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C5–C6 Discogenic Pain Syndrome

Dr. Lisa S. Apfel MD - Spine and Neurosurgery Dr. Lisa S. Apfel MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

C5–C6 discogenic pain syndrome is a type of neck pain originating from degenerative or structural changes in the intervertebral disc between the fifth and sixth cervical vertebrae (C5–C6). As the disc’s internal fibers (annulus fibrosus) develop fissures or tears and the central gel (nucleus pulposus) dehydrates, inflammatory mediators irritate the surrounding nerves, producing localized axial neck pain that may radiate into the shoulder or arm MedscapeMedscape. This syndrome is distinct from radiculopathy (nerve‐root compression) because the primary pain generator is the disc itself.

Anatomy

Structure & Location:
The C5–C6 intervertebral disc sits between the C5 and C6 vertebral bodies in the lower cervical spine. It consists of an outer annulus fibrosus—concentric layers of collagen—and an inner nucleus pulposus—a gelatinous core that resists compression Spine-healthMedscape.

Origin & Insertion:
While not “attached” like a muscle, each disc firmly adheres to the superior and inferior vertebral endplates via the cartilaginous endplate. This bond transmits axial loads from one vertebra to the next Spine-health.

Blood Supply:
Discs are largely avascular; the outer annulus fibrosus receives tiny branches from the ascending cervical arteries, while the nucleus pulposus relies on diffusion through the endplates for nutrients NCBI.

Nerve Supply:
Sensory fibers from the sinuvertebral (recurrent meningeal) nerves penetrate the outer third of the annulus fibrosus. These small nerve endings mediate pain when the annulus is disrupted Medscape.

Functions (6):

