been observed in the inner nuclei of degenerative painful disks (not found in healthy disks). In general, nocireceptive nerves and acidity means pain.
This technology is not yet commercially available. A two-year study has shown very good results and no false positives, but further investigation is still necessary.
Nevertheless, this new technology represents a step forward to diagnose lower back pain in a more efficient, non-invasive manner.
For more information, refer to:
– Keshari KR, Lotz JC, Link TM, et al. Lactic acid and proteoglycans as metabolic markers for discogenic back pain. Spine. 2008;33(3):312-317. PMID: 18303465
– Carragee EJ, Don AS, Hurwitz EL, et al. 2009 ISSLS Prize Winner: Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine. 2009;34(21):2338-2345. PMID: 19755936
– O’Neill C, Kurgansky M, Kaiser J, Lau W. Accuracy of MRI for diagnosis of discogenic pain. Pain Physician. 2008;11(3):311-326. PMID: 18523502
– Serena S et al. Modified Magnetic Resonance Spectroscopy Diagnosis of Painful and Non-Painful Lumbar Intervertebral Discs :Abstract


One Response to “Spectroscopy to diagnose back pain”

  1. Marius Moisa Says:

    Nice web page!

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