Two Causes of Pain: Pinched Nerve vs. Disc Pain

By: Peter F. Ullrich, Jr., MD

In identifying the cause of the patient’s pain, there are two general types of spinal disc problems physicians classify as the cause of the pain:

• Pinched nerve – When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain or radiculopathy (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain stemming from a pinched nerve in the lower spine is usually described as sciatica.
  
• Disc pain – When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain.

Either of the above two conditions can occur in the neck, upper back or lower back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day to day basis.
It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.– refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful as the patient's specific symptoms and the doctor's physical exam results are in determining the source of the back pain and then evaluating potential back care and pain treatments.