All About Provocative Discography for Pain Relief

Feb 07, 2024
All About Provocative Discography for Pain Relief
Provocative discography is a diagnostic procedure to determine if discogenic pain — or pain emanating from inside a degenerating spinal disc — is the root cause of chronic back pain that doesn’t improve with conservative care. Learn more here.

An estimated four in five adults (80%) experience an episode of lower back pain at some point in their lives. The leading cause of this common problem? A herniated spinal disc brought on by degenerative disc disease. In fact, most cases of chronic lower back pain and leg pain (sciatica) can be traced to a herniated disc.

While many people feel much better after a few weeks or months of conservative care, some cases of disc-related back and/or leg pain continue unabated and without obvious explanation. This is when provocative discography can be the best next step toward attaining relief.

At Interventional Sports and Pain Management Associates in Humble and Baytown, Texas, Dr. Okezie N. Okezie and our team specialize in helping Houston-area patients get to the bottom of herniated disc pain that doesn’t resolve with a standard care approach.

Here’s when we’re likely to recommend provocative discography and how it can help.

Understanding spinal disc anatomy 

Intervertebral discs are donut-like cushions positioned between the bones (vertebrae) of your spine. Their height helps maintain proper spacing between vertebrae as well as dynamic spinal alignment; their flexibility facilitates fluid spinal movement and helps protect your spine from the shock force of motion. 

 These essential, resilient “cartilaginous joints” consist of three structures:

  • A tough, rubbery exterior (annulus fibrosus) 
  • A soft, gel-like interior (nucleus pulposus)
  • Hyaline cartilage “endplates” on each flat side

Besides preventing bone-on-bone contact, discs enable spinal flexibility without sacrificing too much strength. Age-related disc deterioration — also known as degenerative disc disease — is the top cause of disc damage, dysfunction, and related pain conditions.  

Normal disc-related pain pathology

As they age, spinal discs become progressively drier, thinner, less resilient, and less effective at shock absorption. When the gel-like interior becomes dehydrated, it no longer fills the tough rubbery shell, leading to partial disc collapse. 

 As the disc loses height and progressively caves inward, it places more pressure and strain on the outer shell. The result? Small tears and fissures gradually appear in the annulus fibrosus, allowing the nucleus pulposus material to ooze (herniate) outward.  

Pain occurs when the flattened disc’s oozing material: 

  • Irritates the sensitive nerves in the disc’s outer shell 
  • Puts pressure on nearby nerve roots in the spine
  • Releases chemical irritants that inflame spinal nerves  

Spinal disc degeneration and herniation is visible on a standard MRI or CT scan. In most cases, conservative therapies like physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and epidural steroid injections can ease pain and foster healing. 

When discogenic pain goes deeper

Sometimes, however, disc-related pain persists for unknown reasons — even when healing spinal discs appear normal on a follow-up scan after months of conservative care. In up to 40% of such cases, discogenic pain may be to blame. 

In young, healthy spinal discs, nerves are mostly limited to the outermost part of the tough exterior shell. In a degenerated disc, however, nerves appear through the deeper intradiscal structures, too, reaching all the way to the inner third of the annulus and the nucleus.  

These nerves can provoke pain from within a disc, even when that disc appears normal on a scan. Provocative discography aims to determine if a disc is the source of back pain.    

Provocative discography evaluation

During an image-guided provocative discography procedure, Dr. Okezie injects contrast dye into the soft inner nucleus of a questionable disc. Internally disrupted discs become painful when they’re mechanically loaded (i.e., poor posture, heavy lifting), including when they’re pressurized with injected contrast dye. 

Functional evaluation

The careful assessment of your response to targeted pain provocation is the functional portion of the evaluation. If the injection provokes a pain response in the disc that’s like your usual symptoms, it strongly suggests that the disc is the likely pain source. If the pain is unlike your usual back pain, the disc isn’t a likely pain source. 

Anatomical assessment

Afterward, Dr. Okezie may supplement the discography results with a CT scan. This helps him more fully assess the disc’s anatomical changes and current level of function. Taken altogether, the results from the entire procedure help guide a more targeted treatment approach — the kind that can finally deliver long-lasting pain relief.   

Are you tired of living with chronic back pain? We can help. Call your nearest Interventional Sports and Pain Management Associates office in Humble or Baytown, Texas, today, or click online to schedule a visit with Dr. Okezie anytime.