Provocative Discography as An Important Tool to Aid in Diagnosing Persistent Spinal Pain

Happy senior couple after provocative discography procedure.

The Hemlock Pain Center prioritizes diagnostics in Macon, Dublin, Milledgeville, and Warner Robins, Georgia. We must first understand the source and nature of your pain. Only then can we recommend treatments that target the root cause and are appropriate. With this understanding, effective relief from pain and associated symptoms is supported.

In our world, “discography” is an important diagnostic tool. Also known as a “discogram,” discography comes in different forms – from functional anesthetic to experimental or investigational. The most common type is called “provocative discography.”

What is a discogram?

This service generally involves imaging painful or affected areas to assess for structure and function. Depending on your needs, discography may be “cervical” and used to assess the health and condition of the discs of the neck region; “thoracic” for those patients with damage to the discs of the mid-/upper-back; and “lumbar,” which focuses on the discs in the lower back. These tests may be recommended for individuals experiencing pain in the neck, lower back, mid-back, hips, buttocks, or legs. The pain may radiate to other areas, too, such as the shoulders, arms, ribs, and abdomen.

What makes provocative discography different from other discograms?

Sometimes called “provocation discography,” this test specifically focuses on injecting a contrast dye into targeted discs to determine if these areas are the source of pain. It gets its name from the fact that the test is designed to detect affected discs by provoking or exacerbating pain. To better understand your needs, it is helpful to reproduce the pain that brought you to our offices in the first place. These insights support treatment targeting the right, painful, and disordered discs.

Is this test appropriate for all patients with pain in the spine region?

Discography is generally not used for initial exams. However, it can be helpful for individuals with chronic pain that does not get better with conservative treatment, such as medications, physical therapy, and targeted exercises. So, it is largely an extension of the clinical exam, similar to how we might palpate or touch tissues to elicit a response that informs our diagnosis and the development of treatments to target the detected problem effectively.

How is it done?

As needed, we may start by administering medication to relax you and antibiotics to protect against the risk of infection. A numbing medication may also be injected into the cleansed skin. Using special imaging techniques, we locate the exact disc(s) that need to be examined. Once located, a contrast dye is applied to the disc. We then use radiography or other imaging to see if the dye spreads. If it doesn’t spread, the disc is not damaged. If it spreads beyond the disc’s center, this indicates degenerative changes. It tells us that this disc may be the source of your pain. Another telltale sign is if you experience a familiar pain sensation when the disc is injected. Such testing also helps to identify normal discs, too.

Senior partners feeling relief after provocative discography.
Doctor examining woman before provocative discography.

How do you use the information from my test?

The Hemlock Pain Center reviews your images and self-reported information about your experience with pain. Because “wear and tear” alone does not always cause pain, discography is often combined with the findings from other diagnostics, including physical exams and CT scans.

If effective treatments for your pain remain elusive, contact one of our patient care coordinators today in Macon (478) 475-2385, Warner Robins (478) 997-6444, Dublin (478) 800-3745, or Milledgeville, GA (478) 280-4670.