Relation between pain location and disc pathology: A study of pain drawings and CT/discography

Objective: The purpose of this study was to determine whether pain location indicated in pain drawings was related to the specific lumbar disc level(s ) that was abnormal in appearance and painful upon discographic injection. Design: Data were collected prospectively. Setting: This study was conducted in a spine specialty clinic. Patients: The study group consisted of 187 patients (118 men, 69 women; mea n age = 37.2 years, range = 18-62 years) with low back pain with or without leg pain. All patients were undergoing computed tomography (CT)/discograph y at the three lowest lumbar levels for diagnostic purposes, Interventions: Pain drawings were completed the day of but prior to undergo ing discography. Discographic pain responses were recorded with respect to the similarity to the patient's clinical symptoms, Pain drawings were class ified based on the presence or absence of pain in five areas: low back and/ or buttocks, posterior thigh, posterior leg, anterior thigh, and anterior l eg, The drawings were scored with the system described by Ransford et al. ( 1976, Spine 1:127-34), and those likely to be indicative of psychological p roblems were analyzed separately (n = 43). Outcome Measures: Results were determined by analyzing the relation between the location of pain in the drawings and the specific lumbar disc level(s) found to be painful and disrupted by discography. Results: There was a significant relation between pain location indicated i n the drawing and the lumbar disc level(s) identified as clinically painful and disrupted by CT/discography (p < 0.05, chi-square). Pain limited to th e low back and buttocks was frequently associated with the absence of disc pathology (58.3%). When pain in the posterior thigh or leg was present but there was no pain in the anterior drawing, patients frequently had a positi ve L5-S1 disc (greater than or equal to 75%). In patients with anterior thi gh pain, with or without posterior thigh or leg pain, the L4-5 disc was fre quently symptomatic (>63%). The pattern of no posterior thigh or leg pain b ut with pain radiating into the leg anteriorly was most commonly associated with the L3-4 disc (71.4%), Conclusions: The results of this study indicate that pain drawings may be h elpful in identifying which specific discs are associated with pain complai nts. As with any evaluation, the drawings should be considered in combinati on with findings from other assessments.