When the Pain Is Deep, Achy, and Just Not Letting Go… This Might Be Why
Some patients describe it as a deep, gnawing ache right in the center of their lower back.
Not sharp. Not shooting down the leg.
Just always there. Worse with standing, bending, or even just trying to get through the day.
Maybe physical therapy helped a little. Maybe injections gave brief relief. But the pain keeps coming back.
If that sounds familiar, you might be dealing with something called vertebrogenic pain. It’s a specific, often overlooked type of chronic low back pain that starts not in the muscles or nerves, but in the bone itself.
For years, this kind of pain was grouped under “degenerative disc disease.” But newer research tells a more accurate story. In many cases, the real issue is inflammation in a small nerve inside the vertebra, called the basivertebral nerve (BVN).
If you’ve felt stuck, frustrated, or like no one has been able to explain why your pain won’t go away, this article is for you.
We’ll walk through what vertebrogenic pain really is, how it appears on MRI, and which modern treatments can actually help.
Because when the diagnosis fits, the plan finally works. And real relief becomes possible.
What Is Vertebrogenic Pain?
Vertebrogenic pain is a specific type of low back pain that arises from the bones of the spine, not the muscles or nerves around them. It’s usually caused by irritation and inflammation in the endplates, which are the contact points between your spinal discs and the bones above and below.
When those endplates get stressed or worn down, they can trigger a small nerve inside the bone called the basivertebral nerve (Fischgrund et al., 2018; Khalil et al., 2019). Over time, that nerve can become overactive and start sending steady pain signals to the brain, even if nothing new is “injured.”
This kind of pain is different from more familiar issues like:
- Sciatica or nerve root compression
- Facet joint arthritis
- SI joint dysfunction
- Muscle strain or spasm
And that difference matters. Because when the source of pain is different, the treatment needs to be different too.
Why the Endplates Hurt: Simple Science
Normally, discs cushion the vertebrae, acting as shock absorbers. But over time, discs can dehydrate and lose height, placing more mechanical stress on the endplates.
That sets off a chain reaction:
→ Disc thinning
→ Endplate stress
→ Inflammation in bone marrow
→ BVN sensitization
→ Persistent pain
The big takeaway?
For some people, it’s not just the disc that’s the issue. It’s the bone–disc interface that’s become inflamed and painful.
Modic Changes: What Your MRI Might Be Trying to Tell You
If your MRI report mentions things like “Modic changes,” “endplate edema,” or “Type 1 or 2 endplate changes,” you’re likely to have signs of vertebrogenic pain.
These are radiology terms that describe changes in the bone just above or below a spinal disc. They’re called Modic changes, and they can be an important clue in diagnosing vertebrogenic pain.
Here’s the basic breakdown:
- Type 1 means there’s active inflammation in the bone. This is often linked to pain.
- Type 2 shows more chronic, fatty changes in the bone,still very relevant for vertebrogenic pain (Modic et al., 1988; Jensen et al., 2008)
- Type 3 is less common and usually not treated with BVN ablation.
You don’t have to become an MRI expert. What matters is this:
If your report shows Type 1 or Type 2 Modic changes, and your pain feels deep, central, and persistent, there’s a strong chance your pain is coming from the bone–disc interface, and there’s a specific way to treat it.
What Vertebrogenic Pain Feels Like
Most patients describe a recognizable pattern:
Location: deep, midline low back pain (often not one-sided)
Quality: achy, heavy, sometimes sharp with certain movements
Triggers: sitting too long, standing too long, bending, lifting
Often missing: dominant leg pain (which is more typical of nerve compression)
This is why people feel stuck. The pain doesn’t “behave” like classic sciatica, and it doesn’t always respond like a muscle strain.
Disc Pain vs. Vertebrogenic Pain (Quick Comparison)
Disc-Related Pain | Vertebrogenic Pain |
|---|---|
Worsens with bending forward | Worsens with sitting, standing, or bending |
Often radiates down a leg | Usually stays central and deep |
May respond to nerve blocks or epidurals | Often unresponsive to those treatments |
Disc is the main issue | Endplates and bone are the pain source |
Why Some Treatments Work Briefly… Then Don’t
Many patients we see have already tried a lot: physical therapy, massage, injections for the SI joint or facet joints, even epidural steroids. And often, these treatments help for a little while. But then the pain creeps back in.
If that’s been your experience, it doesn’t mean you failed treatment. It probably just means those treatments were aimed at the wrong target.
Vertebrogenic pain doesn’t come from the muscles, joints, or even the disc itself. It comes from inflammation around a small nerve inside the vertebra. Until that nerve is addressed, the pain often sticks around (Khalil et al., 2019).
