How can you distinguish facet-mediated back pain from discogenic pain clinically?

• A. Facet pain is localized to the paraspinal area and worsens with extension and rotation, with little to no nerve symptoms; discogenic pain often central or radicular features and may worsen with flexion or loading.
• B. Discogenic pain is localized to the paraspinal muscles.
• C. Facet pain is primarily due to nerve root compression.
• D. Discogenic pain presents with no nerve symptoms at all.

Answer: (A)

Distinguishing facet-mediated back pain from discogenic pain rests on where the pain is felt and how it behaves with loading and movement. Facet joint–driven pain is typically localized to the paraspinal region over the affected joints and is provoked by movements that load the facet joints, especially extension and axial rotation. It usually lacks classic nerve symptoms like numbness, tingling, or weakness because the problem is in the joints and surrounding tissues rather than a nerve root being irritated.

Discogenic pain, on the other hand, tends to be central or refer to the buttock or leg, and it may include radicular features if a nerve root is irritated. It often worsens with flexion or with loading that compresses the disc, such as bending forward, sitting, or lifting.

So the best description matches this pattern: facet pain localized to the paraspinal area, worsening with extension and rotation, with little nerve symptoms; discogenic pain often central or radicular and may worsen with flexion or loading. The other statements don’t fit because discogenic pain is not limited to paraspinal muscles, facet pain is not primarily due to nerve root compression, and discogenic pain can present with nerve-related symptoms.