{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:35:11Z","timestamp":1792694111185,"version":"4.5.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008021","name":"Fujian University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["XB2024190"],"award-info":[{"award-number":["XB2024190"]}],"id":[{"id":"10.13039\/501100008021","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Discogenic low back pain (DLBP) remains difficult to identify clinically because degenerative disc changes are common and symptom patterns overlap with other lumbar or pelvic pain sources. This mini review summarizes evidence relevant to suspected DLBP from a pain-source attribution perspective, focusing on clinical features, disc and endplate magnetic resonance imaging (MRI) findings, assessment of other pain sources, provocative discography, and diagnostic blocks. Clinical features such as axial low back pain, sitting or flexion intolerance, non-radicular referral, and centralization may increase suspicion of disc-related pain, but they have limited specificity when used alone. MRI can identify high-intensity zones, Modic changes, and other disc- or endplate-related abnormalities that support structural compatibility when findings correspond to the suspected level. Assessment of other pain sources helps refine the differential diagnosis and reduces overinterpretation of disc-related imaging findings. Provocative discography and diagnostic blocks provide procedural information through reproduction of familiar pain and pain change after targeted anesthesia, respectively, but these responses require interpretation alongside clinical and imaging evidence. Overall, suspected DLBP is more strongly supported when clinical presentation, level-concordant imaging findings, assessment of other pain sources, and procedural responses point in the same direction within the same patient. Future studies should evaluate whether combined diagnostic information improves diagnostic agreement and patient selection for further diagnostic evaluation.<\/jats:p>","DOI":"10.3389\/fmed.2026.1924460","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:00:41Z","timestamp":1786374041000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic evidence in suspected discogenic low back pain: a pain-source attribution perspective"],"prefix":"10.3389","volume":"13","author":[{"given":"Renpan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pain Medicine, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou","place":["Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqian","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou","place":["Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenchao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou","place":["Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou","place":["Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youyi","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou","place":["Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2665-9913(23)00098-X","article-title":"Global, regional, and national burden of low back pain, 1990\u20132020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","author":"GBD","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"821","DOI":"10.3390\/jpm13050821","article-title":"Defining the patient with lumbar discogenic pain: real-world implications for diagnosis and effective clinical management","volume":"13","author":"Lorio","year":"2023","journal-title":"J Pers Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e10180","DOI":"10.1002\/jbm4.10180","article-title":"Discogenic back pain: literature review of definition, diagnosis, and treatment","volume":"3","author":"Fujii","year":"2019","journal-title":"JBMR Plus."},{"key":"B5","doi-asserted-by":"publisher","first-page":"5915","DOI":"10.3390\/jcm13195915","article-title":"Discogenic low back pain: anatomic and pathophysiologic characterization, clinical evaluation, biomarkers, AI, and treatment options","volume":"13","author":"De Simone","year":"2024","journal-title":"J Clin Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70062","DOI":"10.1111\/papr.70062","article-title":"14. Discogenic low back pain","volume":"25","author":"van Os","year":"2025","journal-title":"Pain Pract."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2394","DOI":"10.3174\/ajnr.A4498","article-title":"MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis","volume":"36","author":"Brinjikji","year":"2015","journal-title":"AJNR Am J Neuroradiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3174\/ajnr.A4173","article-title":"Systematic literature review of imaging features of spinal degeneration in asymptomatic populations","volume":"36","author":"Brinjikji","year":"2015","journal-title":"AJNR Am J Neuroradiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.ejrad.2014.03.016","article-title":"Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome","volume":"84","author":"Tessitore","year":"2015","journal-title":"Eur J Radiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"647","DOI":"10.7150\/ijbs.5.647","article-title":"Clinical diagnosis for discogenic low back pain","volume":"5","author":"Zhang","year":"2009","journal-title":"Int J Biol Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1007\/s00586-007-0391-1","article-title":"Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain","volume":"16","author":"Hancock","year":"2007","journal-title":"Eur Spine J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"101960","DOI":"10.1016\/j.eclinm.2023.101960","article-title":"Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review","volume":"59","author":"Han","year":"2023","journal-title":"EClinicalMedicine."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0166031","DOI":"10.1371\/journal.pone.0166031","article-title":"Diagnosing discogenic low back pain associated with degenerative disc disease using a medical interview","volume":"11","author":"Tonosu","year":"2016","journal-title":"PLoS ONE."},{"key":"B14","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1186\/s12891-024-07981-2","article-title":"Does the high-intensity zone of lumbar intervertebral disc at magnetic resonance imaging have diagnostic value for discogenic low back pain? A meta-analysis","volume":"25","author":"Yang","year":"2024","journal-title":"BMC Musculoskelet Disord."},{"key":"B15","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1186\/s13018-023-04187-5","article-title":"The correlation between the lumbar disc MRI high-intensity zone and discogenic low back pain: a systematic review and meta-analysis","volume":"18","author":"Yang","year":"2023","journal-title":"J Orthop Surg Res."},{"key":"B16","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1177\/230949900901700214","article-title":"Correlation of low back pain to a high-intensity zone of the lumbar disc in Indian patients","volume":"17","author":"Pande","year":"2009","journal-title":"J Orthop Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1007\/s00586-008-0770-2","article-title":"Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain","volume":"17","author":"Jensen","year":"2008","journal-title":"Eur Spine J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"60558","DOI":"10.18632\/oncotarget.18652","article-title":"The value of radiographic indexes in the diagnosis of discogenic low back pain: a retrospective analysis of imaging results","volume":"8","author":"Song","year":"2017","journal-title":"Oncotarget."