The Basivertebral Nerve (BVN): What It Is and Why It Matters
Inside each vertebra lives a small but powerful nerve called the basivertebral nerve (BVN). When the endplates become inflamed, often due to Modic changes, this nerve becomes hypersensitive, sending out chronic pain signals even when there’s no new injury.
That’s why vertebrogenic pain doesn’t always respond to typical treatments. The issue isn’t outside the bone. It’s inside.
What Is BVN Ablation?
BVN ablation is a minimally invasive outpatient procedure that targets pain at its source. Using radiofrequency energy, the procedure quiets the basivertebral nerve, reducing its overactive signals without affecting your spine’s structure.
It’s not a fusion. It’s not a disc replacement. And it’s not a structural surgery.
For the right patient, this one-hour procedure can provide long-term pain relief, restore function, and help avoid more invasive interventions, all while preserving natural spinal motion (Fischgrund et al., 2018; Becker et al., 2021).
Is Vertebrogenic Pain More Common Than We Think?
Absolutely. In fact, many patients who’ve been diagnosed with “degenerative disc disease,” “mechanical back pain,” or even “failed back surgery” may have been dealing with vertebrogenic pain all along (Jensen et al., 2008; Khalil et al., 2019). It just wasn’t clearly identified.
This is one of the most meaningful shifts happening in modern spine care. We’re learning how to name the real source of pain, not just treat symptoms.
The Vertrae® Approach: Answers Before Interventions
At Vertrae®, we take our time with diagnosis. Our spine-focused team considers your full story, from your pain history and physical exam to your imaging, including any Modic changes on MRI.
We also ask what you’ve tried, what helped, and what didn’t.
Only after we understand the full picture do we build a step-by-step treatment plan, always aiming to preserve motion, avoid unnecessary procedures, and move at the pace that fits you.
If BVN ablation turns out to be the right next step, we’ll walk you through it clearly, with time for questions and confidence in the plan.
When to Consider a Spine Evaluation
You don’t need to wait until you’re in constant pain to get answers. But it might be time for a closer look if:
- Your pain has lasted more than three months
- It feels deep, central, and doesn’t seem to change much
- You’ve tried PT, injections, or rest, and the pain keeps returning
- Your MRI report mentions Modic Type 1 or 2 changes
If any of these sounds familiar, we can help figure out what’s really going on.
Final Thoughts: When the Diagnosis Finally Fits
If your back pain has been confusing, unresponsive to treatment, or just doesn’t line up with what your MRI report says, you’re not imagining it.
Vertebrogenic pain is real. It’s often overlooked. But when it’s correctly identified, it’s also highly treatable.
At Vertrae®, we believe in personalized care, not generic paths. We look for patterns, we listen closely, and we match treatments to your unique pain story.
Because when the diagnosis finally fits, so does the relief.
Vertrae® | Dayton • Southwest Ohio • Northern Kentucky • Eastern Indiana
References
Becker, S., Hadjipavlou, A., Heggeness, M. H., & Khalil, J. G. (2021). Ablation of the basivertebral nerve for the treatment of chronic low back pain: 5-year outcomes from a prospective randomized controlled trial. European Spine Journal, 30(11), 3319–3327.
https://doi.org/10.1007/s00586-021-06988-4
Fischgrund, J. S., Rhyne, A., Franke, J., Sasso, R., Kitchel, S., Bae, H., … Yeung, C. (2018). Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: A randomized, double-blind, sham-controlled trial. European Spine Journal, 27(5), 1146–1156.
https://doi.org/10.1007/s00586-018-5496-1
Jensen, T. S., Karppinen, J., Sorensen, J. S., Niinimäki, J., & Leboeuf-Yde, C. (2008). Vertebral endplate signal changes (Modic change): A systematic literature review of prevalence and association with non-specific low back pain. European Spine Journal, 17(11), 1407–1422.
https://doi.org/10.1007/s00586-008-0770-2
Khalil, J. G., Smuck, M., Koreckij, T., Keel, J. C., Beall, D., Goodman, B., … Fischgrund, J. S. (2019). Prospective randomized controlled trial of basivertebral nerve ablation for chronic low back pain: 12-month results. Spine Journal, 19(10), 1620–1632.
https://doi.org/10.1016/j.spinee.2019.05.598
Modic, M. T., Steinberg, P. M., Ross, J. S., Masaryk, T. J., & Carter, J. R. (1988). Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging. Radiology, 166(1), 193–199.
https://doi.org/10.1148/radiology.166.1.3336678
