DEGENERATIVE DISC DISEASE The primary symptom of degenerative disc disease (or internal disc disruption) is midline back pain. Individuals with DDD often experience "referred pain" in the buttocks, pelvis (iliac crests), sacroiliac joints (felt in back of the hips), and the back of the thighs. A referred pain is one that stems from a structure, in this case the disc, but is felt a short distance away. Pain associated with DDD is greater when sitting and standing than when lying down, which decreases the pressure on the degenerating disc. Individuals with DDD usually have difficulty finding a comfortable position when sitting or standing, and constantly have to change positions. Bending and lifting, especially of heavy objects, aggravate the pain. Rising from a chair may be problematic. Although the pain associated with DDD may be felt while walking, it is usually not aggravated by prolonged walks. In addition to the above, in more severe cases of DDD, individuals may experience symptoms of sciatica or a pinched nerve root, similar to that experienced by an individual with a herniated or slipped disc. The degenerating disc collapse and the resulting pressure on the nerve root causes these additional symptoms. In patients that are not surgical candidates, the treatment follows the pain management continuum of physical therapy, pharmacological regimens, and injectional modalities such as epidural steroid injections, as well as I.D.E.T. In selected opioid responsive patients with escalating dose requirements, intrathecal drug delivery systems might be considered.