When Back Pain Comes from Disc Degeneration, Not a Herniation

When to See a Back Pain Doctor for Disc Degeneration Treatment

By Jacqueline Weisbein, D.O.
Double Board-Certified in Physical Medicine & Rehabilitation and Pain Medicine

Quick Insights:

Disc degeneration is a gradual process where spinal discs lose height, hydration, and structural integrity over time. Unlike a herniation where disc material pushes out and compresses nerves, degeneration causes pain through inflammation in the vertebral endplates and basivertebral nerves. This creates deep, axial back pain without leg symptoms. Many patients feel confused when their MRI shows degeneration but doctors say it's "normal aging"—yet the pain is very real and treatable.

Key Takeaways

• Specific patterns of spinal degeneration, such as Modic changes and degenerative disc disease, have been associated with chronic low back pain.
• Vertebrogenic pain from degenerated discs targets different nerve pathways than herniation-driven radicular symptoms.
• Conservative treatments such as physical therapy and injections can provide relief for discogenic pain; however, their effectiveness varies among individuals, leading some patients to consider alternative interventions.
• Basivertebral nerve ablation shows 2-year durability with clinically meaningful improvements in function and pain.

Why It Matters

Understanding why your back hurts despite a "normal" MRI empowers you to seek targeted treatment. When conservative care fails, minimally invasive interventional options can address the specific nerve pathways causing your pain. Dr. Weisbein specializes in matching treatment to pain source, helping patients regain function and return to activities they've been missing.

Introduction

As a double board-certified pain physician serving Napa and surrounding communities, I've spent years helping patients understand why their backs hurt. Learn more about my credentials and approach as Dr. Jacqueline Weisbein, DO—board-certified pain management physician.

Many people feel confused when their MRI shows disc degeneration but their doctor dismisses it as "normal aging." Your pain is real, even when imaging findings seem unremarkable to some physicians.

Research demonstrates that disc degeneration causes pain through a specific pathway called vertebrogenic pain. Unlike herniated discs that compress nerves and create leg symptoms, degenerated discs trigger inflammation in the vertebral endplates and basivertebral nerves. This produces deep, axial back pain without radiating symptoms.

At Napa Valley Orthopaedic Medical Group, I work with residents from Yountville to St. Helena who are seeking answers about their chronic back pain. Understanding this distinction is the first step toward finding treatment that actually works for your specific pain source.

What Disc Degeneration Actually Means (And Why It's Not a Herniation)

Disc degeneration is a gradual process where the cushions between your vertebrae lose height and hydration over time.

This is fundamentally different from a herniation.

When a disc herniates, the inner gel-like material pushes out through a tear in the outer layer. This creates pressure on nearby nerves, causing sharp leg pain, numbness, or weakness that radiates down your leg.

Degeneration doesn't involve that sudden rupture or nerve compression.

Instead, disc degeneration involves progressive structural changes where the disc loses water content, becomes thinner, and develops small cracks in its outer wall. The vertebrae above and below move closer together as the disc space narrows.

In my Napa practice, I see many patients who feel confused when their MRI report mentions "degenerative disc disease" but their doctor says nothing is wrong. The terminology itself creates anxiety—"disease" sounds serious, yet you're told it's normal aging.

Here's what matters: degeneration becomes clinically significant when it triggers inflammation in the vertebral endplates. These are the bony surfaces where your vertebrae meet the disc.

That inflammation activates specific nerve pathways that create deep, aching back pain.

Your pain is real, even when the imaging findings seem unremarkable to some physicians. Understanding this distinction helps you advocate for appropriate treatment rather than accepting dismissive explanations.

How Degenerated Discs Cause Pain: The Vertebrogenic Pain Pathway

The pain from disc degeneration follows a specific pathway called vertebrogenic pain.

This mechanism is completely different from herniation-driven radicular pain.

When discs degenerate, they develop small fissures and tears that allow inflammatory proteins to leak into the vertebral endplates. These endplates contain a dense network of nerves called basivertebral nerves.

Research demonstrates that inflammation sensitizes these basivertebral nerves, creating chronic pain signals that originate in the vertebral body itself.