},{"key":"B19","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/00007632-199404000-00013","article-title":"The relative contributions of the disc and zygapophyseal joint in chronic low back pain","volume":"19","author":"Schwarzer","year":"1994","journal-title":"Spine."},{"key":"B20","doi-asserted-by":"publisher","first-page":"308","DOI":"10.36076\/ppj.2001\/4\/308","article-title":"Evaluation of the relative contributions of various structures in chronic low back pain","volume":"4","author":"Manchikanti","year":"2001","journal-title":"Pain Physician."},{"key":"B21","doi-asserted-by":"publisher","first-page":"513","DOI":"10.36076\/ppj.2008\/11\/513","article-title":"Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates","volume":"11","author":"Wolfer","year":"2008","journal-title":"Pain Physician."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.3390\/diagnostics11122311","article-title":"The role of diagnostic injections in spinal disorders: a narrative review","volume":"11","author":"Kim","year":"2021","journal-title":"Diagnostics."},{"key":"B23","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s11916-011-0239-6","article-title":"Diagnostic discography: what is the clinical utility?","volume":"16","author":"Provenzano","year":"2012","journal-title":"Curr Pain Headache Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/foc.2002.13.2.14","article-title":"Discography interpretation and techniques in the lumbar spine","volume":"13","author":"Tomecek","year":"2002","journal-title":"Neurosurg Focus."},{"key":"B25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1093\/pm\/pnx039","article-title":"No transfer of pressure to adjacent discs during human low-pressure controlled discography: a prospective clinical study","volume":"19","author":"Kallewaard","year":"2018","journal-title":"Pain Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"55","DOI":"10.36076\/ppj.2006\/9\/55","article-title":"Evaluation of the L2 spinal nerve root infiltration as a diagnostic tool for discogenic low back pain","volume":"8","author":"Mendez","year":"2005","journal-title":"Pain Physician."},{"key":"B27","doi-asserted-by":"publisher","first-page":"101397","DOI":"10.1016\/j.neuchi.2022.101397","article-title":"Usefulness of discography, discoblock and a new mechanical method for identifying a painful segment\/disc","volume":"69","author":"Nystrom","year":"2023","journal-title":"Neurochirurgie."},{"key":"B28","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.spinee.2011.07.021","article-title":"Provocative lumbar discography versus functional anesthetic discography: a comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain","volume":"11","author":"Alamin","year":"2011","journal-title":"Spine J."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1007\/s00586-006-0062-7","article-title":"Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography","volume":"15","author":"Laslett","year":"2006","journal-title":"Eur Spine J."},{"key":"B30","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1186\/s13018-023-03839-w","article-title":"Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability","volume":"18","author":"Czaplewski","year":"2023","journal-title":"J Orthop Surg Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e0200677","DOI":"10.1371\/journal.pone.0200677","article-title":"Modic changes-their associations with low back pain and activity limitation: a systematic literature review and meta-analysis","volume":"13","author":"Herlin","year":"2018","journal-title":"PLoS ONE."},{"key":"B32","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jor.2022.11.003","article-title":"The association of modic changes and chronic low back pain: a systematic review","volume":"35","author":"Hopayian","year":"2023","journal-title":"J Orthop."},{"key":"B33","doi-asserted-by":"publisher","first-page":"103416","DOI":"10.1016\/j.msksp.2025.103416","article-title":"Do I need an imaging? Exploring why patients with non-specific chronic low back pain request diagnostic instrumental evaluation: a phenomenological qualitative study","volume":"80","author":"Lullo","year":"2025","journal-title":"Musculoskelet Sci Pract."},{"key":"B34","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1097\/01.brs.0000201242.85984.76","article-title":"Low-pressure positive discography in subjects asymptomatic of significant low back pain illness","volume":"31","author":"Carragee","year":"2006","journal-title":"Spine."},{"key":"B35","doi-asserted-by":"publisher","first-page":"2542","DOI":"10.1097\/00007632-199912010-00017","article-title":"False-positive findings on lumbar discography. Reliability of subjective concordance assessment during provocative disc injection","volume":"24","author":"Carragee","year":"1999","journal-title":"Spine."},{"key":"B36","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1097\/00002508-199809000-00007","article-title":"Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain","volume":"14","author":"Linton","year":"1998","journal-title":"Clin J Pain."},{"key":"B37","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1002\/art.23563","article-title":"A primary care back pain screening tool: identifying patient subgroups for initial treatment","volume":"59","author":"Hill","year":"2008","journal-title":"Arthritis Rheum."},{"key":"B38","doi-asserted-by":"publisher","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ."},{"key":"B39","doi-asserted-by":"publisher","first-page":"51","DOI":"10.7326\/M18-1376","article-title":"PROBAST: a tool to assess the risk of bias and applicability of prediction model studies","volume":"170","author":"Wolff","year":"2019","journal-title":"Ann Intern Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"E497","DOI":"10.36076\/ppj.2015\/18\/E497","article-title":"A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain","volume":"18","author":"Boswell","year":"2015","journal-title":"Pain Physician."},{"key":"B41","doi-asserted-by":"publisher","first-page":"422","DOI":"10.2519\/jospt.2021.10469","article-title":"Diagnostic accuracy of clusters of pain provocation tests for detecting sacroiliac joint pain: systematic review with meta-analysis","volume":"51","author":"Saueressig","year":"2021","journal-title":"J Orthop Sports Phys Ther."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1924460\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:00:42Z","timestamp":1786374042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1924460\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":41,"alternative-id":["10.3389\/fmed.2026.1924460"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1924460","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"1924460"}}