Pain and Pathology in Lumbar Disc Hernia

Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study

“…Radicular pain may be more suited for evaluation with the pain drawing, since the evaluation includes assessment of dermatomal pain distribution. Although we have found only one study demonstrating a predictive value of the pain drawing for the outcome in surgical treatment of disc herniation [50], several studies demonstrate an association of "organic" pain with positive radiological [2,58] and surgical findings [58]. Since the interpretation of the pain drawing both according to Udén [56] and Ransford [41] is based on a normal dermatomal pattern of pain distribution, it seems reasonable to conclude that the pain drawing makes it possible to distinguish radicular from non-radicular pain.…”

“…In sciatica, the pain drawing has predicted radiographic findings [2,55], but has also demonstrated an absence of association with magnetic resonance imaging (MRI) findings [40]. The pain drawing has predicted the level of pathology in patients with disc herniation [58], but it could not discriminate between positive and negative surgical findings [4]. The value of the pain drawing as a predictor of treatment outcome, the ultimate goal of a prognostic instrument, is rarely studied.…”

Pain drawing in lumbar disc hernia

“…In our opinion, pain drawings are not a one-way tool. Pain drawings could also be of value for analyzing the patient's symptoms (Vucetic et al 1995) and, of course, if the diagnosis therefore becomes more accurate, the outcome will also improve. However, we shall soon present a short paper on outcome correlated to pain drawings.…”

Optimal duration of conservative treatment for lumbar disc herniation depending on the type of herniation

“…6,13 The possibility of different clinical outcomes between the two types of LDH has been suggested. [14][15][16][17] Jonsson et al reported that patients whose pain had become suddenly severe had non-contained LDH. 15 However, there have been no reports describing the duration of conservative treatment for LDH in relation the type of LDH.…”