MAPS | Medical Pain Clinics

Because determining the origin of pain is complicated, your interventional pain physician is likely to order some tests. These tests will help pinpoint your pain’s cause, and in turn help your doctor come up with a treatment plan that is just right for you. One of those tests is called discography. This test involves an injection into one or more of your intervertebral discs. Before explaining what the procedure is and what to expect during a discography, first let’s find out what a disc is.

What is a Disc
Your spine is composed of 24 vertebrae; each is called a vertebra. There are seven cervical (neck) vertebra, twelve thoracic (upper and mid back) vertebra, and five lumbar (lower back) vertebra. In between these vertebrae are discs that act like shock absorbers—they are called intervertebral discs. These discs are made up of two substances: nucleus pulposus and annulus fibrosus. The nucleus pulposus is in the disc’s center. It contains water and what are called proteoglycans. The nucleus pulposus is surrounded by the annulus fibrosis. The annulus fibrosus is made up of layer upon layer of collagen fibers. These layers are tightly packed together and make for a very tough and resilient structure that keeps the fluid from the nucleus pulposus from leaking out. Even though our discs are tough, strong structures, they can wear out over time or become damaged, resulting in cracks and tears (called fissures) or even start to bulge out. When this happens, pain can result.

Is Discography Right for Me?
Discography allows interventional pain physicians to see a disc’s internal structure and help establish whether or not it is the source of pain. Even though discography has been proven to be reliable helping physicians make a pain diagnosis, it is done only after other tests have proved to be inconclusive in pinpointing a patient’s pain. A patient who is a good candidate for discography is one who has been experiencing persistent spinal pain, is suspected of having a disc abnormality, has had non-invasive tests that failed to pinpoint the pain’s source, a pain correlation is desired, and the patient is willing to undergo treatment directed at the disc.

How Do I Prepare for My Procedure?
Based upon your individual situation, your doctor or your doctor’s medical staff will give you specific instructions on how to prepare for your procedure. In general, you may eat a light meal within a few hours before the procedure. If you are an insulin dependent diabetic, do not change your usual eating pattern before the procedure. If you are taking medications, you will be given instructions on whether or not to take them. Also, if you are taking a blood thinner, such as coumadin, you should tell your doctor. Many over-the-counter medicines such as aspirin and ibuprofen also thin the blood. Stroke prevention medications, such as Plavix, affect blood thinness and clotting. Be sure to let your doctor know the name of every single medication you take. You might be instructed to temporarily stop using these medications for as much as a week prior to your procedure.

How Is Discography Performed?
To help you relax, you will be given an IV.  A local anesthetic will be applied to your skin. Your doctor will inject you with a dye which will make your disc’s structure more visible on an x-ray monitor. In this way, your doctor will be able to see whether or not your disc is torn, bulging, leaking, or otherwise damaged. Another type of discography you might have performed is called provocation discography. In this, your doctor will try to duplicate your pain so that pain can be pinpointed. If a normal disc is injected, you will feel some pressure, but not any pain. If a damaged or worn out disc is injected, pain will be felt. It is important that you tell your doctor whether the pain is the same as or different from what you have been feeling. More than one disc might be injected during your discography procedure.

What Do I Do When I Go Home?
After your recovery on-site, you will be released to go home. Someone will need to drive you, since you should not drive or operate machinery for 12 hours after treatment. Also, you should not make important decisions for 12-24 hours. You might require some assistance in walking or getting around. Basically, just rest and take it easy. You can take your usual medication when you get home and even resume your regular diet. If your injection site hurts, ice or heat can be applied. If your IV site hurts, place a warm towel on it for twenty minutes, two-to-three times a day. Most patients tolerate this procedure quite well. However, if there is a major change in your pain pattern or the amount of your pain, if you have excessive or abnormal bleeding, or if you experience persistent chills or a fever over 100ºF, call your doctor’s office right away. If you cannot reach the office, go to the nearest hospital emergency room. Finally, since discography is a diagnosis tool and not a treatment, you will be scheduled to return for an appointment so you can discuss the findings of your discography procedure and what treatment your doctor has decided is the right one for you.

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