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The actual spinal pain or ‘local’ pain of spinal degenerative disease can stem from a number of structures. The outer part of the intervertebral disc, the annulus, has a nerve supply and is sensitive to injury. Minor splits or larger tears in the annulus and the resultant bulging of the disc itself (herniation) can all generate a good deal of local spinal pain. Furthermore, each intervertebral disc is coupled with a pair of facet joints, which regulate movement of the disc. When a disc bulges it loses height and the facet joints become slightly displaced. They then become inflamed, producing a localised form of arthritis. This also causes pain, experienced in the spine but often felt on one side or the other, rather than in the mid-line. Finally, when discs bulge and facet joints displace, the muscles of the spine may go into spasm and themselves become a source of pain.

In addition to local discomfort a person may experience what is called referred pain. This is pain which is felt in a different part of the body than that from which it actually originates. For example, pain arising in the facet joints may be experienced in the shoulder and upper arm (in the case of neck disorders) or in the bottom and the thigh (in the case of lumbar disease). The reason for this is that some parts of the body are able to get clearer pain messages to the brain than others. The skin, for example, is able to transmit very precise information to the brain, whereas internal organs, including bones and joints, have poor links with the brain. As a result, pain arising from internal structures may be interpreted by the brain as coming from a site remote from its actual source.

The third type of pain is neuralgic or nerve pain, which is very different from the other two sorts of pain described. It is usually sharp or shooting in nature and is often likened to an electric shock, although it can also be a gnawing and burning sensation. When this sort of pain occurs in the spine it results from pressure on nerves and commonly spreads to the arm or the leg (from the neck or lumbar regions respectively). This sort of pain has what doctors call ‘localising value’. This means that the distribution of the pain reveals its level of origin in the spine.