This produces deep, axial back pain—meaning pain centered in your spine rather than radiating down your legs.

You won't have the shooting leg pain, numbness, or weakness that comes with nerve root compression from a herniation. Instead, you experience a constant, deep ache that worsens with sitting, standing, or transitional movements like getting out of a chair.

When evaluating spine pain in Napa-area residents, I focus on distinguishing between these two mechanisms. The treatment approach differs significantly depending on whether your pain originates from nerve compression or vertebrogenic inflammation.

Many patients tell me they've tried multiple treatments without understanding why nothing worked. Often, it's because the treatment targeted the wrong pain pathway.

Epidural steroid injections work well for herniation-related nerve inflammation. They don't address the basivertebral nerve inflammation in degenerated discs.

Understanding your specific pain mechanism is the first step toward finding treatment that actually addresses your problem.

Why Your MRI Might Show Degeneration But Your Doctor Says 'It's Normal'

This is one of the most frustrating experiences patients describe to me.

Your back hurts constantly, yet your doctor reviews your MRI and says the findings are "age-appropriate" or "normal wear and tear." You leave feeling dismissed and confused about why you're in so much pain.

Here's the truth: disc degeneration appears on MRI in many people who have no back pain at all. Studies show that by age 50, over 80% of people have some degree of disc degeneration visible on imaging.

This creates a diagnostic challenge.

Not all degeneration causes pain. Some physicians see degeneration on your MRI and assume it's incidental because it's so common. They focus on looking for herniation, stenosis, or other "surgical" findings.

But research shows that specific patterns of degeneration do correlate with chronic pain. When degeneration involves Modic changes—visible bone marrow inflammation in the vertebral endplates—it strongly predicts vertebrogenic pain.

I've found that careful diagnostic work often changes the treatment path. When I evaluate patients with disc degeneration, I look beyond the disc itself to assess endplate inflammation and correlate imaging findings with physical exam findings.

Your pain is real even when standard imaging interpretation suggests otherwise. The key is finding a physician who understands vertebrogenic pain mechanisms and knows how to identify which degeneration findings are clinically significant.

Conservative Treatments: What Works and When They're Not Enough

Most patients with disc degeneration start with conservative treatments.

Physical therapy, anti-inflammatory medications, and activity modification form the foundation of initial care. These approaches can help some patients manage symptoms and improve function.

Core strengthening exercises may reduce mechanical stress on degenerated discs. Anti-inflammatories can temporarily reduce pain signals. Manual therapy and postural training provide short-term relief for some patients.

But evidence shows these conservative approaches often provide inadequate relief for discogenic pain.

Epidural steroid injections target nerve root inflammation from herniation. They don't address the basivertebral nerve inflammation in vertebrogenic pain. Many Napa residents undergo multiple epidural injections without improvement because the treatment doesn't match their pain source.

In my practice, I see patients who've spent months or years cycling through physical therapy, medications, and injections. They feel frustrated and hopeless when nothing provides durable relief.

This doesn't mean you failed treatment. It means the treatment didn't address your specific pain mechanism.

When conservative care fails to restore function after three to six months, it's reasonable to consider interventional options. Continuing ineffective treatments delays access to procedures that could actually help.

The goal isn't to rush to intervention. It's to recognize when conservative care has reached its limit and more targeted treatment is needed.

For patients suffering from persistent back pain related to degeneration, exploring chronic pain treatment options can help identify therapies tailored to your needs.

Advanced Interventional Options for Napa Disc Degeneration Pain

When conservative treatments fail, minimally invasive interventional procedures offer targeted options.

These procedures address the specific nerve pathways causing vertebrogenic pain from disc degeneration.

Research comparing surgical fusion to nonoperative interventional care shows that minimally invasive options can provide meaningful relief without the risks and recovery time of major spine surgery.

Basivertebral nerve ablation uses radiofrequency energy to interrupt pain signals from the inflamed vertebral endplates. The procedure targets the specific nerves sensitized by disc degeneration.

Studies demonstrate that basivertebral nerve ablation produces durable improvements in pain and function through two years. Responder rates show that over 60% of appropriately selected patients achieve clinically meaningful pain reduction.

