What criteria are used to make the diagnosis of discogenic pain based on provocative discography

To diagnose discogenic pain, one must document evidence of disc degeneration on a nucleogram and concordant pain during injection of the target disc. Injection of adjacent normal control discs should not elicit pain. The sole purpose of discography is to identify painful intervertebral discs. At least one normal-appearing adjacent disc is tested as a control. A valid test requires the absence of pain in the control disc. It has been observed that some discs can be made painful if sufficient pressure is applied. False-positive results can be reduced by using manometry to record pressure during discography. The following criteria for diagnosis of lumbar discogenic pain using manometry are recommended:

1. Stimulation of the suspected disc reproduces concordant or familiar pain

2. The pain that is reproduced is registered as at least 7 on a 10-point visual analog scale

3. The pain that is reproduced occurs at a pressure less than 50 psi or less than 15 psi above the opening pressure. (Opening pressure is defined as the amount of pressure that must be exerted to start the flow into the disc.)

4. Stimulation of adjacent discs provides controls such that when only one adjacent disc can be stimulated, that disc is painless or pain from that disc is not concordant and is produced at a pressure greater than 15 psi above opening pressure

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