  1. Shock Absorption: Cushions axial loads during daily activities.

  2. Load Distribution: Evenly spreads compressive forces across vertebral bodies.

  3. Flexibility: Allows controlled flexion, extension, lateral bending, and rotation in the cervical spine.

  4. Stability: Maintains proper vertebral alignment and foramen height for nerve roots.

  5. Protective Barrier: The annulus fibrosus contains the nucleus pulposus, preventing extrusion.

  6. Spacing Maintenance: Preserves intervertebral height to safeguard spinal cord and nerve roots Spine-health.

Types of Discogenic Lesions

  1. Internal Disc Disruption: Fissures in the annulus without outward bulge; primary pain generator.

  2. Annular Tear: Radial or concentric tears allowing chemical irritants to escape.

  3. Disc Bulge: Circumferential extension of disc margin, often asymptomatic.

  4. Protrusion: Focal herniation where the base is wider than the herniated material.

  5. Extrusion: Herniated nucleus pulposus breaks through the annulus but remains connected.

  6. Sequestration: Free fragment of nucleus pulposus migrates into the spinal canal MedscapeScoliosis Reduction Center®.

Causes

  1. Age‐Related Degeneration: Natural wear and tear reduces disc hydration and height Medscape.

  2. Genetic Predisposition: Family history of early disc degeneration increases risk Spine-health.

  3. Repetitive Microtrauma: Chronic neck flexion or rotation in certain occupations Physio-pedia.

  4. Acute Trauma: Sudden injuries (e.g., whiplash) can tear the annulus MD Searchlight.

  5. Poor Posture: Forward‐head posture increases compressive forces on C5–C6 Spine-health.

  6. Smoking: Impairs nutrient diffusion, accelerating degeneration Spine-health.

  7. Obesity: Greater axial load stresses cervical discs Spine-health.

  8. Heavy Lifting: Improper technique stresses the cervical spine.

  9. Vibration Exposure: Prolonged driving or machinery work can degrade discs.

  10. Dehydration: Low water intake reduces disc resilience.

  11. Inflammatory Disorders: Rheumatoid arthritis can accelerate disc damage.

  12. Metabolic Diseases: Diabetes alters disc matrix composition.

  13. Nutritional Deficiencies: Lack of vitamins C and D impairs collagen repair.

  14. Sedentary Lifestyle: Weak cervical musculature fails to support spinal loads.

  15. High‐Impact Sports: Football or gymnastics injuries.

  16. Autoimmune Conditions: Lupus and related conditions can inflame discs.

  17. Degenerative Spondylosis: Osteophyte formation alters load distribution.

  18. Neck Strain: Sudden heavy strains from weightlifting.

  19. Occupational Stress: Desk work without breaks.

  20. Congenital Disc Weakness: Rare hereditary disc abnormalities NCBI.

Symptoms

  1. Axial Neck Pain: Deep, aching pain centered at C5–C6.

  2. Shoulder Pain: Referred pain to the trapezius or scapula.

  3. Arm Pain: Radiates along dermatomal distribution (C6 follows thumb/index) Medscape.

  4. Stiffness: Difficulty turning or tilting the head.

  5. Morning Pain: Worse upon waking due to overnight disc dehydration.

  6. Pain on Movement: Flexion, extension, or rotation aggravates pain.

  7. Headaches: Occipital headaches from upper cervical irritation.

  8. Muscle Spasm: Protective tightening of neck muscles.

  9. Paresthesia: Tingling or “pins and needles” in the arm.

  10. Weakness: Reduced grip strength if C6 root involvement.

  11. Pain with Cough/Sneeze: Increases intradiscal pressure.

  12. Reduced Range of Motion: Limited neck flexion/extension.

  13. Deep Aching: Constant low‐grade ache around the neck.

  14. Tenderness: Palpable pain on pressure over the disc.

  15. Postural Imbalance: Difficulty maintaining upright posture.

  16. Fatigue: Muscle fatigue from constant guarding.

  17. Sleep Disturbance: Pain interrupts sleep cycles.

  18. Radiating Scapular Pain: Into the shoulder blade region.

  19. Neuropathic Pain: Burning or electric shock–like sensations.

  20. Activity Avoidance: Fear of movement due to pain anticipation MedscapeScoliosis Reduction Center®.

 Diagnostic Tests

  1. X-Ray (Standing): Assesses disc height and osteophytes.

  2. MRI: Gold standard for visualizing disc degeneration and annular tears Medscape.

  3. CT Scan: Detects bony spurs and calcified discs.

  4. Discography: Provocative test injecting contrast to reproduce pain.

  5. EMG/Nerve Conduction: Evaluates nerve root function.

  6. Flexion/Extension X-Rays: Identifies segmental instability.

  7. Ultrasound Elastography: Assesses disc stiffness.

  8. Bone Scan: Rules out infection or tumor.

  9. Quantitative Sensory Testing: Measures small‐fiber nerve function.

  10. Provocative Maneuvers: Spurling’s and neck extension tests.

  11. High‐Resolution CT Myelography: Detailed nerve root imaging.

  12. Inflammatory Markers: ESR and CRP to exclude infection.

  13. Dynamic Motion X-Ray: Real‐time motion analysis.

  14. PET Scan: Rarely, to assess metabolic activity.

  15. Selective Nerve Root Block: Differentiates nerve vs. disc pain.

  16. Laboratory Tests: Autoimmune panels if inflammatory.

  17. Provocative Neurodynamic Tests: Upper limb tension tests.

  18. Pain Pressure Threshold Testing: Quantifies tenderness.

  19. Thermography: Maps heat changes over painful segment.

  20. Psychosocial Assessment: Evaluates pain perception factors MD SearchlightMedscape.

Non-Pharmacological Treatments

  1. Cervical traction

  2. Physical therapy (McKenzie approach)

  3. Postural correction exercises

  4. Strengthening (deep neck flexors)

  5. Stretching (upper trapezius)

  6. Heat therapy

  7. Cold packs

  8. TENS (transcutaneous electrical nerve stimulation)

  9. Ultrasound therapy

  10. Low-level laser therapy

  11. Acupuncture

  12. Massage therapy

  13. Chiropractic mobilization

  14. Spinal manipulation