The procedure is performed through a small incision under fluoroscopic guidance. Most patients go home the same day and return to normal activities within weeks.

My approach emphasizes matching the procedure to the pain generator. Not every patient with disc degeneration is a candidate for basivertebral nerve ablation. Careful diagnostic work identifies which patients will benefit most.

Other interventional options include intradiscal procedures that target the disc itself and regenerative approaches that address endplate inflammation. The key is selecting the right procedure based on your specific imaging findings and pain pattern.

These procedures aren't experimental. They're evidence-based interventions with published outcomes data showing durability and safety. They offer a middle ground between conservative care that hasn't worked and major fusion surgery.

If your pain is specifically related to the lower back, state-of-the-art minimally invasive back pain procedures may provide targeted relief and support your return to daily activities.

Understanding your options empowers you to make informed decisions about your care rather than accepting chronic pain as inevitable.

A Patient's Perspective

As a pain physician, I know that patient experiences help illustrate what medical terminology can't fully capture.

Karen came to see me struggling with chronic back pain that multiple doctors had dismissed as "normal aging." Her MRI showed disc degeneration, but previous physicians told her nothing could be done. She felt frustrated and unheard.

"Dr. Weisbein made me feel very valued as a patient. She described in detail how we would deal with my situation. I would definitely recommend her and her staff to all!"

— Karen

This is one patient's experience; individual results may vary.

What made the difference was taking time to explain her specific pain mechanism and matching treatment to her diagnosis. When patients understand why they hurt, they can make informed decisions about their care.

Conclusion

Disc degeneration causes real pain through vertebrogenic pathways, even when your MRI looks "normal" to some physicians. Understanding this mechanism is the first step toward finding treatment that actually works.

As a double board-certified physician in Pain Medicine and Physical Medicine & Rehabilitation, I specialize in matching treatment to your specific pain source. When conservative care fails, evidence-based interventional procedures can target the basivertebral nerves causing your deep back pain.

You don't have to accept chronic pain as inevitable. We proudly serve Napa and nearby communities including American Canyon and surrounding areas. To learn more about your personalized treatment options and begin your path toward relief, schedule a consultation at Napa Valley Orthopaedic Medical Group today to explore personalized pain management options that address your specific diagnosis.

Nearby facilities in the region include Providence Queen of the Valley Medical Center and Adventist Health St. Helena, which serve the broader Napa Valley community.

This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

Frequently Asked Questions

What's the difference between disc degeneration and a herniated disc?

Disc degeneration involves gradual loss of disc height and hydration without nerve compression. A herniated disc occurs when inner disc material pushes out and compresses nearby nerves, causing leg pain and numbness. Degeneration creates deep back pain through vertebral endplate inflammation, while herniation produces radiating leg symptoms. Both appear on MRI but require different treatment approaches based on the specific pain pathway involved.

Why does my back hurt if my doctor says disc degeneration is normal aging?

Disc degeneration appears on MRI in many pain-free people, which is why some physicians dismiss it. However, specific patterns involving Modic changes—visible bone marrow inflammation in vertebral endplates—strongly correlate with chronic pain. Your pain is real even when imaging findings seem unremarkable. The key is finding a physician who understands vertebrogenic pain mechanisms and can identify which degeneration findings are clinically significant rather than incidental.

What treatment options exist when physical therapy and injections haven't helped my disc degeneration pain?

When conservative treatments fail, minimally invasive interventional procedures offer targeted relief. Basivertebral nerve ablation targets the specific nerve pathways causing vertebrogenic pain from degenerated discs. Studies show durable improvements in pain and function through two years. These procedures address the inflammation in vertebral endplates rather than treating nerve compression, which is why they work when epidural injections designed for herniation-related pain don't provide relief.

Where can I find a back pain doctor in Napa?

Dr. Jacqueline Weisbein at Napa Valley Orthopaedic Medical Group offers physician-guided disc degeneration treatment tailored to your specific pain mechanism. Located in Napa, our practice provides personalized interventional pain management in a professional, supportive environment. Schedule your consultation today to experience advanced care for chronic back pain.