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What Does Degeneration Mean..?

Still, today Doctors look for an anatomical cause for painful spinal conditions (even though the biomedical model has been replaced by the biopsychosocial model) to provide a Diagnosis of Degenerative Disc Disease (DDD). Conveying an underlying belief that pain is caused by the faulty anatomy whilst simultaneously disregarding a patient’s likely conclusion that they are broken or past it. A conclusion that will impact a full recovery.

Despite the widespread use of degeneration for generations the term itself remains controversial without an agreed definition. The importance of degeneration in painful spinal conditions is also unclear. The lay person is left to come to their own conclusion of the importance of said degeneration.

Disc Disease

Degenerative disc or degenerative facet joints or just degeneration has been reason enough to perform surgeries. Yet when a person presents with radicular (nerve) pain that is different to their degenerate spinal level or when a person’s spine looks awful on imaging and they have no pain or when a person’s spine looks great on imaging and they have constant chronic pain the idea of a specific anatomical fault or defect is called into question. Is it helpful to mention degeneration in all cases..?

 

There is a responsibility before all spinal clinicians to use diagnostic labels that are not psychologically damaging nor pain experience perpetuating. I see people with degeneration in their body who consult me for help with their pain experience who completely resolve. That is their pain clears but the degeneration stays. This clinical experience is why I do not choose to use the term degeneration when describing likely sources of pain because I consider degeneration to be an unhelpful term with a misleading meaning based in an outdated model.

References:
Hartvigsen J et al (2018) What Low Back Pain is and why we need to pay attention. Lancet 391 p2356-67
Battie MC et al (2019) Degenerative Disc Disease. Spine 44 (21) p1523-29

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