Discogenic Low Back Pain May Need Precision Care Instead of Generalized Algorithms

This narrative review looked at how to manage discogenic low back pain. The authors suggest that current generalized algorithms may not be the best approach for every patient. Instead, the review points toward a phenotype-driven precision framework. This framework includes options like basivertebral nerve ablation, bipolar cooled radiofrequency ablation, neuromodulation, rehabilitation, manual therapy, and ultrasound-guided dry needling. The goal is to integrate structural imaging and functional soft-tissue assessment to select the right intervention for each individual. By matching the treatment to the specific patient phenotype, clinicians might improve selection and reduce unnecessary procedural escalation. The review does not report specific safety concerns or adverse events. Because this is a narrative review, it summarizes existing evidence rather than reporting new trial data. Readers should understand that this is an expert opinion on how to organize care, not a report of a specific clinical trial. The main takeaway is that shifting toward mechanism-informed precision care could help personalize treatment for this condition.