What is a provocative discogram?
Central to understanding the value of the provocative discogram the concept that pain is a physiological condition, not an anatomical event. While the use of an MRI can detect only anatomical distortions, the use of the provocative discogram, which is a physiological test, is more reliable for diagnosing chronic pain. A disc is like a jelly doughnut, with the annulus being analogous to a doughnut, and the nucleus pulposa being analogous to the jelly inside a doughnut. Most physicians do not know that there are pain fibers in the rear one third of the annulus, or the doughnut portion, that, when anatomically compressed, mechanically disrupted, or chemically irritated, will produce pain that feels exactly like a herniated disc pushing on a nerve root. However, this “internal disc disruption,” i.e. the herniation of the nucleus pulposa into the posterior portion of the annulus, does not show up on the anatomical tests such as MRI, CT or myelogram, because there is no anatomical distortion
