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Provocative Discography

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Treatment of Chronic Pain by Interventional Approaches

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Abstract

Discography was introduced in the 1940s to diagnose herniation and internal annular disruption of the lumbar and subsequently cervical and thoracic intervertebral discs. While the development of CT and MRI scans unquestionably provides the physician with invaluable information, discography combined with a CT scan remains the most accurate method of detailing internal annular disruption and disc morphology. Unlike noninvasive imaging tests, pressurizing the disc adds critical information if significant; concordant pain is reproduced; and more importantly, a negative response to provocation discography assists in identifying negative discs for which surgery is not recommended. Theoretically, speed- and pressure-controlled injection of contrast media into the disc nucleus stimulates nerve endings via two mechanisms: a chemical stimulus from contact between contrast dye and sensitized nociceptors and a mechanical stimulus resulting from the fluid-distending stress simulating loading.

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Author information

Authors and Affiliations

  1. Comprehensive Spine and Sports, 591 Redwood Highway, Suite 2300, Mill Valley, CA, 94941, USA

    Irina Melnik M.D.

  2. Spinal Diagnostics and Treatment Center, 901 Campus Dr, Suite 310, Daly City, CA, 94015, USA

    Irina Melnik M.D.

  3. 901 Campus Dr, Suite 310, Daly City, CA, 94015, USA

    Richard Derby M.D.

  4. Evergreen Spine and Musculoskeletal Program, Kirkland, WA, USA

    Ray M. Baker M.D.

Authors
  1. Irina Melnik M.D.
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  2. Richard Derby M.D.
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  3. Ray M. Baker M.D.
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Corresponding author

Correspondence to Richard Derby M.D. .

Editor information

Editors and Affiliations

  1. President and CEO, Clinical Professor of Anesthesiology, The Center for Pain Relief, West Virginia University School of Medicine, Charleston, West Virginia, USA

    Timothy R. Deer

  2. Clinic Chief, Clinical Associate Professor, Department of Anesthesiology, Stanford Pain Medicine Center, Redwood City, CA, USA, and Stanford University School of Medicine, Stanford, California, USA

    Michael S. Leong

  3. Department of Anesthesiology, Orthopedic Anesthesia, Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA

    Asokumar Buvanendran

  4. Center for Interventional Pain & Spine, DE and Bryn Mawr, Newark, Pennsylvania, USA

    Philip S. Kim

  5. President, National Institute of Pain, Tampa, Florida, USA

    Sunil J. Panchal

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© 2015 American Academy of Pain Medicine

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Melnik, I., Derby, R., Baker, R.M. (2015). Provocative Discography. In: Deer, T., Leong, M., Buvanendran, A., Kim, P., Panchal, S. (eds) Treatment of Chronic Pain by Interventional Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1824-9_26

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  • DOI: https://doi.org/10.1007/978-1-4939-1824-9_26

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