  15. Yoga for neck stability

  16. Pilates for core support

  17. Ergonomic workstation adjustments

  18. Cervical collar (short-term)

  19. Activity modification

  20. Education on body mechanics

  21. Biofeedback training

  22. Cognitive behavioral therapy

  23. Relaxation techniques

  24. Dry needling

  25. Inversion therapy

  26. Hydrotherapy

  27. Electrical muscle stimulation

  28. Myofascial release

  29. Kinesio taping

  30. Ergonomic pillow use MD SearchlightSpine-health.

Drugs

  1. Ibuprofen: NSAID for pain and inflammation.

  2. Naproxen: Long-acting NSAID.

  3. Diclofenac: Topical or oral NSAID.

  4. Celecoxib: COX-2 inhibitor with fewer GI side effects.

  5. Acetaminophen: Analgesic for mild pain.

  6. Cyclobenzaprine: Muscle relaxant for spasms.

  7. Methocarbamol: Central muscle relaxant.

  8. Gabapentin: Neuropathic pain modulator.

  9. Pregabalin: Similar to gabapentin.

  10. Amitriptyline: Low-dose tricyclic for chronic pain.

  11. Duloxetine: SNRI for neuropathic pain.

  12. Prednisone: Short-course oral steroid.

  13. Methylprednisolone: Tapered oral steroid regimen.

  14. Diazepam: Benzodiazepine for severe spasm.

  15. Tramadol: Weak opioid for refractory pain.

  16. Codeine: Short-term opioid.

  17. Lidocaine Patch: Topical nerve blocker.

  18. Capsaicin Cream: Depletes substance P.

  19. Ketorolac: Potent NSAID for acute flare-ups.

  20. Epidural Steroid Injection: Long-acting steroid at root MD SearchlightDeuk Spine.

Surgeries

  1. Anterior Cervical Discectomy & Fusion (ACDF)

  2. Cervical Disc Arthroplasty (Total Disc Replacement)

  3. Posterior Cervical Foraminotomy

  4. Posterior Microdiscectomy

  5. Laminectomy

  6. Laminoplasty

  7. Anterior Cervical Corpectomy & Fusion

  8. Posterior Cervical Fusion

  9. Minimally Invasive Endoscopic Discectomy

  10. Artificial Cervical Disc Insertion MedscapeScoliosis Reduction Center®.

Prevention Strategies

  1. Maintain neutral neck posture

  2. Regular cervical strengthening exercises

  3. Use ergonomic chairs and desks

  4. Avoid sustained forward head positions

  5. Lift with proper technique (bend knees, keep back straight)

  6. Break up prolonged sitting with neck stretches

  7. Stay hydrated for disc health

  8. Quit smoking to preserve disc nutrition

  9. Maintain healthy body weight

  10. Use supportive pillows and sleep positions Spine-health.

When to See a Doctor

  • Severe or worsening neck pain lasting more than 6–8 weeks

  • Neurological deficits such as persistent numbness, tingling, or muscle weakness

  • Loss of bladder or bowel control (medical emergency)

  • Sudden onset after trauma (e.g., motor vehicle accident)

  • Unrelenting night pain that disrupts sleep

  • Signs of infection: fever, chills, redness over spine Medscape.

 FAQs

  1. What is cervical discogenic pain syndrome?
    Pain arising from degenerative changes in the C5–C6 disc without overt nerve compression.

  2. How is it diagnosed?
    Primarily via MRI and confirmatory discography.

  3. Can it resolve without surgery?
    Yes—over 70% improve with conservative care.

  4. Is discogenic pain the same as herniation?
    No; herniation implies nucleus protrusion, discogenic pain can occur without herniation.

  5. How long does recovery take?
    Typically weeks to months with proper treatment.

  6. Will I need a fusion?
    Only if conservative measures fail and instability or severe pain persists.

  7. Is physical therapy effective?
    Yes, especially stabilization and postural exercises.

  8. Are steroid injections safe?
    Generally, with low complication rates when performed by specialists.

  9. Can posture correction help?
    Absolutely—neutral head alignment reduces disc stress.

  10. Does smoking affect recovery?
    Yes—it impairs healing and increases degeneration.

  11. What exercises should I avoid?
    High-impact activities and deep neck flexion under load.

  12. Is traction beneficial?
    In selected patients, yes—to temporarily relieve nerve pressure.

  13. Can weight loss reduce symptoms?
    It helps by decreasing overall spinal load.

  14. What pillow is best?
    A contour cervical pillow that supports neutral alignment.

  15. When is surgery recommended?
    After 6–12 weeks of failed conservative care or if neurological deficits progress MedscapeMedscape.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 04, 2025.

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  40. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  41. https://dermnetnz.org/topics
  42. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  43. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  44. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  45. https://www.nibib.nih.gov/
  46. https://www.nei.nih.gov/
  47. https://en.wikipedia.org/wiki/List_of_skin_conditions
  48. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  49. https://en.wikipedia.org/wiki/Skin_condition
  50. https://oxfordtreatment.com/
  51. https://www.nidcd.nih.gov/health/
  52. https://consumer.ftc.gov/articles/w
  53. https://www.nccih.nih.gov/health
  54. https://catalog.ninds.nih.gov/
  55. https://www.aarda.org/diseaselist/
  56. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  57. https://www.nibib.nih.gov/
  58. https://www.nia.nih.gov/health/topics
  59. https://www.nichd.nih.gov/
  60. https://www.nimh.nih.gov/health/topics
  61. https://www.nichd.nih.gov/
  62. https://www.niehs.nih.gov
  63. https://www.nimhd.nih.gov/
  64. https://www.nhlbi.nih.gov/health-topics
  65. https://obssr.od.nih.gov/
  66. https://www.nichd.nih.gov/health/topics
  67. https://rarediseases.info.nih.gov/diseases
  68. https://beta.rarediseases.info.nih.gov/diseases
  69. https://orwh.od.nih.gov/

References

 

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